Work has been continuously changing throughout history. The most severe changes to work occurred because of the industrial revolutions, and we are living in one of these moments. To allow us to address these changes as early as possible, mitigating important problems before they occur, we need to explore the future of work. As such, our purpose in this paper is to discuss the main global trends and provide a likely scenario for work in 2050 that takes into consideration the recent changes caused by the COVID-19 pandemic. The study was performed by thirteen researchers with different backgrounds divided into five topics that were analyzed individually using four future studies methods: Bibliometrics, Brainstorming, Futures Wheel, and Scenarios. As the study was done before COVID-19, seven researchers of the original group later updated the most likely scenario with new Bibliometrics and Brainstorming. Our findings include that computerization advances will further reduce the demand for low-skill and low-wage jobs; non-standard employment tends to be better regulated; new technologies will allow a transition to a personalized education process; workers will receive knowledge-intensive training, making them more adaptable to new types of jobs; self-employment and entrepreneurship will grow in the global labor market; and universal basic income would not reach its full potential, but income transfer programs will be implemented for the most vulnerable population. Finally, we highlight that this study explores the future of work in 2050 while considering the impact of the COVID-19 pandemic. Work has been continuously changing throughout history. Industrial revolutions represent “profound changes in the means of production,” and they change work in a short period. We had three industrial revolutions: the first was the implementation of factory-based production using steam-powered machines, the second was characterized by changes in production provided by electricity, and the third was triggered by information and computation technologies , 2.New technologies and their combined use, such as artificial intelligence (AI), robotics, biotechnology, and nanotechnology, are seen as the starting point of the 4th industrial revolution . These tThe methodology of this study is based on Foresight. We use four methods from future research—namely Bibliometrics, Brainstorming, Futures Wheel, and Scenarios—to present the main global trends that are most relevant for the future of work. These trends were then further analyzed and consolidated in a likely scenario for work in 2050. According to Grupp and Linstone , severalIn recognition of the tremendous impact of the pandemic on work  and its This section details the methodology used in this work. First, we present the study dynamics, detailing who participate in the study, how the study was placed in time (number and types of sessions), the foresight methods used, specific goals for each method, and how each method contributed to achieving our main goal, which is to provide scenarios for the future of work in the 2050 horizon. Second, we introduce each method used and explain how they were used in the context of this work.Foresight studies follow no specific methodology, each study tailor the methodology according to its goals. However, the literature indicates that Foresight becomes more reliable when different and complementary methods are combined , once thIn this study, we decided to present our results as scenarios, which is a method to develop consistent evolutions of the future based on a set of assumptions  and presThe study was performed by thirteen researchers (including the moderators) with different backgrounds, for example, in computer engineering, production engineering, public management, architecture and urbanism, and design. These researchers were divided into five groups, taking into consideration their expertise and interests, corresponding to different topics regarding the future of work: computerization/automation (2 researchers), employment (2 researchers), education (3 researchers), social welfare (2 researchers), and economy (2 researchers). The topics were defined by a literature review  that wasThe study was conducted during 8 sessions, once per week. Each session had an approximate duration of 2 hours. Since the duration and format of the sessions were defined before the execution of the study, there were few absences from the participants, and most of them were communicated previously. In absences, the moderators explained the work to be done by e-mail and were available to answer any question. Since most of the work was done in the week between the sessions, each group could perform meetings to produce their contributions. However, the Brainstorming for all groups was performed in a single 5-h session with mandatory attendance.This study was performed with the aid of software, named Tiamat . Tiamat In the first session, the moderators presented the methodology and the Tiamat software and also divided the researchers into the aforementioned five groups. Between the first and the second session, the participants were responsible to search the literature and gather relevant material to be analyzed. The use of bibliometrics is useful to level the knowledge among the interdisciplinary participants, gather and store the state of the art of the topics of the study and select primary citations for further writing future scenarios. Details of the results are presented in the next section.In the second session, each group presented its findings and the participants had the opportunity to recommend papers to other groups. Each participant would then have two weeks to fully read the papers considered important for their topics.The third session was focused on discussing their findings until the moment. Each participant would share how the documents that were read up until that session contributed to understanding the future of the topic assigned to their group. Also, the participants were encouraged to share any trends found in the reading that was related to the topic studied by another group, thus stimulating the collaboration between groups.initial events, allowing the participants to include, remove, or modify events while they indicate cause-consequence relationships between events, i.e., discovering primary and secondary consequences of events.In the fourth session, the moderators performed five Brainstorming sessions (one for each group) in which the researchers presented the main events they found. For example, the employment group found the event “more flexibility in the employment contract.” In the Brainstorming, we discussed the impacts of each event and proposed new events from the discussion. The Brainstorming ended with voting on which events should be included in the next steps. The moderators lead the brainstorming sessions according to Osborn’s brainstorming guidelines for the generation of ideas . The partrends for each topic using the scenarios technique and the literature already gathered to support their research—new literature could be added further. We call trend a set of possible future events that told a cohesive matter, heavily supported by the literature—not only the literature gathered in the bibliometrics step. Each group developed trends related to the topic of their study.In the fifth session, each group presented and discussed their Futures Wheel. At the end of the fifth session, the moderators asked the groups to use the list of expanded events, developed during the Brainstorming and Futures Wheel to identify and develop the main most likely outcome for each event. The participants were asked to check the consistency of each scenario produced.In the sixth and seventh sessions, the participants presented the trends for each topic. After the seventh session, the moderators dismissed the topic division, joining all participants to develop 3 scenarios: one which considers the best outcome for each event, one that considers the worst outcome for each event, and one that considers the Therefore, the eighth session was focused to check the produced scenarios. The moderators provided one extra week for the participants to fix all spelling and formatting errors and analyze the proposed suggestions from the eighth session. The final version of the scenarios was delivered using the Tiamat software. This study encounters dynamic is presented in Fig. With the COVID-19 pandemic, we knew that our study had to be updated to consider its impact. The update was done in 2 months, from June to August 2020, by gathering seven of the researchers involved in the first part of the study and assigning at least one of them to each of the five topics of the research. The methodologies applied to explore the impact of COVID-19 on the future of work and update the trend scenarios were Bibliometrics and Brainstorming. The Bibliometrics was based on 42 papers about the impact of COVID-19 on the different topics that were being studied with several reports serving as a support to grasp the scenario that was unfolding during the pandemic. Then, the group reviewed the likely scenario to consider how the combination of these individual impacts would change the future of work in 2050. We performed the update without face-to-face sessions, as expected during the COVID restrictions.The resulting trend scenarios presented in Section 3, and the likely scenario presented in Section 4 already consider the COVID-19 pandemic impact on the future of work.Employment will be used to illustrate the methodology in this section. Since trends and scenarios are the main findings presented in detail in this work, we present in this section only example results from Bibliometrics, Brainstorming, and Futures Wheel.In this section, we formalize the study dynamics: first, we provide a global view of the study, in the form of a workflow; second, we explain how each method work and provide results for methods from one topic as an example of the methodology. The topic of We highlight that the participants were trained and guided during the study to produce high-quality data and guarantee its uniformity and consistency. In Fig. The five topics were analyzed individually using four methods: Bibliometrics, Brainstorming, Futures Wheel, and Scenarios.Bibliometric analysis is the analysis of large numbers of scientific documents. Bibliometric analysis is usually taken from patent and scientific publication databases  and shouIn this study context, we used bibliometrics to perform a simple literature review, using both scientific databases and documents available on the Internet, such as governmental reports. Therefore, the researchers gathered data in the literature to build a knowledge base, used to identify trends and support scenarios. Moderators did not enforce the use of systematic reviews of the literature; therefore, we infer the use of random search on several bases and Google to include gray literature. Snowballing was also allowed. We expected to reach beyond the academic literature, including data from technical reports from governmental organizations, non-governmental organizations, think tanks, and companies to capture early signals of change and enrich the study by providing plural views about the future of work. Due to the time restriction between the sessions, we back down from performing a mapping of the literature. The summary of the Bibliometrics results is presented in Table employment group.As an example of an output of the Bibliometrics method, Table Brainstorming  is a groEmployment group in Table In this study context, we used Brainstorming to raise possible future events of each group research topic—computerization/automation, employment, education, social welfare, and economy—on work, based on the literature analyzed in the previous step (Bibliometrics). Moderators place these events are the starting point for the further analysis performed by each research group, following the Putman and Paulus rules. Participants were stimulated to use the literature to develop the events, which were not limited to the Bibliometrics results—i.e, the participants could perform snowballing for example to gather more information. However, the main source of possible future events comes from their understanding of the complex scenario and their further reasoning into ideas. Such ideas—even if they exist—are not easily findable in the literature. Finally, we voted on the list of proposed ideas, developing basic trends to be further analyzed. We present the selected brainstorming events from the The Futures Wheel  is a metThe participants of the Futures Wheel map the event to its consequences, producing concentric graphs, which highlight the potential complexity of interactions, showing that the consequences do not happen all at once, but in an evolutionary, interactive sequence .Employment group is shown in Fig. In this study context, we used Futures Wheel to further discussed the events listed in the Brainstorms. Therefore, the Futures Wheel mapped the events to their consequences, producing concentric graphs of primary, secondary, and tertiary consequences. New events were included as a result of this analysis. The Futures Wheel from the Scenarios are possible evolutions of the future consistent with some set of assumptions . ScenariScenarios represent the combination of a set of extrapolated current trends or projections, and these must be internally consistent, i.e., not contradict each other. For example, when analyzing possible futures related to ATM usage, a scenario where an increase in cashless money transfer and an increase in the usage of ATMs by the general population should be pruned, as these events are mutually exclusive, therefore making the scenario inconsistent . Indeed,In this study context, we used scenarios to analyze the events and developed the trend scenarios that are presented in detail in Section 3, using each group Futures Wheel and literature gathered. Therefore, the trend scenarios discuss trends for each topic of this study, and they are heavily based on the literature.good or bad for society. Due to space limitations, we present the likely scenario in Section 4, which considers the combination of the trends for the future of work that the participants considered as most probable.Finally, we also use scenarios to develop three scenarios for work in 2050: an optimistic/positive scenario, a pessimist/negative scenario, and a likely scenario. To develop such scenarios, we dismissed the division of groups into topics, since the scenarios must consider all topics. The Scenarios for work in 2050 were built on all the knowledge gathered in all previous steps. Therefore, the scenarios are based on the joint analysis of the trend scenarios to understand how they interact. We also classify the trends as more or less likely to happen and if a trend can be considered This section will present the future trends for the areas analyzed in this study: computerization/automation, employment, education, social welfare, and economics.The last century started a transition in industrial automation as machines are increasingly better to make decisions, not only performing manual activities but allowing more activities to be automated. The most cited paper concerning the topic estimated that 47% of the US workforce was under a high probability of computerization  in the next decades . Later sAreas such as the retail market, archiving, data collection and processing, and line assembly operations will be highly impacted. Still, even for workers at higher risk, adopting automation is not simple: it requires analysis of some key points, such as technical feasibility; development and implementation costs; labor market dynamics, considering its demand, costs, and social characteristics; economic benefits, such as governmental policies; and social acceptance .As automation increases, it will require policies to protect unprepared and vulnerable workers, allowing them to migrate to the new model of production . UnderdeThe increasing adoption of automation technologies results in ever-lower costs of hardware, sensors, network, processing, and storage; a more refined and accurate set of data allowing tests and studies even without human supervision; and a great expansion and absorption of knowledge unprecedented .The last 20 years have brought remarkable progress in AI, one of the most important technologies in the current wave of automation, and now, we can build machines capable of learning even when humans are unable to teach them, producing new knowledge faster than humans . Due to The Internet of Things (IoT) is another important automation technology that has been experiencing considerable expansion, especially in areas such as medical and health care, smart building, intelligent transportation, industry, and logistics . IoT incIoT evolved into the development of smart medical devices creating the concept of the Internet of Medical Things (IoMT). IoMT allows real-time monitoring of the health condition of a person using smart sensors and connected devices and can also help the medical staff at the hospitals by remote monitoring chronic-conditions patients at home. Thus, IoT reduces the workload on medical staff and becomes a necessity instead of a luxury .The COVID-19 pandemic affects several automation-related segments such as telemedicine, IoMT, manufacturing, and supply networks, AI, and smart payments. In telemedicine, the increased adoption of telemedicine to keep patients and medical staff safe can be highlighted. One example is Tele-Critical Care (TCC), a tool related to telemedicine that enables intensivists in traditional intensive care units (ICU) to speed up critically ill triage, thus improving ICU bed management; in hospitals without ICU, TCC enables remote care for critically ill patients, preventing transferring these patients. Another telemedicine tool is Telementoring, in which experts from low-demand areas help their high-demanded peers. During the COVID-19 crisis, intensivists used tiered telementoring to provide consultation on patients with a higher risk from experiencing respiratory and organ failure. One intensivist was capable to oversee 100–250 patients through telementoring .Manufacturing is also being adapted for the post-COVID era, as workplace standard practices are adapted to the physical-distancing policy, thus stimulating concepts such as Smart Manufacturing and Industry 4.0 , 49. AI Finally, smart payment  technologies minimize human contact during cash payments; their demand tends to continue high in the post-COVID era .The COVID-19 pandemic accelerated the adoption of several technologies—such as Big Data, robotics, AI, and IoT—as they help companies and society in general to mitigate the impacts of the pandemic. In some cases, the adoption of technologies was necessary to maintain the operation of businesses, making digital literacy an essential skill, and allowing workers to see technologies more as a tool than a replacement , a movemThe world is entering its 4th Industrial Revolution where technologies such as AI, nanotechnology, 3D printing, robotics, and biotechnology are being used in combination and creating new possibilities for production . TechnolGlobalization, another major force in the future of employment, has created two trends in the markets: outsourcing and immigration. Remote work is already a reality, even in traditional enterprises such as IBM, where only 42% of employees work in IBM’s location . Remote There is also a trend for greater flexibility for workers, making it possible for them to mix different part-time jobs. In this scenario, virtual reality (VR) and augmented reality (AR) may be used to amplify immersion and collaboration, allowing workers to be “where” they are needed .The return of the elderly to the workforce will be motivated by the increased difficulty in fulfilling their retirement plans, in general, and also by the sense of helping society with their experience , 61. ThiAccording to the International Labor Organization (ILO) , “non-stRecognizing the inevitable growth of non-standard forms of employment, a policy proposed by Harris and Krueger  introducThe labor movement suffered recent changes influenced by globalization and technological change but has managed to remain relevant as new forms of work and challenges for workers appeared . Some exThe job losses caused by the current pandemic are expected to be worse than the 2008 crisis because around 38% of the global workforce is in economic sectors that are suffering a collapse in demand such as manufacturing, hospitality, tourism, and transportation. The crisis is also expected to increase unemployment rates around the world to two-digit numbers even in places that had very low rates before the pandemic as the USA and developing countries can experience even worse outcomes .In Italy, an analysis of the impact of the coronavirus on 7800 companies shows that the aggregate shock on a 3-month horizon is −21% and −16% in twelve months with companies canceling 44% of the preexisting scheduled R&D plans. When it comes to employment, the expected aggregate drop is −6.5% . In the Another challenge brought by the pandemic is the asymmetry of the impact on jobs as it will disproportionately affect entire social categories as low-skilled, low-wage jobs usually held by minorities, immigrants, women, and other disadvantaged groups will suffer the effects of the crisis in the long term , 53.COVID-19 showed the importance of the low-wage workforce which comprises a considerable portion of the essential sectors. Immigration systems in advanced economies tend to be more open to high-skilled workers and more restrictive when it comes to low-skilled workers. In the UK, 16.1% of essential workers are foreign-born. Specifically in the health industry, 18.6% of the workforce is foreign and 13.4% of the workforce is not from the European Union. In a “sharp” crisis like the one caused by COVID-19, immigration systems cannot change quickly enough to supply immigrant workers to needed areas. Forty-six percent of foreign-born essential workers in the UK do not meet the post-Brexit immigration rules that stipulate minimum thresholds for immigrants’ jobs’ skills and wages .Many unemployed people will seek jobs in other cities and countries, leading to migration. Massive migrations to other countries may cause two impacts: anti-immigration laws in the countries receiving immigrants and a lack of young workers to develop the countries losing their workforce . AccordiAt the micro-level, as the measures to control the coronavirus spread involve social distancing, society is experiencing a surge in remote work, specifically working from home . This chThe changes in the world of work will force education to be adapted and advancements in technology may help teachers to achieve this goal. The education system needs to train increasingly specialized workers, due to the end of some careers and the emergency of new ones . This cyAs work will need less time to be performed due to automation , workersNew jobs will require highly skilled, knowledge-intensive workers . ScienceIn addition, the worker of the future will need to learn the following skills: critical thinking and problem-solving (cognitive skills), presentation and conflict resolution , and adaptability and self-development  . Jobs wiDuring the COVID-19 pandemic, millions of students were unable to go to school and received general recommendations to use digital tools such as online study platforms –91.Before the COVID-19 pandemic, we assessed that as free information becomes more prevalent in society, we may see teachers replaced by MOOCs if people became more self-taught. From mid-March to mid-May 2020, Coursera, one of the most used MOOC platforms, saw a growth of ten million new users .Regarding the impact on schools in the USA, Dutta  discusseThe World Bank produced a report on the impact of the pandemic on education financing. They projected declines in government revenue due to slower economic activity. On the other hand, countries are overspending their budgets on health and social protection. Such a combination will deteriorate the fiscal balances in most countries during 2020. Therefore, governments will tend to reprioritize their budgets, reducing the education budget, reducing the per capita education spending in almost all country income groups and regions, and impacting future education outcomes. Even in a scenario of economic growth for 2021, the education budget tends to stay stagnate or fall in most countries .Technological progress will affect how we work. In healthcare, technology will increase the quality of diagnoses and improve people’s quality of life. The population is proportionately aging , and, asIn general, eligibility rules for retiring are complex and the pension benefit varies according to the objectives of each government. In 2014, the normal age of the normal pension was 64.0 years (men)/63.1 years (women), assuming entry into the labor market at age 20 . The forFigure Gender equality influences the return on capital rate and the growth of income and output. An increase in women’s participation in the economy results in more political power. If the trend toward increasing gender equality is sustained in the coming decades, a slower increase in economic inequality can be expected .Gender equality has improved in the last 50 years, but several countries still fail to provide even fundamental rights to women, especially in North Africa and the Middle East. The gender gap has slowly reduced in the past decade. Health and education subindexes reached values close to 1 , while economic and political show much lower values. At the current rate, the gender gap will only be closed by the year 2100 [Some researchers argue that growing inequality is a result of the exponential shift in technology. The new technology provides the economic reward for the winners of our modern economy, while the losers become increasingly expendable and less resourceful . Racial For McGahey , technolThe COVID-19 pandemic affected social welfare in several ways because it causes an economic crisis and global recession. Although each country tries to stimulate its economy, methods vary due to financial and political constraints. US unemployment raised to its highest level since the great depression. Most households have insufficient savings to live through this type of adversity. Governments provided liquidity to the most vulnerable households through penalty-free withdrawals from retirement savings accounts and stimulus checks, among others. The consequences of such actions include large government debts .Massive unemployment led many families with young children to become food insecure. Household Food Insecurity (HFI) increases the risk of chronic undernutrition and infectious diseases in children, maternal anemia, obesity, and type 2 diabetes . AccordiThe current demographic changes will highly impact the economy in 2050. The first demographic change will be caused by world population growth, which will rise from the current 7.6 billion to about 10 billion people by 2050 . This woA second demographic change that will impact economies is population aging. By 2050, the population of developing countries will still be younger than those of developed countries . As the A third demographic change is an increase in urbanization. Besides the population growth, people in rural areas are migrating to medium and large cities. According to Schwettmann , 64% of The 2050 economy will be based on knowledge-intensive work. Knowledge-intensive services now include business services such as finances, accounting and software, medical services, and engineering . KnowledTechnology is only a factor to determine economic results such as growth, inequality, or employment—however, technology is the main driver of Gross Domestic Product (GPD) growth per capita. Leading economies have access to similar technologies which resulted in different economic results throughout history, mostly because they have different policies and institutions .According to the McKinsey Global Institute , in the Rises in labor productivity usually translate into increased average wages, providing the opportunity for workers to reduce their working hours and increase the offer of goods and services .Another important trend related to the economy is a phenomenon named “Rise of The Rest,” which describes the shift of the GDP from developed countries to developing countries. Nowadays, global economic activity is already shifting from the G7 to the G20 , 112. AsThe COVID-19 pandemic produced a health and economic crisis with unprecedented scale and magnitude producing an unforeseen combination of supply and demand shocks for the global economy that will affect it for a long time even after the coronavirus control policies . Almost Among developing countries, large fiscal deficits and high levels of public debt will pose significant challenges, particularly for economies dependent on commodities and tourism. The severity of the economic impact depends mainly on two factors: the duration of the restrictions  and the size and effectiveness of fiscal responses to the crisis .Households are strongly affected due to lockdown restrictions, causing job losses. This situation reflects in a decreased consumer power, being perceived as more accentuated in sectors such as tourism/hospitality and clothing . The greThe global production chain was also impacted: mainly affected by the closure of countries’ borders, this network of international economic relations proved to be highly dependent on a small number of countries, such as China—causing the absence of industrial inputs and unbalancing the trade balance of the countries under its influence .The COVID-19 pandemic also impacts the financial sector. Risk management models built over the past few decades have not been able to guarantee global financial stability and contain the effects of this financial crisis . Stock eThe governmental response involves a set of strategic actions, learning lessons from this event to build resilience for possible future crises. At the household level, governmental actions include proposals for financial support for those who had income losses and for stimulating family cost savings to build emergency finance reserves. At the business level, governmental actions include preventing corporate bankruptcy and mass layoffs by identifying companies that are in the most critical stage to support loans and investments so that they can rebuild. At the local economy level, governmental actions include identifying interventions to improve business recovery after COVID-19 and prioritizing investment in critical economic sectors and businesses, based on the added value to the local community .Stronger development cooperation, supporting efforts to contain the pandemic, and extending economic and financial assistance to countries most affected by the crisis will be of utmost importance to accelerate the recovery and put the world back on the path of sustainable development .In this section, we use the trends and trend scenarios presented in Section 3 to build a most-likely scenario of how working will be in the year 2050. First, a short story of this scenario is told, followed by a discussion of the actions that the social actors  would take to lead us into this future.The advancement of computerization will make some jobs obsolete while new ones will be created, as happened in previous industrial revolutions. The benefits generated by automation are important and induce widespread improvements in society as society has taken the right actions to guarantee that technology adoption does so, at least in most cases.Occupations that involve social and creative intelligence, and/or advanced perception and manipulation tasks will be less affected by computerization due to the technology limitation to emulate these behaviors.Society will see a job shift from low-skill to knowledge-intensive occupations. Many people will face unemployment and companies will be stimulated by governments to help reduce the transition impact by training workers in new skills before completely automating their jobs. Those that cannot be helped by these measures will receive a basic income from the state.Communication will be globally improved due to the reduction of costs in Internet access in most countries. Better communication will further improve the integration between national and international markets, allowing more people to offer their services on the internet. The COVID-19 pandemic and the measures adopted to contain it still have an impact on work because by 2050 employers will be aware that they may be forced to move their production to remote work at any time. Thus, we expect some jobs to have at least one “remote day.”Workers will not be associated with traditional trade unions as new forms of worker organization movements will be recognized by governments and employers. These organizations will show that new technologies can be used to innovate not only the way people work but also how they defend their rights as workers.As populations age, the minimum retirement age will increase. This will not represent a big impact on companies for, as jobs become more knowledge-intensive, it will be increasingly easier and even profitable to keep senior workers in their jobs.Gender equality will increase, but even in 2050, many countries will still be far from the ideal equality between men and women. Another group that will see advancements in their rights, despite some resistance from far-right groups, will be the LGBTQIA+ as more initiatives such as anti-discrimination laws are created. Racial discrimination will also reduce.The income distribution will be another factor for social inequality reduction. Several UBI and UBA trials will happen worldwide, but few societies are going to adopt these social welfare policies permanently.The world population will be close to 10 billion, and governments will face the challenge of creating jobs for hundreds of millions or, at least, providing means for their survival. As some countries will fail to do so, workers will either migrate or use the internet to offer their services globally. Both developing and developed countries will see a reduction in their rural population as urbanization grows.In 2050, the economy will be more knowledge-intensive as low-skilled jobs are reduced and new ones, based on more creative and social activities, are created. Rises in labor productivity will provide increased average wages, allowing workers to reduce their working hours while the offer of goods and services is increased.The COVID-19 crisis will affect the global production chain in the long term. Many governments will consider the production of some fundamental industrial inputs as strategic, demanding local production by law, even with higher costs. This will reduce their dependence on other countries.Several countries will face large fiscal deficits and high levels of public debt, aggravated by the COVID-19 pandemic. The severity of the economic impact will be related to how strongly each government acted to break the spreading of the SARS-CoV-2 virus. Another effect to be seen is the increased migration in the search for better economic opportunities, which will lead to an increase in nationalist and far-right movements in Europe and the USA.In this section, we present a compilation of a set of actions that could be taken to make the most-likely scenario come to fruition. Most of these actions are related to public policy and have been mapped during the different steps of the research.For the most-likely scenario to become true, governments will have to make sure that technology meets not only the capital demands but also the population’s needs. As such, governments that promote regulatory policies to control the advancement of computerization, avoiding mass unemployment without stopping innovation, will perceive better results—both in economic growth and welfare. These regulatory policies include the ones aimed to protect vulnerable people, those with few resources and less educated, who must be prepared for this transformation. Governments will be able to respond to the job shift by investing in broader and better education and teaching new skills for the new occupations that will arise while providing the displaced workers with, at least, the minimum living conditions during this period of transition .As companies perceive the consumer market reduction risk due to unemployment, they will promote reducing the working hours, thus maintaining a stable employment rate, and allowing economic growth. This type of action benefits not only the consumer market but can also relief the pressure on the social safety net by reducing the unemployed . More thIn many countries, non-standard employment workers will have minimum rights granted through government regulation after a series of disputes with their employers. This will improve the quality of services provided and reduce the insecurity of workers in this category. Disputes surrounding the employment contract of platform workers are already a reality around the world with mixed results and different proposals are already being put forward and can be expected to increase in the future to create at least some intermediary set of rights that place NSE workers in a situation of less insecurity than the current one .By progressively increasing taxes for larger corporations, and taxing great fortunes and heritages, the government will distribute wealth to the poorer sections of society, including the promotion of basic income efforts. Wealth distribution efforts would allow the reduction of poverty and the stabilization of inequality. The implementation of international tax cooperation could also help with the reduction of inequality between developed and developing countries with the payment of universal basic income as a way of transferring resources from the first group to the second . This isWork has changed in the past, and it is continuously changing. Future studies are important to highlight which important changes must be made now to prevent future problems. Therefore, the future of work is a relevant subject for future study because we are currently going through the 4th Industrial Revolution—focused on robotics, AI, biotechnology, and nanotechnology—and a global pandemic which are events that produce fast and profound changes to society and work.In this study, we analyzed the future of work on the horizon of 2050. We divided our scope into five groups: computerization/automation, employment, education, social welfare, and economy. As a result, we point out trend scenarios about the future of work—with some conflicting trends. Therefore, we developed and integrated these trends into three scenarios of Work in 2050: an optimistic/positive scenario, a pessimist/negative scenario, and a likely scenario which were presented in detail. The likely scenario combined the trends which we consider the most probable future outcomes, including the impacts caused by the COVID-19 pandemic.Results show that computerization and automation continues to advance in industry and will reduce the demand for low-skill and low-wage jobs; non-standard employment tends to be better regulated, with minimum worker rights granted; new technologies will allow a transition to a personalized education process; the workload to the workers will reduce due this personalized education and computerization; automation will impact all types of work, and workers will receive knowledge-intensive training to make them able to perform the fewer available jobs; the self-employment and entrepreneurship will grow in the global labor market; society will demand more transparency and participation in political matters using new technologies; population will age and legislations will be amended so that pensions have increased ages; universal basic income would not reach its full potential, but income transfer programs will be implemented for the most vulnerable population; knowledge-intensive work and services will become more advanced; and extreme poverty will decrease but inequality will be slightly higher than it is nowadays.This study contributes to the understanding of the current situation of work and its current future trends. We contribute to the discussion of problems related to work, to help decision-makers to understand them and take efficient actions to mitigate them.


Different coping strategies have been associated with various effects on infertile couples’ mental health. Considering the close interaction between couples, the present study aims to develop coping strategies for infertile couples using a couple-based approach.The present mixed-methods study will be conducted in three phases. In order to develop coping strategies, a qualitative study will be conducted in the first phase, during which semi-structured interviews will be implemented with infertile couples in order to collect data related to their lived experiences in using coping strategies. These data will be inductively analyzed using qualitative content analysis and interpretative phenomenological analysis. In the second phase, using the Delphi method, an initial draft of coping strategies will be designed using a couple-based approach based on the data obtained from the qualitative study and the related literature review. In the third phase, the designed couple-based strategies will be provided to two groups of infertile couples as a randomized field superiority trial study. The couples’ levels of stress, anxiety, depression, and adjustment will be evaluated using validated questionnaires before and 3 months after the intervention.Couple-based coping strategies encourage couples to become aware of each other’s feelings while interacting and choose a strategy based on such feelings.IRCT20191014045102N1. Registered on 19 October 2021. Protocol version: Current protocol: version 1 (22 May 2022)Iranian Registry of Clinical Trials  Infertility affects approximately 10 to 15% of couples of reproductive age worldwide . This exMost couples choose coping strategies to deal with infertility and mitigate the resulting mental pressure. Coping strategies are a set of cognitive and behavioral efforts made to interpret, analyze, and modify a stressful situation . LazarusCoping strategies are classified into four groups: active coping, active avoidance, passive avoidance, and meaning-based coping . The effHowever, the existing coping strategies are mainly focused on the individual. Coping strategies that can reduce an individual’s infertility stress may negatively impact the spouse’s mental health. Therefore, considering the interactive effect of couples’ coping strategies, it is essential to identify coping strategies whose interactive effect outcome is accompanied by a reduction in the psychological burden of infertility in both men and women, particularly in situations where men and women do not equally bear the psychological and social burden of infertility. In traditional societies where infertility is mainly attributed to women, they are more vulnerable to the social stigma of infertility than men .Comparison of the depression, anxiety, and stress levels in the intervention and control before and after the interventionComparison of the infertility adjustment in the intervention and control before and after the interventionTherefore, the present study intends to develop coping strategies for infertile couples using a couple-based approach and evaluate the effect of the designed coping strategies on infertile couples’ mental health. This trial will be a randomized field trial, superiority framework, with two parallel groups. The study objectives are as follows:This mixed-methods sequential exploratory study will be conducted in three phases with the permission of the Ethics Committee of Isfahan University of Medical Sciences in Isfahan, Iran. This study will be conducted in three phases. The first stage will consist of data collection and preparation of lists of couple-based coping strategies and includes qualitative study and advanced literature review. The second stage will include the Delphi method and assess the feasibility of the designed coping strategies in a randomized field trial study.The qualitative phase of the study will be conducted by inductive content and interpretative phenomenological analyses in order to explain the infertile couples’ lived experiences of using coping strategies. At this stage, to collect data, the researcher will use in-depth and semi-structured interviews with infertile couples individually and in pairs. Guiding questions will be designed for in-depth interviews and used in semi-structured interviews. To collect data, voice recording, note-taking, and field notes will be used. This stage of the study will be conducted in comprehensive health centers and infertility centers in Isfahan.In the first phase of the study, participants will include Iranian infertile couples who underwent infertility treatment at Isfahan Fertility and Infertility Center. The couples will be selected using the purposeful sampling method with maximum diversity in terms of age, education levels, economic status, job, duration of infertility, type of infertility, cause of infertility, and level of adjustment with infertility. The inclusion criteria will include no history of mental disorders and at least 2 years of infertility.The participants will be selected using the purposeful sampling method. In order to invite the participants, the study objectives will be explained, and the interview time and setting will be determined. Participants’ details will be recorded before the interview. Moreover, the fertility adjustment scale will be completed by participants to ensure sampling with maximum diversity in terms of the adjustment with infertility.In a face-to-face meeting, data will be collected through in-depth interviews, voice recordings, and field notes of the observations. Couples who are willing will participate in the interview as a pair. Considering the psychological conditions of the participants and their readiness to be interviewed, the interview may be postponed or stopped and resumed another day.The interview will be unstructured to allow the discovery of new ideas and will be continued using semi-structured interviews. An interview will be developed containing a list of questions to be asked during the interview with the participants. To further deepen the interview and gain richer data, some exploratory questions such as “Could you explain this through more examples?” will be used. Data collection will be continued until data saturation.These data will be inductively analyzed using qualitative content analysis and interpretative phenomenological analysis introduced by Smith et al. . The proTo evaluate the validity and reliability of the data, credibility, dependability, conformability, and transferability standards will be used as the scientific accuracy criteria. In order for credibility, the member checking technique will be used to verify the trustworthiness of the data and codes. In order to ensure dependability, initial codes and examples of the categories, themes, and items extracted from the texts of the interviews for each category will be provided to an external observer. To ensure confirmability, the text of a number of the interviews and extracted codes and categories will be provided to research colleagues and three reproductive health and psychology experts, and they will be asked to evaluate the accuracy of the data coding process. In order to ensure the transferability of the findings, the participants’ statements will be presented as objectively as possible.At this stage, an initial draft of couple-based strategies will be confirmed and validated. In the first round, to prepare an initial draft of couple-based coping strategies to deal with infertility as well as a questionnaire of open-ended items, firstly, the qualitative data will be analyzed; secondly, couple-based coping strategies to deal with infertility will be identified and extracted; thirdly, advanced reviews of related literature and document will be implemented. In order to improve, the initial draft will be sent (either by email or post) to 10 specialists, including psychologists and reproductive health specialists, to inquire about their opinion on the developed coping strategies.In the second round, strategies modified in the first round will be ranked in a checklist using a Likert scale. In this round, moreover, coping strategies approved or disapproved by experts will be separated. In the checklist, there will also be a section for the participant experts to express their new ideas, correction, interpretation, and deletion; explain the strengths and weaknesses of the strategies; and elaborate on the reason for prioritization of coping strategies. The checklist will be sent to the experts to complete. The data will be reviewed and analyzed after receiving the completed checklists.In the third round, the final checklist of couple-based coping strategies to deal with infertility will be prepared based on experts’ opinions in the second round and sent to the study experts to ask for their opinion. Furthermore, in this phase, the participants will be asked to review their answers, revise them if necessary, and present their reasons for any disagreement. The findings of both the qualitative study and the Delphi panel will be triangulated to design the field trial.This parallel-group, double-blind, controlled, randomized field trial, superiority framework with an allocation ratio of 1:1 will be conducted on infertile couples who underwent infertility treatment in Isfahan Fertility and Infertility Center, Isfahan, Iran. Couples, at least one of whom suffers from mild to moderate depression, will be invited to participate in the quasi-experimental study. The inclusion criteria will include no history of severe mental disorders and no stressful event during the last 3 months. The exclusion criteria will be a stressful event or the onset of assisted reproductive treatment during the intervention and ovarian hyper-stimulation syndrome due to ovarian induction.A pilot study will be carried out to estimate the number of couples required for initial screening, attrition rate, and the rate of reduction in postoperative depression. This pilot study will be performed on 50 infertile women. After obtaining informed consent, the couple’s depression level will be measured using a standard questionnaire.The sample size required for initial screening in the field is estimated based on the prevalence of mild to moderate depression. Furthermore, to assess feasibility, after receiving informed consent, the intervention will be performed on couples who are eligible for research, and their level of depression will be measured for the second time. The depression levels at the first and second assessments will be compared by the research supervisor. If the level of depression would be increased in the second assessment, the trial will be stopped.If any problems are identified in the implementation of the intervention, the necessary changes will be applied by the research team after reaching a consensus. Couples participating in the pilot study will not participate in the clinical study, and the results of the measurements will not be included in the analysis.The sample size will be calculated for a 1:1 allocation ratio, considering presumed depression score reduction after the intervention, estimated sample loss, and 95% confidence level.Couple’s eligibility assessment and screening will be performed by the Ph.D. candidate in reproductive health. During the first interview, X infertile couples will be invited, and the levels of depression, anxiety, stress, and infertility adjustment will be evaluated using validated questionnaires. After determining the eligible couples, X couples will be randomly selected and invited by the researcher to participate in the study. The study objectives and the way of participating in the study will be explained to couples who accept the invitation.The informed consent will be obtained from eligible couples by a legal advisor in the infertility center. The representative of the Ethics Committee of the Isfahan University of Medical Sciences will supervise all stages of the research and will decide to end the trial.After determining the eligible couples, X couples will be randomly selected by the researcher. To randomly assign the couples to the intervention and control groups, X closed envelopes containing blue and green cards will be prepared. The couples will be referred to the midwife consultant and receive one of the envelopes and complete demographic characteristics.The midwife and participants will be blinded to the study group. After random allocation, one researcher, who will not be involved in sampling and random allocation, will assign each group’s card color. Couples’ depression, anxiety, stress, and infertility adjustment levels will be evaluated using valid questionnaires 2 and 3 months after starting the intervention and compared between the groups Table .Table 1SThe intervention will begin before starting medical treatment. The counselors will be MSc holders in psychological counseling. They will be trained in the developed couple-based coping strategies using face-to-face education and a role modeling approach.For the intervention group, a counseling psychologist will be educated on the developed couple-based coping strategies based on the color chosen for one group (intervention group) and solution-oriented counseling for the other group (control group).The number, duration, and intervals of the sessions for intervention and other educational intervention (control) groups will be set identically. It is estimated that the counseling program will be scheduled 3 to 5 times once or twice each week. The researchers will bear the intervention and transportation costs for both intervention and control groups. Participants should not participate in any other research during the intervention. The research is expected to proceed without any harm; however, in case of harm, the main researcher will be responsible for compensating for the reparable harm.The outcome will be the mean score of depression, anxiety, stress, and infertility adjustment and the magnitude of their change on enrollment and 3 months after starting the intervention in couples in the intervention group compared with those in another educational intervention (as the control group).Data will be collected using a self-report 21-item Depression Anxiety Stress Scale (DASS-21) and a revised version of the Fertility Adjustment Scale (R-FAS) . Each ofAdjustment to infertility will be assessed using the self-report R-FAS, including 12 items on a 6-point Likert scale (1–6) from 1 (strongly disagree) to 6 (strongly agree). The final score will be obtained by summing the scores of questions; a higher score indicates a lower adjustment toward infertility.To promote participant retention and complete follow-up, prior to each counseling session, the researcher will encourage couples who discontinue or deviate from intervention protocol to participate in counseling sessions through a telephone call. Missed data will be completed by the researcher through a telephone call and questions. Data monitoring in all phases will be done by the principal investigator.Researchers directly will be accountable for relevant information about the trial to the potential participants. When entering data in the datasheet, participants’ details will be removed, and the code will be assigned.t-test, pair t-test, chi-square, and repeated measures analysis of variance (RM ANOVA). If the measurements at the enrollment phase appear differently in the groups, analysis of covariance (ANCOVA), controlling for baseline data and independent variables (group as a fixed parameter and enrollment mean scores as a covariate), will be used. Also, the baseline value of outcome variables and potential confounding variables which are different between the two groups will be adjusted to avoid potential risk of bias and detect independent results. The data normality will be evaluated through the Kolmogorov-Smirnov test. If the data are not normally distributed, nonparametric tests such as Wilcoxon will be used. In the case of missing data, we will utilize the last value carried forward method to impute missing values.Data will be analyzed using the SPSS 19 software and statistical tests, including the independent All results of the trial without any restrictions will be published.Given that coping strategies have dissimilar effects on infertile couples’ mental health, appropriate coping strategies need to be taught to promote their mental health. A study has indicated that strategies used by infertile couples are influenced by cultural and social values and norms of the society where they live . It has Therefore, it is necessary to develop supportive programs in treating couples’ infertility according to their lived experiences facing infertility and their social and cultural context. In addition, the infertility crisis is an event that affects couples’ married life and interactions, management of which requires active and responsible participation of couples. As a result, the interaction between coping strategies of each couple does not increase the psychological burden of infertility on the other.In an effort to provide psychological support to infertile couples, Zurlo has developed a model of mental health predictor variables in infertile couples undergoing treatment that demonstrates the importance of adaptive coping strategies for infertile couples’ mental health . The effIn a study by Czamanski et al., positive reappraisal coping intervention and problem-solving skills training in women awaiting assisted reproductive technology resulted in increased use of problem-focused strategy and decreased use of emotion-focused strategy .One study evaluated the effect of Positive Adjustment Coping Intervention using a smartphone to provide psychological support to women undergoing infertility treatment and found that the program was associated with a reduction in women’s psychological burden during treatment . MoreoveIn the present study, coping strategies used by infertile couples to interact with each other and improve their adjustment to infertility will be extracted by analyzing their lived experiences and evaluating their emotions and feelings toward infertility. Such strategies, extracted and designed based on society’s cultural and social contexts, will better meet the couples’ emotional needs compared to other strategies. When a strategy is used by a partner regardless of the other partner’s emotional and strategic needs, it may harm another partner’s mental health. Therefore, designing couple-based coping strategies based on the data of a qualitative study and the cultural conditions of society is expected to minimize the possible friction between strategies used by couples and improve their relationships.


This study examined the effects of social interaction, cognitive flexibility, and seniority on the correct response among emergency ambulance teams during case intervention.The research, structured with the sequential exploratory mixed method, was conducted with 18 emergency ambulance personnel. The approach process of the teams working on the scenario was video recorded. The records were transcribed by the researchers, including gestures and facial expressions. Discourses were coded and modeled with regression.The number of discourses was higher in groups with high correct intervention scores. As the level of cognitive flexibility or seniority increased, the correct intervention score tended to decrease too. Informing has been identified as the only variable that positively affects the correct response to the emergency case, especially in the first period, which is directed toward case intervention preparation.Within the findings of the research, it is recommended that activities and scenario-based training practices that will increase the intra-team communication of the emergency ambulance personnel should be included in the medical education and in-service training.The online version contains supplementary material available at 10.1186/s12909-023-04091-w. Pre-Hospital Emergency Medical Services (PH-EMS) cover the initial evaluation, emergency response, and appropriate transfer to the hospital, carried out by professional health personnel, who are transported to the scene by emergency ambulances and trained for such emergency assistance cases. This health service, which is taken to where the patient or injured is, directly affects the morbidity and mortality rates. Decisions made as a team in complex cases under stress and environmental factors by emergency ambulance personnel are vital for the served individuals .Health personnel working in emergency health service stations work as a group in 24-hour shifts. In studies on patient safety, it has been accepted that team performance is essential to provide safe patient care . A groupMedical conditions such as injuries and traffic accidents, in which emergency assistance arises, are often complex situations requiring clinical reasoning. Intervening a problem as a team may be more effective than an individual effort. Many skills are used during this intervention. Of utmost importance among these skills is communication skills. Effective communication within the team will affect the clinical reasoning skills of the emergency ambulance team. The quality of the communication between the emergency ambulance team and the way they use their clinical reasoning skills while intervening crucial. The idea that ‘the group is more than the members that make up that group’ is one of the basic principles of social psychology . ObservaGroups have various functions. The intimacy formed in the group meets the adaptation needs of the group members, tasks the group handles meet the achievement needs of the group members, and sociability in the group allows for meeting the identity-based needs of group members . People The communication component, one of the elements that support effective teamwork, can play a role that supports emergency teams’ clinical reasoning skills for working as a team. Clinical reasoning, on the other hand, is considered the cognitive process underlying clinical practice and is often referred to as problem-solving. While novice learners tend to have little and scattered knowledge, knowledge is organized and placed in more advanced structures and schemes with increasing experience. Studies reveal that clinical reasoning is a critical component of clinical competence , 13. CliRegression analysis examines how variables before the event and discourse affect the final state in many situations where sequential discourses are experienced, such as during emergency response. Different studies that encode and digitize the discourses of group members and model them in regression analysis have taken their places in the literature. For example, Chiu and Khoo used regression analysis on solving problems in small groups in mathematics classes through the interaction between students’ certain characteristics and discourses in the process and showed less creativity in smaller groups in the mathematics lesson . While CThis research examines the effects of communication, social interactions, clinical reasoning skills, and seniority characteristics of ambulance personnel on the correct case intervention.The research was carried out with 18 ambulance personnel who volunteered to participate and allowed audio and video recordings with their informed consent. First, the speeches, gestures, and facial expressions of the personnel working as a team were recorded with video and audio recordings. These discourses were then coded. Finally, these discourses showing the quality of communication and cognitive flexibility, and seniority characteristics were modeled using regression modeling. Therefore, the research was structured with the sequential exploratory mixed method .Participants were emergency ambulance personnel, who served as a team at the stations they served, worked with their own teams (in groups of three) on the cases given by the researchers. The researchers explained the purpose of the study and how it would be conducted to volunteer paramedics. Information on the group work being video recorded was provided. A total of 18 paramedics participated in the study, who signed the informed consent forms and approved the audio and video recording.Within the scope of the research, data were collected on a case that allows paramedics working in emergency ambulances to work in groups and demonstrate their decision-making and communication skills. This process was video recorded, the team’s conversations and body languages while solving the case were written down, the conversations were coded, and the effect on the decision-making skills was analyzed.The case was created by researchers and structured by expert control. Researchers included specialists in emergency medicine, medical education, and educational sciences. Afterward, the prepared case was presented to the opinion of four emergency medicine and three medical education specialists apart from the researchers. In line with the opinions received, corrections were made to the case, and its final form was given (Appendix 1).The cognitive flexibility level of the emergency ambulance personnel participating in the research was determined by the Cognitive Flexibility Scale developed by Martin and Rubin  and adapThe research was completed following the procedures listed below:The approval of the ethics committee and relevant institutions was obtained to carry out the research.Before the group work, necessary explanations were made to paramedics, and expectations were explained. To increase validity and reliability, study participatory opportunities for paramedics when they wish to leave were clearly specified (honesty in informants), and only voluntary participants were included . Of thesParamedics were divided into six groups of three team members working together. The simulated emergency intervention case  was given to the groups. The same case was given to the groups simultaneously, and interactions were recorded at six separate stations.In the simulation consisting of three stages, 10 min were given for each stage, adding up to a total of 30 min.In the first stage, as per the scenario, the information described by the patient’s relatives at the scene was presented to the teams by the command control center (see Appendix 1). At this stage, the teams were asked to discuss and write down their possible preliminary diagnoses. In addition, they were asked to write down the reasons for their preliminary diagnoses and the preparations they would make while going to the scene.In the second period, scene arrival, the incident was described, and the findings of the primary evaluation were given. The teams were then asked to discuss whether the probability of any preliminary diagnoses decreased after the information was presented and to write down the reasons.In the third period, secondary evaluation findings  of the case and examination results related to the case were given (see Appendix 1). With the last information given, they were asked to write down “the last diagnosis for the patient and why they thought about this diagnosis” and “interventions to be made for their diagnosis” by discussing in the team.Care was taken to obtain valid data per the purpose of the research. The whole process was recorded with video cameras. In the video camera recording, a professional camera and a microphone were used to clearly capture the voices of the paramedics in the group.For credibility, the researchers transcribed participants’ speeches in the video and audio recordings  .Each team assigned one team member to read the case form. Discourses in which the case was read were coded as question reading and were excluded from the analysis.There were several discourses that could not be understood while listening to the audio recordings and transcriptions. These discourses were coded as ‘incomprehensible’ and excluded from the analysis. After the discourses of reading questions and excluding the incomprehensible conversations, the remaining 1640 discourses were coded and analyzed. Discourses were coded by the researchers. Coding was carried out as follows.Paramedic 1: Preliminary diagnosis may be “arrest” due to sports injury, friends, because it’s a diving accident! (Informing)Paramedic 2: Couldn’t it be MI too? (Asking Questions)Paramedic 1: Command center told us he had a rash on his head. In other words, chest pain may be “arrest” due to MI or “arrest” due to trauma. Shall I write this on our answer sheet? (Guiding/Directing)Paramedic 3: Okay, write. (Approving)Paramedic 1: I’m writing sports injury. Arrest due to sports injury. (Suggesting)Paramedic 2: Did he jump headfirst? (Asking Questions)Paramedic 1: He dived, yes. (Responding)Paramedic 3: First has stomach ache and palpitations. As a result, he jumps to relax. (Giving More Information)Paramedic 2: Yes. (Approving)Paramedic 3: Let’s not miss this, he does not go swimming directly into the sea. Meanwhile, he jumps into the sea to relax. His friends said, “He coughed by holding his chest while getting out of the water.“ Here he comes out of the water with his own means. (Informing)Paramedic 1: Yes. (Approving)Paramedic 3: It doesn’t seem like a very serious neck trauma. As long as he can get out of the water by himself. (Guiding/Directing)Paramedic 1: There is mention of a rash on his forehead. (Guiding/Directing)Paramedic 3: He also has a rash on his forehead. It may be related to diving; as you said, there may be an injury, but it is not very serious. (Informing)The discourse in which the text of the conversation was written was read. The contextual nature of each discourse in the video recording was examined. The semantic nature of each discourse has been examined. Codes for suggestions, approvals, rejections, guidances/directives, etc. were assigned.Discourses were coded in the research. Then, two of the 18 paramedics participating in the study were reached again. Their opinions were taken on whether the coding reflected what they said. This way, the participant verification strategy was used to provide credibility , 24.Discourses were coded independently by 5 experts, two of whom were emergency medicine specialists, one experienced in discourse analysis, two qualitative research specialists, and an educational scientist. These 5 coding experts were not included in the research and were experts in external evaluators. In this way, an external audit , 24, 25 Is the coding made consistent? Inter-rater reliability can be examined with Kripphendorff Alpha in the process performed by more than two raters assigning codes to more than two categories . The quaA small amount of mismatched coding was detected between the external coders and the encodings performed by the researchers. A panel was held on which code would be given to these codes. In this panel, the codes were discussed, and the final code to be given was decided. This process utilizes the coding made by each researcher for other researchers’ usage to obtain reliable data (dependability) .Case-related responses of the six teams were scored according to clinical reasoning scoring criteria  (see Appendix 1).As explained previously under the heading of data collection tools, the total scores of each participant from the cognitive flexibility scale were determined.All data were transferred to the statistical package program.In this study, the variables in the data file and the data belonging to these variables can be summarized as follows:Discourses within the team while working on the case.The case the teams are working on and the correct intervention process consists of three stages. In each stage, new information is added to the case, and the discussion gains a new dimension. For this reason, the discourses were divided into three periods: Discourses that took place in the first, second, and third periods.The effect of discourses on the outcome (correct intervention) was included in the regression modeling for three periods separately. Multiple linear regression was used. The discourses included in the predictor variables were categorical . Therefore, discourses were included in the regression model as dummy (dichotomous) variables. It is appropriate for categorical variables to be included in regression models as dummy variables , 29.Cognitive flexibility scores.A cognitive flexibility scale was applied to each paramedic in each group. The total scores of each paramedic from the cognitive flexibility scale, obtained with the lowest 12 and the highest 72 points, were determined. Cognitive flexibility scores were continuous variables. In the regression modeling, cognitive flexibility scores were used as the group’s arithmetic mean of the three paramedics. While different regression models were created for the three periods, the cognitive flexibility group mean score was included in the model as a continuous variable.Seniority.Seniority is the number of years worked by each paramedic in each group. Therefore, it is a continuous variable. The seniority of the three paramedics in each group was converted into an arithmetic mean. In the regression modeling, seniority was used as the arithmetic mean of the three paramedics in the group. While different regression models were created for the three periods, the seniority group mean was included in the model as a continuous variable.Success in case intervention.Each group achieved a success score for the three intervention periods in the case (see Appendix 1). It is a continuous variable. These achievement scores were used as output variables in the regression models.In the regression analysis, autocorrelation (multicollinearity) analysis was performed between predictors. In the regression models, the smallest Variance Inflation Factor (VIF) values for the variables were determined as 0.823, and the highest VIF values as 1.621. The obtained VIF values were very close to 1. If the VIF values calculated according to the literature are close to 1, it can be interpreted that there is no variance inflation factor and autocorrelation in the variables. VIF values above 5 are interpreted as variance inflation findings. Therefore, it was decided that there was no autocorrelation between predictors , 31.The types and numbers of discourse occurring in each group for three periods were examined. In addition, the correct intervention scores (case example in Appendix 1 and the team’s score for correct intervention based on the information provided [outcome variable for this study]) obtained in the groups were also examined. The results are summarized in Table Correct intervention scores (case example in Aappendix 1 and the team’s score for correct intervention based on the information provided [outcome variable for this study]) also increased in groups where the number of discourses increased. It was determined that the group with the highest correct intervention score used informative discourse more than the other groups in the first and second periods. The discourse numbers of the groups with low correct intervention scores were below 200 and lower than those with high scores. A cognitive flexibility scale was applied to each paramedic in each group. The total scores of each paramedic from the cognitive flexibility scale, obtained with the lowest 12 and the highest 72 points, were determined. In the regression modeling, cognitive flexibility scores were used as the group’s arithmetic mean of the three paramedics. In addition, the cognitive flexibility levels and seniority of the paramedics in the groups were examined. The results are summarized in Table The lowest possible score on the cognitive flexibility scale was 12, and the highest score was 72. The data showed that correct intervention scores did not increase proportionally with higher cognitive flexibility and seniority. Therefore, cognitive flexibility, seniority, and the level of predicting the correct intervention in the discourses formed in the group were examined separately in each period. Appendix 1 presents a case in which paramedic groups will be intervened simulatively. The case intervention consisted of three periods. Additional information is provided to the team at the beginning of each period. The first period is mostly related to the preliminary diagnoses of the cases and the reasons for these preliminary diagnoses and physical examinations. The second period is about reaching a more probable definitive diagnosis than preliminary diagnoses with new information given. The third period is about confirming the possible diagnosis reached with the new information given and the definitive diagnosis. The structure of the three periods is in the form of tasks within a task. The duties of paramedics also vary. For this reason, the regression modeling of the three periods was done separately. Because cognitive flexibility, seniority, and the nature of discourses  may have different effects on reaching the right result, depending on the necessity of the task in the intervention. The results of the regression analysis performed are summarized in Table In the regression analysis, “Informing” was determined as the reference group, and other discourses will be interpreted according to “Informing.“ The results showed that guiding/directing, cognitive flexibility, and seniority negatively predicted correct intervention in the first period. According to informing, the insignificance of discourses other than guiding/directing indicates that the reference group informing is a positive predictor of correct intervention. In the second period, the analysis showed that correcting, suggesting, asking questions, guiding/directing, cognitive flexibility, and seniority negatively predicted correct intervention. The analysis results for the third period showed that correcting, giving more information, ignoring, suggesting, cognitive flexibility, and seniority negatively predicted correct intervention in this period.When the distribution of discourses according to the groups in Table This study examined the effects of communication, interaction, clinical reasoning skills, and seniority characteristics of ambulance personnel who make critical decisions about human health in complex cases and respond as a team to emergency cases on the correct intervention. This is the first study in the literature to discuss how intra-team communication of ambulance personnel affects clinical reasoning skills. In addition, the high number of discourses in groups with high correct intervention scores, which emerged in the research findings, reveals the positive effect of the formation of an intense communication environment on the correct intervention. Determining the level of cognitive flexibility and seniority as variables that negatively affect the correct response to emergency cases were the findings that made this study unique.One of the methods frequently used in the evaluation of group dynamics is the scenario-based observation method . DiffereIn the study by Lingard et al. (2005), three video-based scenarios for the tension level, responsibility for creating, and resolving the tension of three professions working together as a surgeon, nurse, and anesthesiologist were evaluated independently. Although the tension levels of the three professions working together are similar, it has been revealed that each profession evaluates the responsibility of creating and solving tension differently and generally evaluates their profession as relatively less responsible than the others . Since pIndividuals with cognitive flexibility are expected to be aware of their options, cope effectively with new and difficult situations, produce alternative thoughts and ideas, and adapt to new situations. The increase in the seniority of the individuals in their profession takes them from apprenticeship to the level of expertise, teaches them to cope with an ever-expanding environment and increasing stimuli, and enables them to take the appropriate cognitive position in the face of the problem. The development of these skills, along with increasing seniority in the profession, is supported by cognitive flexibility . It is tClinical reasoning is the information integration and synthesis from a clinical case with the knowledge and experience of healthcare professionals, and it’s used in the patient’s diagnosis and in the management of the patient . PersonnAs in similar studies, some limitations in our study may affect the interpretation of our findings. Worldwide, emergency health services are provided based on various models and with teams of different members. In this respect, future research can contribute to increasing the generalizability of the results obtained in this research by working with teams providing emergency health services in different countries and health professionals from different seniorities.Within the research findings, the decisions made as a team in complex cases under stress and environmental factors are vital for the individuals who receive service. Therefore, we recommend that activities and scenario-based training practices that will increase the intra-team communication of the ambulance personnel working as a team for 24 h should be included in the in-service training.Below is the link to the electronic supplementary material.Supplementary Material 1


As policy innovation is essential for upscaling responsible innovation, understanding its relationship to value change(s) occurring or sought in sociotechnical systems is imperative. In this study, we ask: what are the different types of values in the policy process? And, how does value change influence policy innovation? We propose a disaggregation of values and value change based on a four-stream variant of the multiple streams framework (MSF), a conceptual lens increasingly used for explaining policy innovation in sociotechnical transitions. Specifically, we posit that the values that ‘govern’ problem framing, policy design, political decision making, and technological diffusion can evolve relatively independently, potentially leading to value conflict. We apply this framework to the ongoing case of the market-based economic dispatch of electricity (MBED) policy in the Indian energy transition using content analysis. We find that the MBED scheme—with its emphasis on efficiency (problem), economic principles (policy), low-cost dispatch (technology), and centralization (politics)—attempts value change in each stream. Each instance of value change is, however, widely contested, with the ensuing value conflicts resulting in significant opposition to this policy innovation. We conclude that a disaggregation of values based on the MSF can facilitate an analysis of value change and value conflict in sociotechnical transitions and lay the foundation for systematically studying the relationships among technological change, value change, and policy change. The field of responsible research and innovation aims to “promote the inclusion of public values in innovation processes to address grand challenges” . The literature on the ethics of science & technology has made a distinction between values in the engineering community, the policy making community, and the general society  scheme in the ongoing Indian energy transition, from a carbon-intensive energy system to one prioritizing renewable energy. For our study, the MBED scheme represents a case of a policy proposal that is on the government agenda but is facing significant opposition during adoption, at least in part, due to the value conflict brought to the fore by the proposed policy design. In contrast to a typical MSF analysis—which prioritizes explaining the process of agenda setting or policy adoption—with this case study, we focus on understanding the opposition to policy innovation based on a disaggregation of values in the policy process. An investigation of this case: (i) demonstrates the applicability of our analytical framework for differentiating values and uncovering value change in the policy process; and (ii) indicates how value change can create value conflict that underpins resistance to a new policy. Further, this exercise is useful from a policy perspective as the Indian renewable energy transition is critical for global sustainability and will play a key role in achievement of the target to limit global temperature rise to 1.5 degrees Celsius by 2050. In addition, identifying key value conflicts in the Indian energy transition can facilitate lesson-drawing for the renewable energy integration in other low- and middle-income countries, which share several similarities with the policy context in India.and operationalizing values in the context of our analytical framework and case study. Third, we demonstrate the use of the MSF for systematically conceptualizing the interactions among stakeholders involved in the policy process in the context of a sociotechnical transition  of value change in a sociotechnical system. While numerous scholars only differentiate values pertaining to technology generally from values in society, Van De Poel et al.  add a fuThe MSF originally explained agenda setting using five key elements: three streams, windows of opportunity, and policy entrepreneurship Kingdon, . The proScholars have since applied the MSF to analyze policy making in over 300 cases, at various levels of government in diverse policy areas around the world  in 2018  test the applicability of the above conceptualization of values using the MSF; and (ii) uncover the key value conflicts, if any, that constrain the adoption of the proposed MBED policy. We employ the case study to answer the following empirical questions: what are the key values and value changes in the proposed MBED scheme in India? How do value conflicts contribute to the opposition to the MBED scheme in the context of the increasing share of intermittent renewable electricity in India? A closer look at the case shows that a key reason for this opposition is the value changes embodied in the policy proposal and the value conflicts engendered by it. As a result, while the other real-time market had come into operation by June 2020, the proposal for the MBED scheme did not move beyond the policy formulation stage, and remains un-implemented even four years later, as of this writing.In this section we present the data sources and describe the analysis techniques used in the study.We base our analysis on documents from government websites, interviews, news articles, policy reports by think tanks, and secondary literature. While we refer to much background material to understand the context of the policy proposal, our primary data sources for value conflicts are the discussion paper on the MBED scheme released by the Staff of the CERC, along with the 37 official responses to it as part of the public consultation process. The policy proposal and the responses received are publicly available CERC, b. We triWe examine this data using content analysis with pre-defined coding  concepts or beliefs; (ii) referring directly or indirectly to the desirable; (iii) described with little or no reference to a specific context; and (iv) employed for prioritization of alternatives. Illustratively, consider the statement: “it [self-scheduling] leaves several low-cost generation capacities partially or sub-optimally utilized” CERC, , p. 9. TIn this section we present the findings of our analysis regarding the value changes explicitly or implicitly embodied in the MBED scheme and the value conflicts that drive, to a significant extent, the opposition to this scheme.The idea of designing the electricity market to facilitate renewable energy integration is dominant in policy communities across Europe and the United States , after which all such generators as well as the DISCOMs with whom they have contracts should also be mandated to participate in the day ahead Market Based Economic Dispatch system” CERC, , p. 38. In 2021, three years after the CERC proposed the MBED scheme, the Ministry of Power, Government of India, circulated another discussion paper that acknowledged the challenges in the adoption of the scheme  speculated about the fallout of the scheme: “without a contract, what if the generator sold their power to a different entity?” In another instance, the regulator in the state of Karnataka  compared dealing with price volatility in the electricity market as akin to gambling. Further, the principle underlying the distribution of efficiency gain that might ensue from implementation of the policy was heavily contested. While the Staff had proposed a 50:50 split between the electricity generating company and the distribution utility to which it was contractually bound, some contended that the latter should receive the entire profit as it, in effect, owned the electricity under the long-term contract PKCL, . More fuThird, the proposed design of the MBED scheme conflicted with some values in the technology stream too. Specifically, the values of ‘low-cost’, and ‘better flexibility’ would take on a new importance in the technology stream with the introduction of the MBED scheme. Although the MBED scheme is designed to incentivize low-cost operation, stakeholders who would stand to lose (as compared to the status quo) raised concerns about uneven impacts on different power plants, and called for the value of a ‘level playing field’ to be upheld, thereby implying that all power plants should be treated the same. For instance, stakeholders raised concerns about the various ways in which the design might favor power plants with lower costs due to fuel linkages or access to concessionary coal, or those with an existing long-term contract and lower incremental cost of generation IEX, .Fourth, the key value conflict within the politics stream concerns the conflict between the values of federalism and centralization in energy governance in India. In proposing a national merit order of electricity dispatch, the MBED scheme would promote the centralization of electricity governance in India  innovation processes, it is important to examine its relationship to value change and value conflict. In this study, we addressed this gap by posing the following questions: what are the different types of values in the policy process? How does value change influence policy innovation? We conceptualized values, value change, and value conflict using a four-stream variant of the MSF, positing that problem framing, policy design, technological innovation, and political decision making are influenced by different—albeit potentially overlapping—values, which can evolve relatively independently. Our application of this analytical framework to the ongoing case of the MBED policy in India showed that the policy espoused the value of efficiency in the problem stream and the corresponding value of ‘economic principles’ in the policy stream. A consequence of its design was the prioritization of (variable) cost as the key value in the technology stream and the centralization of decision making in the politics stream. These value changes embedded in the MBED proposal created several value conflicts.In the problem stream, respondents highlighted autonomy, economic growth, and regional development as values that influence issue framing. Meanwhile, in the policy stream, value conflicts involved both the process as well as the substance of policy design. In the process, incrementalism, consultation, and transparency were emphasized as values not reflected in policy formulation. Simultaneously, certainty and equitable distribution were articulated as values missing in the design, and the notion of economic efficiency as the sole value in the policy stream was contested. Further, the idea of a level playing field  came through as a value in the technology stream that could be threatened by the value of ‘low-cost operation’ espoused in the proposed design of the MBED scheme. At the policy-politics interface, the operationalization of economic principles in the proposal conflicted with the values of decentralization and federalism. The process of decision making was also seen as antithetical to consensus building. These value conflicts prevent coupling among the streams and result in opposition to the policy innovation.The literature on ethics in science & technology has proposed a rather coarse disaggregation of values in terms of societal values and technological values. In a more fine-grained conception, Van De Poel et al.,  have disOur approach provides a way for analyzing interactions among stakeholders in sociotechnical transitions over a long time frame. While the dynamics in our case have unfolded over a relative short timeframe, the MSF itself has been used to analyze policy processes lasting over a decade. Further, it has previously been proposed to study normative contestation compatible, why and how do values change, and how do value changes influence policy innovation are questions that have not been studied adequately using the MSF. Here, we take a step in that direction. Further, existing research on the MSF is biased towards successful policy change and policy entrepreneurship. In one example of an exception, Llamosas et al.  have depFinally, our study has an important policy implication. The analysis of the policy process of the MBED scheme shows that value conflicts lie at the heart of the resistance to this policy innovation. Therefore, a resolution of the key value conflicts identified here—in a manner that facilitates alignment among  problem framing, policy design, technology diffusion, and political decision making—will be necessary for moving the policy process forward. While the subsequent discussion paper by the union government is indicative of this realization, it is a delayed response at addressing the opposition to the policy proposal. Further, rather than enabling alignment in problem, policy, technology, and politics, it aims to minimize the role of the states in the initial implementation of the policy to circumvent the ensuing value conflicts. To promote the policy innovation, a policy design that incorporates multiple public values—both procedural and substantive—is more likely to bear fruit. Also, an ex-ante approach to the assessment of value change and value conflict—perhaps using the framework presented here—can inform future policy making and help accelerate the Indian energy transition.


The article “United States Dietary Trends Since 1800: Lack of Association Between Saturated Fatty Acid Consumption and Non-communicable Diseases,” written by Lee et al. and published in January 2022 in Frontiers in Nutrition .First, the article is categorized as a systematic review, while the method section or appendix lacks a systematic search for literature data, as well as inclusion and exclusion criteria for data selection for both literature and database data. Instead, this work should be classified as a longitudinal ecological study, aiming to assess time-related trends in the aggregated prevalence of NCDs and identify population-level dietary factors that might explain these changes over time. A major limitation is that aggregated data cannot be attributed to the individual level. Moreover, using food availability data has the crucial disadvantage as it cannot accurately portray consumption nor distribution of foods within the population . Without replication of the results at the individual level, the association stated by the authors can only be considered hypothesis forming  and not Furthermore, handling of missing data and data processing was not described in the article. For example, it is unclear how the increases in poultry and cheese availability of 550 and 908%, respectively, ultimately arrive at net increases of 136 and 209%. What are the food losses based on? In any case, these losses are not in line with the estimated total global food waste of around 30% (Lastly, the title concludes there is a lack of association between the consumption of SFAs and NCDs. However, no attempt has been made to quantify the SFAs coming from different foods. In fact, Table 2 shows an increase in the consumption of poultry by 413%, dairy products by 15%, and eggs by 241%. The results section also shows an increase in fish and shellfish consumption by 186%, and an increase in intake of processed meat by 3%. All these foods are significant sources of SFAs. Furthermore, the authors do not report any data on NCDs nor perform statistical tests to assess the association between SFAs and NCDs. Interestingly, while the article of Lee et al. suggests an inverse correlation between SFAs and NCDs, Figure 2 shows a relatively stable 18% increase in SFA-consumption while NCDs have 'risen dramatically' according to the authors. Although the authors claim this rise is due to an increase in added plant- and not animal-based fats, given the lack of data on NCDs, quantification of SFAs, and an adequate statistical analysis to support their claim, this conclusion should be interpreted with the utmost caution because it could be detrimental to health.The title of the article is misleading because the stated conclusion cannot be drawn from the research described in the article. In addition, studies show mortality rates due to cardiovascular disease have declined significantly in recent decades  which caThe aim and hypothesis of the study by Lee et al. were not stated clearly and most importantly, no statistical analysis is described that would show a lack of association. We are concerned that this utterly unsubstantiated title may find its way into the practices of medical doctors and dietitians, who—without proper evidence—may recommend people to eat more saturated fats, and thus damage their health. We therefore ask the authors of the discussed article  to proviWW and CJ: conceptualization. WW, CJ, AK, MP, CW, FT, HK, SH, and DS: original draft preparation. DS: supervision. All authors have read and agreed to the published version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.