Based on the normative conflict model, this study proposes a dual-pathway model that is constituted of organizational identification and normative conflict, and examines the double-edged sword effect of ethical leadership on subordinates’ constructive deviance. According to the analysis of 449 questionnaires collected from Chinese employees, the results show that ethical leadership can promote employees’ constructive deviance by improving their constructive intention , and it can weaken employees’ deviance motivation (normative conflict) to prevent their constructive deviance. Moreover, ethical leadership has different effects on different types of constructive deviance. This research further enriches the formation mechanism of constructive deviance and provides practical guidance to exert the effectiveness of constructive deviance in organizational management. In the VUCA era, the uncertainty of the external environment and the low efficiency of the internal operation of the organization make the traditional organization management face the dilemma of simultaneous internal and external risks . OrganizAs the information publisher and resource distributor of the organization, the leader is an important environmental factor affecting employee’s behavior . StudiesThrough combing the literature on ethical leadership and constructive deviance, the potential relationship between ethical leadership and constructive deviance is preliminarily established theoretically. However, the specific path of ethical leadership influencing constructive deviance should be further explored. According to the core hypothesis of the normative conflict model, only individuals with high organizational identification and experience high normative conflict will express dissent for organizational well-being . TherefoThis research aims to make the following theoretical contributions: First, based on previous studies, this study further clarifies the relationship between ethical leadership and constructive deviance. Based on ethical leadership’s dual essence of ethics and compliance, this study proposes the double-edged sword effect of ethical leadership on constructive deviance . It respAccording to the normative conflict model, employees raise dissent to the existing norms of the group to help and improve the group they belong to . EthicalHowever, ethical leadership also has an inhibiting effect on constructive deviance, which will reduce employees’ intention to violate organizational norms. Different from other positive leaderships, ethical leadership attaches more importance to the organizational ethical norms and strengthens ethical norms through rewards and punishments . Some scAlthough ethical leadership has a double-edged sword effect on constructive deviance, however, this research proposes that the overall effect of ethical leadership on constructive deviance should be positive. Ethical leadership attaches importance to organizational norms, which does not mean that leaders are inflexible. For example, Hypothesis 1: Ethical leadership has a positive effect on the COD of employees.Hypothesis 2: Ethical leadership has a positive effect on the CID of employees.Hypothesis 3: Compared with CID, ethical leadership plays a weaker role in promoting COD.Organizational identification is an individual’s perception of organizational identification and emotional connection to the organization . AccordiEthical leadership can promote the formation of subordinates’ organizational identification. First of all, ethical leadership emphasizes and practices organizational norms within the organization, and helps employees to have a clearer understanding of the organization through two-way communication. In this process, organizational norms and values are gradually internalized among employees, thus promoting employees’ perception of organizational identification . SecondlOrganizational identification can predict the constructive deviance of employees. According to the normative conflict model, organizational identification is an important motivation to promote employee’s dissent . SpecifiThe normative conflict model holds that organizational identification is an important prerequisite for employees to raise dissent. However, theories related to social identity and empirical studies generally draw opposite conclusions, that is, employees with high organizational identification tend to be loyal supporters of organizational order . TherefoHypothesis 4: Ethical leadership promotes COD by positively influencing employees’ organizational identification.Hypothesis 5: Ethical leadership promotes CID by positively influencing employees’ organizational identification.Hypothesis 6: Compared with CID, ethical leadership plays a weaker role in promoting COD through organizational identification.According to the normative conflict model, individuals will experience normative conflict when they perceive differences between the actual norm of the group and some better alternative standards . Warren Ethical leadership can improve the objective rationality and subjective authority of organizational norms to reduce employee’s normative conflict. On the one hand, ethical leadership respects the opinions of their subordinates and takes the initiative to discuss business values and ethics with them . ThroughIn addition, the normative conflict model holds that different normative conflicts will occur according to the difference in violation of the norms , and then leads to different types of dissents . This reHypothesis 7: Ethical leadership inhibits COD by negatively influencing employees’ normative conflict.Hypothesis 8: Ethical leadership inhibits CID by negatively influencing employees’ normative conflict.Hypothesis 9: Compared with CID, ethical leadership has a stronger inhibitive effect on COD through normative conflict.Based on the above analysis, the theoretical model of this study is shown in The samples for this study came from 30 enterprises in Liaoning, Beijing, and Zhejiang of China, mainly including construction, banking, information technology and other industries. Based on the preliminary research of the research group, this study selected 19 Liaoning local enterprises that had pleasant cooperation experiences as the investigated enterprises. In addition, in order to increase the sample size and reduce the impact of regional differences, the research group contacted 11 enterprises located in Beijing, Zhejiang through alumni relations. With the support of the enterprise’s leader, the research group contacted the human resources department and asked for the name list of the grass-roots staff (including name only). The research group set an appropriate sampling ratio according to the size of the company, and selected the sample frame of this study according to the principle of random sampling including a total of 561 respondents. In order to ensure the quality of the questionnaire, a preliminary survey was conducted before the formal survey, and the wording and presentation of some questions in the questionnaire were adjusted appropriately according to the results of the preliminary survey. Questionnaires were collected anonymously, and the researchers highly emphasized the confidentiality of data. In order to ensure the sample size is sufficient, questionnaires were collected online and offline and lasted for about 2 months from the beginning of September 2021 to the end of October 2021. First of all, the research group sent questionnaires to some local enterprises in Liaoning province on the spot, and collected 347 paper questionnaires on the spot after the questions were answered. Second, team members contacted enterprise managers in Beijing, and Zhejiang, with the consent of the manager, the research group entrusted them to distribute the electronic questionnaire to their subordinates through online social networking tools . In order to improve the quality of the electronic questionnaire and the participants’ enthusiasm, every participant can be rewarded with petty cash after check. As a result, a total of 212 electronic questionnaires were collected. Finally, a total of 449 valid questionnaires were obtained with an effective recovery rate of 80.3% after screening the 559 collected questionnaires  The basic situation of valid samples is as follows: the proportion of females is slightly higher than that of males, accounting for 52.8%; the age was mainly 36–45 years old, accounting for 56.1%; most of them were married, accounting for 53.5%. Most of them had a bachelor degree, accounting for 72.4%; 69.3% of them have worked for less than 3 years and 3–5 years. Demographic characteristics are described in In order to ensure the reliability and validity of the scale, all the scales in this research are mature scales published in journals and verified by many empirical studies in the Chinese context. In addition, this research strictly followed the “translation-back” procedure and invited experts to review the translated scale, so as to ensure that the Chinese scale could accurately restore the meaning of the original English scale . The LikThe measurement of this variable adopts the scale developed by This variable is measured by the scale developed by This variable was measured by a 6 items scale developed by The measurement of this variable adopts the 8 items scale developed by Referring to previous studies , demograr = 0.133, p < 0.01), CID , and organizational identification . It is negatively correlated with the normative conflict . Organizational identification is positively correlated with COD  and CID . Normative conflict is positively correlated with COD  and is no significant correlation with CID due to the possible masking effect  test were used to test the possible common method bias. First of all, Harman single factor test’s result shows that the first factor explained 27.9%, below the recommended threshold of 40%, so there was no significant common method bias . HoweverFirst, in this research, all the scales are mature scales published in foreign journals and verified by many empirical studies in the Chinese context, thus, the content validity was good. Second, the AVE and CR of all variables are calculated, and the results are shown in The Structural equation model was used to test the relationship between latent variables in this study. Specifically, this research used AMOS 26 and conducted 5,000 bootstrapping samplings to examine the path coefficients, mediating effects, and total effects among variables. The path coefficients are shown in This study uses the same method to test the mediating role of organizational identification and normative conflict. As shown in This research discusses the double-edged sword effect of ethical leadership on constructive deviance, and responds to the previous researchers’ call to further explore the antecedents of constructive deviance from the perspective of ethics . In addiIn addition, this research examines the mediating role of organizational identification and normative conflict between ethical leadership and constructive deviance. However, the analysis results show that organizational identification has no significant mediating effect between ethical leadership and COD, which is inconsistent with hypothesis 4 of this research. However, such a result is not surprising. Traditional social identity studies believed that individuals with high organizational identification are usually the maintainers of organizational norms, and for them, the benefits brought by engaging in constructive deviance may be far less than the costs of breaking formal organizational norms. On the one hand, What is more, the negative mediating effect of normative conflict in this research is masked by the direct effect of ethical leadership on constructive deviance, but this does not mean that the mediating effect of normative conflict is worthless. First of all, as above, ethical leadership has a screening effect on constructive deviance, and can raise the threshold of the employee deviance by setting the violation cost and screen of irrational constructive deviance, thus improving the overall quality of staff constructive deviance, it conforms to the claims of the present study, namely the negative effect of ethical leadership on the constructive deviance of employees is actually a positive screening effect, rather than knocking down all of them. Secondly, In summary, based on the normative conflict model, this study proposes a dual-pathway model that is constituted of organizational identification and normative conflict, and examines the double-edged sword effect of ethical leadership on subordinates’ constructive deviance. Specifically, ethical leadership stimulates employees’ constructive intention by improving their organizational identification and weakening employees’ normative conflict, restraining their deviant motivation, then realizing the double-edged sword effect on constructive deviance. In general, the overall effect of ethical leadership on employee constructive deviance is positive, and the positive effect of ethical leadership on CID is significantly higher than that of COD.First, this research examines the double-edged sword effect of ethical leadership on constructive deviance, providing a new idea for previous studies on the impact of ethical leadership on constructive deviance from a positive or negative perspective . In receSecondly, the normative conflict model is revised reasonably in this research. The core hypothesis of the normative conflict model is that normative conflict moderates the relationship between organizational identification and member dissent, that is, normative conflict is the boundary condition of the relationship between organizational identification and member dissent . This reThirdly, this research confirms the explanatory power of the normative conflict model between leadership style and constructive deviance, and provides a new theoretical perspective for the formation mechanism of constructive deviance. In recent years, researchers have gradually begun to focus on the negative effects of constructive deviance, but most of them attribute the negative effects to the defects of constructive deviance, ignoring the quality problems caused by the behavior’s initiator with the low level of competence. To exert the effectiveness of constructive deviance, it is necessary not only to encourage employees to engage in constructive deviance, but also to screen out irrational and low-quality constructive deviance. On the one hand, the analysis results show that ethical leadership can stimulate the constructive motivation of employees by improving their organizational identification, and on the other hand, it can weaken the normative conflict of employees and inhibit their deviant motivation, so as to realize the double-edge sword effect on the constructive deviance. This conclusion is helpful to understand the formation mechanism of constructive deviance more comprehensively.Finally, this research further explores the impact of ethical leadership on different types of constructive deviance. Compared with other positive leadership, ethical leadership pays more attention to employees’ compliance with organizational standards and normative expectations . TherefoFirstly, this study provides practical guidance for organizations to deal with the double-edged sword effects of constructive deviance. In most cases, constructive deviance helps to improve employees’ innovation and organizational competitiveness . HoweverSecondly, ethical leadership should not be regarded as the opposite of organizational innovation. In recent years, with the deeper excavation of ethical leadership, more and more scholars proposed that ethical leadership’s excessive attention on organizational norms will hinder the development of organizational innovation . In factFinally, this study suggests that organizations should pay attention to the cultivation of employees’ organizational identification, and give appropriate guidance according to the actual situation of the organization. Employees with high organizational identification do not always follow regulations, and sometimes choose to break organizational norms for the benefit of the organization , some emFirst of all, this study is a cross-sectional study in nature and cannot deduce the causal relationship between the variables studied. Therefore, future studies can conduct experimental study confirm the causal direction of the proposed model and test the robustness of the conclusions in this study. In addition, future research can also adopt qualitative research, such as case analysis, to further verify the double-edged sword effect of ethical leadership on constructive deviance in practical situations.Secondly, this study only proposes the mechanism of ethical leadership on constructive deviance, and does not further explore the boundary conditions of this model. Although the results of this study show that the formality of norms may be an important factor influencing the relationship between ethical leadership and constructive deviance. However, it is necessary to further explore the boundary conditions of this model. For example, in the context of high collectivism culture like China, ethical leadership’s compliance essence may be further amplified . So futuThird, this study only examines the mediating role of organizational identification and normative conflict between ethical leadership and constructive deviance. However, the significant main effect in the analysis results suggests that there may be other mediating mechanisms between ethical leadership and constructive deviance, the future study can excavate potential mediation mechanisms in light of other theoretical perspectives.Finally, this study theoretically analyzes the double-edged sword effect of ethical leadership on constructive deviance, which can control the number and improve the quality of constructive deviance in the organization, but the research results can only prove the inhibition path of ethical leadership on constructive deviance, and cannot reflect the improvement of its quality. Therefore, future research can use the combination of self-evaluation and superior evaluation to measure employees’ constructive deviance, and take the difference between them as the basis for judging the quality of constructive deviance.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Liaoning Technical University. The patients/participants provided their written informed consent to participate in this study.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This study was supported by the National Natural Science Foundation of China (nos. 52174184 and 51504126), the Department of Education of Liaoning Province (no. LJ2020JCW002), the Department of Education of Liaoning Province (no. L20BGL030), and the Humanities and Social Science Foundation of Ministry of Education of the People’s Republic of China (no. 19YJA630038).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.


Small extracellular vesicles (EVs) in the last 20 years are demonstrated to possess promising properties as potential new drug delivery systems, biomarkers, and therapeutic targets. Moreover, EVs are described to be involved in the most important steps of tumor development and progression including drug resistance. The acquired or intrinsic capacity of cancer cells to resist chemotherapies is one of the greatest obstacles to overcome to improve the prognosis of many patients. EVs are involved in this mechanism by exporting the drugs outside the cells and transferring the drug efflux pumps and miRNAs in recipient cells, in turn inducing drug resistance. In this mini-review, the main mechanisms by which EVs are involved in drug resistance are described, giving a rapid and clear overview of the field to the readers. Extracellular vesicles (EVs) are small cell-released particles with a diameter ranging from 30 to 1,000 nm . In addimembrane debris” sedimented at high-speed centrifugation of plasma supernatant  alteration of drug targets (2), activation of drug pumps, (3) detoxification mechanisms, (4) reduced susceptibility to apoptosis, (5) increased ability to repair DNA damage, and (6) altered proliferation. Also, local modifications of stroma, tumor microenvironment (TME), and local immunity could contribute to the development of resistance . KeepingEfflux pump mechanisms are physiologically important in many processes such as toxin clearance from the gastrointestinal tract, elimination of bile from the hepatocytes, effective functioning of the blood–brain and placental barrier, and the renal excretion of drugs. In drug-resistant tumors, the overexpression of these proteins  allow thEVs could also transfer drug metabolizing enzymes to inactivate drugs. Yang et al. described that the expression of GSTP1 (glutathione S-transferase P1), an enzyme belonging to phase II drug-metabolizing proteins, was higher in doxorubicin-resistant cells and in their EVs, which are capable of transferring the GSTP1 enzyme to sensitive cells . AccordiCell viability could even be enhanced by EVs’ transferring of pro-survival factors like cell surface receptors, miRNAs, and cellular proteins. These cargoes could improve cell viability by decreasing apoptosis and activating proliferative signals –81.Introduction, EVs are involved in cell–cell communication. This mechanism could play a role in the bidirectional crosstalk between tumoral and stromal cells also regarding drug resistance mechanisms. EVs derived from cancer-associated fibroblasts (CAFs) are described to be involved in drug resistance in different types of tumor. In colorectal cancer, EVs derived from CAFs are able to induce chemoresistance to 5-FU and oxaliplatin both in vitro and on patient-derived mouse xenografts  through the transfer of the mRNA of O-6-methylguaninene-DNA methyltransferase (MGMT) by EVs  induce the overexpression of this enzyme in the recipient cells, playing an important role in the cisplatin resistance mediated by EVs in the xenograft model . In this) by EVs . EVs tra) by EVs , 108. InLncRNA delivered by EVs often serves as competing endogenous RNA (ceRNA) to help miRNA in their drug resistance regulatory mechanisms . LncRNAsEVs can be isolated from various types of body fluids including blood, urine, and saliva. It is demonstrated that in the cancer patient population, the amount of EVs present in the blood is more than double compared to healthy individuals , suggestConsidering the importance of EVs in the regulation of chemoresistance, a few drugs were utilized to inhibit their production, release, or action.+-EVs derived from NSCLC through aptamer recognition. NPs, after binding to EVs in the bloodstream, are delivered to the liver and excreted in the intestinal tract to be removed from the organism. It was demonstrated that by employing this system, the in vivo cancer metastatic overgrowth could be reduced (It is described that drug-resistant cancer cells could produce an increased number of EVs than their drug-sensitive counterpart, thus contributing to the spread of resistance , 126–128 reduced .in vitro stage, it is necessary to deeply investigate the roles of EVs in cancer drug resistance for many important aspects.The discovery of new cancer therapies is a stimulating topic that is investigated by a lot of researchers all over the world. The need for new therapeutic approaches is required because of the interpatient variability in terms of drug response, and also the development of drug resistance represents a very hard hurdle to overcome. Drug resistance appears in almost all types of cancer, and the underlying mechanisms are not yet clearly understood. In the last few years, the wide implication of EVs in drug resistance has been investigated, and in this manuscript, the major implications in this process are described and summarized. Although many described experiments are limited to preclinical and often to an in vitro, they could be developed to target different types of malignancies. There is also the possibility of studying artificial EVs for therapeutic employment with the advantage of producing standardized EVs with a defined content to facilitate the transition into a clinical application.First of all, the involvement of EVs in drug resistance and their profiling could be exploited in the clinical approach to define new hallmarks of prognosis of drug response avoiding invasive procedures. On the other hand, as already explained, clarifying the role of EVs on drug resistance could stimulate the development of new anti-cancer strategies based on EVs targeting to revert drug resistance. Most importantly, cancer-released EVs should be deeply characterized, and their peculiar properties should be investigated. In this way, the development of new targeted strategies able to discriminate tumor-derived EVs could be set up. Moreover, the employment of artificial EVs could be considered in order to revert drug sensitivity , 136. EVSP wrote and revised the text. FR and VC conceptualized the work and edit the final version. All authors contributed to the article and approved the submitted version.This research was funded by Italian Ministry of Health – Ricerca Corrente.We thank all the colleagues from “Aviano Centro di Riferimento Oncologico” and from Ca’ Foscari University for the constructive discussions about the topic of the review helping us to develop the final work.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.


The booming development of educational livestreaming platforms has caused the prevalence of user experience to a certain extent, which profoundly affects users' purchase intention and behavior, and has become a hot topic of current research in the online education field. However, there is a lack of in-depth analysis on the mechanism of the role of user experience in influencing purchase intention. Based on the analysis of user experience and psychological ownership, this study constructs a moderated mediation model to investigate the mediating psychological mechanism and boundary conditions of user experience affecting purchase intention. In this study, a valid sample of 372 users was used for structural equation modeling analysis. The results of the study found that user experience not only had a significant positive effect on purchase intention but was also mediated by psychological ownership. We also found that the effect of psychological ownership on purchase intention was moderated by privacy concerns. This study examines the role of user experience in purchase intention and reveals the mechanism of the role of user experience in an educational livestreaming platform. With the rapid development of network technology, educational livestreaming platforms have emerged in large numbers, gradually becoming a new platform for users to learn online, share knowledge, and communicate online, attracting a large number of users  to 7 (strongly agree). The measurement items are shown in The educational livestreaming platform is currently a popular virtual community product with a relatively large user scale and rich product types. Considering the representativeness of the sample collection, users of the most popular Himalaya in China were selected as the research subjects in this study. Himalaya is a mobile client launched in March 2013, more than 2 years mobile user scale has exceeded 200 million, becoming the fastest growing and largest online mobile educational livestreaming platform in China. Two rounds of high financing were completed within 2014 to further lead the Chinese educational livestreaming platform in China. With Himalaya, consumers can upload their work using their fingertips, create a personal live platform dedicated to them, and continue to grow and accumulate fans and stay connected to them. This shows that Himalaya is representative and typical as an educational livestreaming platform.The data collection method was mainly used to obtain the sample data using the web platform provided by the web company “Questionnaire Star” to form an electronic questionnaire, and then the web link of the electronic questionnaire was published in each browser community. In order to improve the efficiency of the questionnaire collection, each user who fills out the questionnaire is given a reward of 5 yuan. The questionnaire survey was conducted from November 2021 to March 2022, and 472 questionnaires were obtained by this method, excluding invalid questionnaires there, forming 372 valid questionnaires. The sample information is shown in This study evaluates and revises the Confirmatory Factor Analysis (CFA) measurement model based on a two-stage model Kline, . CurrentThe results of the discriminant validity analysis are shown in This study used a wide range of methods used in previous structural equation modeling studies to analyze structural model fit. That is, nine goodness-of-fit indicators were analyzed to determine whether the study model has a good fit  has a positive and significant impact on psychological ownership (PO). Therefore, hypothesis 1 is supported. User experience (UE)  has a positive and significant impact on purchase intention (PI). Therefore, hypothesis 2 is supported. Psychological ownership (PO)  has a positive and significant impact on purchase intention (PI). Therefore, hypothesis 3 is supported.The regression coefficients are shown in p-value is < 0.05.The results of the intermediary effect analysis are shown in p-value is <0.05. Therefore, there is a total effect that exists. The indirect effect is 0.303, “0” does not include the bias-corrected 95% confidence interval range, the z-value is >1.96, and the p-value is <0.05. Therefore, there is an indirect effect. The direct effect is 0.243, “0” includes the bias-corrected 95% confidence interval range, the Z-value is >1.96, and the p-value is not <0.05. Therefore, no direct effect exists. Therefore, hypothesis 4 is established and is a partial mediation.The total effect of user experience on purchase intention is 0.546. At the 95% confidence level, “0” does not include the bias-corrected 95% confidence interval range, the z-value is >1.96, and the z = |−3.04| > 1.96, p-value <0.01), implying the presence of a negative moderating effect of privacy concern (PC) on the relationship between psychological ownership (PO) and purchase intention (PI). Specifically, the slope of psychological ownership (PO) on purchase intention (PI) increases negatively by −0.073 units for each 1-unit decrease in the moderating variable privacy concern (PC). That is, privacy concern (PC) has a positive moderating effect. Therefore, hypothesis 5 is verified.The moderating effects are reported in First, the results of the data analysis confirm the role of user experience on purchase intention. The findings are consistent with those of Tan (2019) and Huang and Xu , indicatSecond, the results of the structural equation modeling indicate that user experience has a significant effect on psychological ownership. The findings confirm the positive effect of user experience on psychological ownership, and the findings are consistent with the results of existing studies such as Zhao and Jing  and Yao Third, the results of the structural equation modeling indicate that psychological ownership has a significant effect on purchase intention. The findings confirm the hypothesis that psychological ownership affects purchase intention and are consistent with Ham and Lee  logical Fourth, the results of the data analysis indicate that psychological ownership has a significant effect in mediating the effect of user experience on purchase intention. The results of the study confirm the hypothesis that psychological ownership affects purchase intention and are consistent with the logical reasoning of the existing literature. This suggests that the better the user experience in the educational livestream platform, the more likely the user is to develop psychological ownership of the educational livestream platform and the more likely the user is to develop purchase intention. The reason for this situation may be that in the process of using the educational livestreaming platform, the individual gets not only fun but also a sense of psychological satisfaction and pleasure while gaining user experience. In this process, the stronger the user experience, the more the individual feels that the educational livestreaming platform or a part of the educational livestreaming platform belongs to the individual, and the stronger the sense of psychological possession of the educational livestreaming platform. In this process, the user develops psychological ownership and tends to associate the self with the educational livestreaming platform. Users strengthen their knowledge of the educational livestreaming platform and enhance their love for the educational livestreaming platform through continuous access to information and interaction. In this context, users gradually develop stronger psychological ownership, which in turn increases and stimulates their purchase intention.Fifth, the results of the structural equation modeling indicate that privacy concerns have a significant negative moderating effect on the relationship between psychological ownership and purchase intention. The findings confirm the moderating role of privacy concerns between psychological ownership and purchase intention, and the results are consistent with Yin and Zhang's (2020) logical deduction results. This indicates that the higher the privacy concerns of users on the educational livestreaming platform, the stronger the negative effect of psychological ownership on purchase intention. Although the value created by the educational livestreaming platform can lead individuals to have purchase intention. However, privacy concerns counteract the positive effects of psychological ownership in this process, which in turn counteracts to some extent the facilitative effect of psychological ownership on purchase intention. Thus, as a reflection of the individual's anxiety and concern in the educational livestreaming platform, privacy concerns stimulate a strong sense of responsibility and enhance self-protection. This inevitably hinders individuals' purchase intention, as well as the positive influence of psychological ownership on purchase intention. In addition, the educational livestreaming platform organizes offline gatherings of learners at the right time as a way to enhance the impact of psychological ownership on individual purchase intention, which is a major reason to mitigate the negative moderating effect of privacy concerns.Therefore, privacy concerns negatively moderate the relationship between psychological ownership and purchase intention in educational livestreaming platform.First is enhancing the user experience of individuals in the educational livestream platform. To strengthen the regulatory mechanism in the product content and provide users with reliable and valuable product information, the educational livestreaming platform can place the most valuable posts or those with the highest number of user comments on the product display page to help users understand the product information more accurately and comprehensively. At the same time, the educational livestreaming platform should also delete or filter posts with extreme emotions or unreliable sources in order to improve the quality of information in the platform to achieve consumer satisfaction, which will lead to purchase intention.In addition, users of the educational livestreaming platform are mainly young people who are pursuing mavericks and have higher and higher requirements for personalization of products and services display. The educational livestreaming platform should design the website from enhancing the uniqueness of consumers, so that consumers can feel a more authentic shopping platform. At present, powerful information technology provides technical support for online platform, traditional text information or simple picture display is no longer enough to impress consumers, and 3D display, panoramic mode, and other new ways are emerging day by day. Therefore, the educational livestreaming platform can create the most suitable display method for this product, so that consumers can have an immersive feeling when viewing the educational livestreaming platform, which will increase their curiosity about the educational livestreaming platform and enhance purchase intention. The educational livestreaming platform should take various measures to promote the interactive experience among consumers. For example, the platform takes the initiative to throw out the topic discussion and make different reward policies for members who participate in the discussion, so as to attract consumers to actively participate in the platform discussion and express their views, and enhance user experience by stimulating users' interest.Second is stimulating consumers' psychological ownership of educational livestreaming platform. The research results show that psychological ownership can effectively promote the purchase intention of educational livestreaming platform users, and that psychological ownership of educational livestreaming platform users needs external stimulation to be generated. Ownership requires external stimuli to be generated. Therefore, educational livestreaming platform should take some external measures to stimulate users' psychological ownership to increase consumers' purchase intention. First of all, the educational livestreaming platform should pay attention to the impact of users' self-efficacy on their psychology. For example, the educational livestreaming platform can improve users' skills of using the educational livestreaming platform while increasing users' understanding of the community through online teaching and other means to stimulate users' self-efficacy of control, which in turn promotes users' desire for control and ownership of the community. Then, the educational livestreaming platform should create a warm and pleasant feeling for its members as much as possible. For example, the layout and background music of the educational livestreaming platform create a warm feeling as much as possible to give consumers a sense of intimacy, which in turn leads to a sense of dependence, belonging, and, thus, psychological ownership. Finally, educational livestreaming platform should try to understand the needs of different types of users for products and services, make corresponding policy changes according to the types of users, and promote purchase intention. In addition, educational livestreaming platform should make full use of big data technology to understand and analyze users' past browsing behavior, so as to more accurately recommend products that users are interested in, and recommend to them some experience posts shared by educational livestreaming platform experts on related products, etc. At the same time, it should increase the infectious power to the users, enhance their expectation to become better, improve the associated experience, and promote the purchase intention of the users.Third is care for the core interests of community users and giving them a greater sense of access. The study found that they have different levels of requirements in terms of how much they perceive the educational livestreaming platform caring about their needs or welfare and how much they value their contributions. The higher the privacy concerns, the more credible the educational livestreaming platform is for consumers, the more reliable they perceive the product information, and the more effective it is in reducing the uncertainties arising from the purchase decision process, which reduces the shopping risk and thus promotes consumers' purchase intention. Therefore, it is necessary to propose a strategy for cultivating high privacy concerns from the perspective of educational livestreaming platform. Educational livestreaming platform managers should change the traditional marketing concept, proactively establish the awareness of providing support for educational livestreaming platform consumers, make full use of modern Internet technology for data mining and analysis, effectively differentiate educational livestreaming platform users according to their data mining and analysis by making full use of modern Internet technologies, effectively differentiate educational livestreaming platform users according to the operation process and participation needs of the educational livestreaming platform, and develop supportive policies for different user groups. For example, for new users of educational livestreaming platform, they can develop activities to encourage new users' purchase behavior by giving them a commemorative gift bag or coupons for their first purchase of educational livestreaming platform products, so as to stimulate new users' purchase intention. In addition, consumers should be able to perceive how much the educational livestreaming platform values their contributions. For consumers who can bring benefits to the platform, such as those willing to share goodies and recommend products or services of the educational livestreaming platform in their circle of friends, certain incentive policies should be formulated and corresponding rewards should be given, such as awarding medals and cashback, to guide consumers to pay attention to the future development of the educational livestreaming platform, thus promoting the purchase intention.The present study may have some limitations, and further research can be conducted in the future in the following two aspects. First, in this study, users of the educational livestreaming platform “Himalaya” were selected as the target population, and the sample selection was limited. Future studies may consider selecting more users of other educational livestreaming platforms for validation, in order to enhance the generalizability of the study results. Second, this study focused on the influence of user experience on purchase intention in the context of educational livestreaming platform. The results of this study vary depending on the mediating and moderating variables, and subsequent studies can examine other potential variables, such as personal characteristics and product type, to further enrich the intermediate mechanism of user experience on purchase intention.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.HZ: conceptualization. YZ: formal analysis and investigation. HZ and YZ: writing  and writing (review and editing). All the 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.


To investigate the correlation between TERC gene and cell proliferation and migration of oral squamous cell carcinoma.  By comparing the traditional surgical treatment with the minimally invasive treatment of digital technology, the influence of Shengxin analysis method on the proliferation and migration of oral squamous cell carcinoma cells was analyzed.  Digital technology minimally invasive treatment has a great impact on the operation and survival rate of patients. TERC has a significant impact on the proliferation and migration of oral squamous cell carcinoma cells. Digital technology minimally invasive treatment can prevent TERC from great changes.  TERC under the minimally invasive treatment of digital technology has little effect on the proliferation and migration of oral squamous cell carcinoma cells. It can promote the proliferation of oral squamous cell carcinoma cells. The inhibitors of migration and invasion can play an effective role in antiproliferation. With the improvement of living standards, people's quality of life has also changed. People are also increasingly concerned about health. They will have regular physical examination every year to pay attention to any problems that may occur in their physical functions. However, there are many diseases that cannot be found in the early stage. It is possible that the occurrence of a disease will cause problems in other organs. Today, many cancers cannot be cured. People are suffering from cancer, both physically and at home. With the change of living conditions, people are also pursuing some so-called “game,” in which many bacteria and viruses are eaten into the stomach. What cannot be absorbed by itself will lead to physical problems, such as oral squamous cell carcinoma, which refers to the malignant tumor occurring in the mouth and mainly composed of squamous cells. It is the most malignant and harmful tumor in the head and neck, accounting for 50% of the cases of head and neck squamous cell carcinoma. How does the mode of medical care integration affect oral squamous cell carcinoma? Jia 2022) and others analyzed the impact of integrated management intervention on oral squamous cell carcinoma patients and discussed their oral health, quality of life, and psychological status. The results showed that it could effectively improve their quality of life and psychological enthusiasm and more effectively alleviate patients' anxiety . We can 022 and oThere are about 100000 new oral cancer patients in the world every year. A large number of patients with oral cancer are mainly of high malignancy. The treatment is mainly a combination of surgery, radiotherapy, and chemotherapy. However, the survival rate of patients within 5 years fell to 50%. In this regard, Lin (2022) and others analyzed the value-added of their disease, and the results showed that this research and analysis could inhibit the value-added of cancer cells and promote cell apoptosis . In the 80 patients with oral squamous cell carcinoma treated in our hospital from 2018 to 2022 were selected, including 58 males and 22 females. The age of male patients is 32~68 years old, and the age of female patients is 37~66 years old. Among them, 18 cases were tongue lesions, 22 cases were palate lesions, 11 cases were buccal lesions, 7 cases were floor of mouth lesions, and 22 cases were lesions in other parts.All patients were patients with simple oral squamous cell carcinoma, including oral squamous cell carcinoma caused by different reasons such as heredity, environment, and living habitsAll other organs of all patients have complete structures and are normal after medical examinationAll physical indicators of all patients were normalThose who did not return to the hospital on time were excluded in the observation stagePatients who did not comply with medication were excluded in the observation stageAll patients have no infectious diseases or are allergic to drugs for the treatment of the diseaseOral squamous cell carcinoma is mainly treated by surgery for a wide range of excised lesions. Because of oral squamous cell carcinoma, the main purpose of surgery is functional repair. For example, if squamous lesions occur in tongue or buccal mucosa, they can be directly closed and sutured if they are removed early. For extensive invasion, there must be good repair methods, such as taking the forearm flap or taking the lateral oral flap. When the squamous cell carcinoma develops seriously, it may be necessary to cut off part of the jaw, including the maxilla, mandible, and oropharynx, which will cause the loss of oral function. In this case, more complex repair methods will be used to restore the patient's oral function while removing the lesion.Use digital technology to analyze the precise focus before operation, scan and image the maxillofacial bone, and make a personalized operation plan according to the results. Using minimally invasive surgery, according to the preoperative plan, the squamous cell carcinoma cells in the oral cavity were accurately removed and neck lymph node dissection, and then microsurgical vascular anastomosis and defect repair were performed. In the early stage, there can be no symptoms. With the progression of the tumor, local masses can appear, accompanied by ulceration and easy bleeding. Surgical treatment should be the first choice after the diagnosis of oral cancer. The specific surgical method also needs to be determined according to the size of the tumor, the scope of invasion, and whether there is metastasis in other parts. If there is no metastasis and the focus is small, it can be minimally invasive without sweeping other tissues.Bioinformatics analysis refers to the analysis of biological information, which reflects the state and mode of biological movement. Biological information is mainly biological genetic genes. All kinds of tumors and cancers are diseases that cause cells to stimulate the formation of new organisms due to DNA mutations. With the development of gene sequencing technology, the impact of TERC gene on the proliferation and migration of oral squamous cell carcinoma cells was identified through biological information analysis. The bioscience analysis process is shown in Analyze the data of its cancer patients, input the data into the big data platform, filter and sort out the gene expression data through the big data platform to obtain the available data, screen the TERC gene of its cell cancer, analyze and discuss the impact of TERC on the proliferation and migration of cancer cells after minimally invasive treatment with digital technology, and finally draw a conclusion. This method is not only the fastest but also the most effective treatment method. It can more intuitively carry out a more specific biochemical analysis of oral squamous cell carcinoma cells and have a deeper understanding of the patient's condition, so that the treatment is more conducive to the patient's treatment plan.t-test method is used to compare the differences of data. When t < 10.000, it is considered that there is statistical difference in the data and the significance p value of the statistical data. When p < 0.05, it is considered that the statistical results are credible, and when p < 0.01, it is considered that the statistical results have significant statistical significance.The study set up the conventional surgical treatment group and the digital technology minimally invasive treatment group, the statistical data are different according to the different treatment of patients. According to the statistical information obtained in the above treatment methods, group analysis was carried out to analyze the statistical correlation and corresponding relationship between the data. The statistical software platform is IBM SPSS 24.0 data analysis platform, and the bivariate Oral mucosal epithelium belongs to squamous epithelium. The cancer that occurs in oral mucosal epithelium is called oral squamous cell carcinoma, namely, oral squamous cell carcinoma. Oral squamous cell carcinoma is a common and harmful malignant tumor in the mouth. Now, patients with oral squamous cell carcinoma are treated in groups, and the effects of the two methods on surgical focus location, intraoperative focus clearance, and postoperative recurrence rate are compared. The data are made into As shown in In In normal human cells, telomerase activity is closely regulated. Only in cells that constantly divide and clone can telomerase activity be detected. In this tumor cell, TERC gene expression increased, which indicates that TERC gene plays an important role in this cancer cell. The effects of TERC on cell proliferation and migration under the two methods are analyzed, and It can be seen in At present, the prevalence of cancer is increasing year by year, but there are also many cancers that cannot be cured. Once found, some cancers may be in the late stage of cancer, or even in the middle stage, and the survival rate is low. In this regard, the survival rate of oral cancer must be found earlier and treated in time. It also has a certain relationship with the standardization of treatment. For example, if standardized surgery is carried out and other treatments are followed up, its cure rate can be greatly improved. If it is found late or does not get standardized treatment, and the best treatment time and treatment period are delayed, its survival rate will be reduced by half. In this regard, two different treatment methods were used to compare the survival rates of the same number of patients. The survival rates of 1, 3, and 5 years were compared. t < 10.000 and p < 0.05 between the two comparisons of the data, which was statistically significant. In order to observe the data values in the two different treatment methods more intuitively, In As shown in With the acceleration of the pace of life and the increase of social pressure, more and more people suffer from cancer, and the symptoms are becoming more and more complex. In this regard, Cong (2022) and others talked about the possible mechanism of aspirin inhibiting the proliferation of its cells by inducing apoptosis . At presBased on TERC under digital technology minimally invasive treatment, this study studied the influence of cell proliferation and migration of oral squamous cell carcinoma. Through the comparison of surgical effects and survival rates of patients under different treatment methods, the influence of TERC gene changes on cell proliferation and migration was studied and analyzed. Under the new technology research, the application of digital technology minimally invasive treatment can effectively control and treat its disease. With the rapid development of precision medicine and information technology, digital technology is gradually applied to various fields of medicine, which can promote the development of medicine towards precision and minimally invasive. Improve the accuracy of diagnosis, treatment, and nursing in the treatment process, improve the effect of treatment, and reduce labor intensity. In the digital information age, medicine needs to follow rules and regulations, but also needs innovation and development to obtain more extensive applications. No matter in any field or industry, the impact of digitalization has an inseparable relationship with the development of all walks of life, which is more conducive to the progress of social economy and the rapid development of society.


The following work is based on real-time temperature monitoring during the construction and during the operation of a dam. For this purpose, we have proposed a sensing model named: the “complex wireless sensors model (CWSM)” for measuring the value of different factors like temperature, humidity and pressure on the dam. The installation of the proposed model has been discussed with its wireless networking. The model contains five types of sensors i.e. humidity, temperature, pressure, sun and irradiance sensors for measuring the variation of different factors. The computation modeling of CWSM has been discussed in the paper. 3-D Finite Element method is used for thermal analysis. As the result, it is concluded that the wireless network will be more suitable for measuring and analyzing the effects of temperature, humidity, water pressure and solar radiation on the dam. Because a large proportion of concrete splints are caused by changes in temperature, temperature management is the main strategy for crack prevention . ConsideStress Analysis of Concrete Structures” that are adversely affected by parameter of thermal stress Step 6: Calculate the temperature difference between calculated and measured valuesStep 7: Get output and draw graph for analysisStep 9: End processThe proposed complex wireless sensors model (CWSM) for real time monitoring of dam temperature is suitable model for real time thermal analysis. CWSM will be used for measuring the effect of temperature, humidity and water pressure on the dam. CWSM use different type of super sensor for real time monitoring of temperature. For this purpose Temperature Sensor, Humidity Sensor, Sun Sensor, Pressure Sensor and Solar Irradiance Sensor are used. Following is CWSM algorithm and flow chart for computation and thermal analysis as in CWSM is based on Token Ring with respect to networking topology. The data is collected from all attached sensors for the FEM thermal analysis as showing in 5Real time monitoring of dam temperature is necessary to conduct thermal analysis. Thermal analysis is performed to minimize cracks occurrence in dams. The cracks occur in dam’s body due to thermal changes. During construction and operation phases, temperature effects on dam are studied. For thermal analysis during construction phase, with respect to transfer of heat, heat of hydration, ambient temperature variation and variation of solar radiations and taking into consideration along with other factors along with cooling pipes. Whereas during operation phase, analytical equations are used for temperature and thermal stresses. So the real time temperate measurement is necessary from engineering point of view for the accurate and timely thermal analysis of dam to avoid cracks and complications.Keep in view the importance of real time temperature measurement; this paper presents a complex wireless sensors model (CWSM) for real time monitoring of dam temperature. This proposed model is based on the wireless sensors which will be used for measuring the effect of temperature, humidity and water pressure on the dam. The model is also consisting of the sun sensor for observing the elevation of sun. In complex wireless sensors model installation, all the sensors are installed at specific distance. For example the internal side of dam contains two types of sensor i.e. temperature and pressure. Through these sensors, we want to find the temperature and pressure effects of reservoir on the dam. Similarly, temperature, humidity and solar irradiance sensors are implanted at the top of the dam. The temperature sensors will be used to observe the temperature effects of sun on the dam. Moreover, humidity sensors will be used for humidity effects and sun sensors to measure the sun elevation. After the real time measurement of values, 3-D Finite Element method is used for thermal analysis. As this is a prototype model for real time monitoring of dam temperature. So, the statistical analysis of the proposed model will be done in future research.Jamil Afzal, Zhou Yihong, Usama Afzal, Muhammad Aslam: Conceived and designed the experiment; Performed the experiment; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.This work was supported by the China Three Gorges University Research and Innovation Fund. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Data will be made available on request.The authors declare no conflict of interest.


Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care.Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia.This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach.The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022.The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic.Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769&isReview=trueDERR1-10.2196/35083 Employees working within health care settings are at greater risk of mental health concerns compared with the general public. Health care workers have been found to experience high rates of work-related stress, burnout, depression, anxiety, and suicidal ideation -3. This Recently, an Australian framework, named “Every Doctor, Every Setting,” has been designed to support the mental health and well-being of doctors and medical students . Its guiVarious interventions have been implemented within health care settings to increase empathy and improve patient care, reduce work stress and burnout, and improve staff well-being -8. WhileSchwartz Rounds have been developed by the Schwartz Centre for Compassionate Care as a unique intervention where health care workers can share and reflect on their experiences of the social and emotional aspects of health care . SchwartTo facilitate Hospital staff attendance and participation, the Rounds were designed to follow the Hospital medical rounds structure in that they have a topic, a panel, and an audience; they are conducted monthly (for approximately 1 hour), and usually during the lunch time and with food provided for the participants. The key distinguishing features of the Rounds are that their content is focused on the emotional and social aspects of care rather than the clinical aspects, and that they are open to all staff, clinical and nonclinical. The purpose of the Rounds as an intervention aimed at exploring and sharing the emotional and social challenges of providing care, rather than solving problems or debriefing, is stated at the outset of every Round. The Rounds start with a brief introduction of their history and purpose. This is followed by 2-4 panelists sharing their stories about the emotional aspects of care for about 5 minutes each, and a facilitated, reflective discussion where the participants share their thoughts and reflections on the content heard.There is evidence that the Rounds have a positive impact within hospital and educational settings for staff, patients, and organizations ,12. TheyDespite the considerable evidence regarding the benefits of the Rounds, a recent systematic review has identified that the overall level of evidence is low to moderate with many of the studies lacking methodological rigor . FurtherThe primary study objective is to examine the feasibility of the Rounds in an Australian setting through the assessment of participant feedback provided via postround evaluation surveys and focus groups, Rounds’ attendance, and fidelity.The secondary study objective is to evaluate the impact of Rounds on improving staff well-being, compassionate care, and organizational culture.The research questions we explore within the study are as follows:What are the factors that underpin feasibility of Rounds?What impact does Rounds have on staff well-being, compassionate care, and organizational culture?This prospective pilot study will utilize a mixed methods, uncontrolled, repeated measures design. This design was selected to test the feasibility and preliminary efficacy of the Rounds and inform possible adaptations of their content and structure that may be needed in future larger studies. The study will be conducted in Mater Hospital, an Australian tertiary metropolitan hospital that offers a wide range of medical, surgical, and mental health services for adolescents and adults.As this is a pilot study of Schwartz Rounds in hospital settings, main eligibility criteria for participation in the study will include being employed at Mater Hospital and willingness to participate in all aspects of the study (focus group participation is not mandatory). Members of the research team and planning committee will be excluded from participation in the study to avoid any risk of bias. Participants will include both clinical staff  and nonclinical staff  employed at Mater Hospital.Staff interested in participating in the Rounds will receive an email from the department head that will include the research flyer and the participant information and consent form, and they will be asked to return the signed consent form to the research team via email. Potential participants will be given the opportunity to receive further information and ask questions to the research team regarding the study over the phone or via email. Once consent forms have been received, participants will be sent a link to the online baseline survey to complete prior to commencement of Rounds. The surveys will be distributed by the study research assistant, via email, 1-2 weeks prior to each Round and returned by the day of the Round. Facilitators will meet with the panel members 2-3 weeks prior to each Round, for 1-2 hours, to discuss the topic and familiarize them with the Rounds processes.During the study planning, the research team liaised with several Mater Hospital departments, and based on the staff interest and teams’ needs, selected 2 teams to participate, the intensive care unit (ICU) and the gastroenterology department. The study participants will therefore be recruited in 2 groups, the ICU group and the gastroenterology group, who will complete 3 unit-based Rounds each. The participants will complete a quantitative survey focusing on staff well-being, compassionate care, and organizational culture at baseline, after the Round, and 3 months’ follow-up. They will also complete a short postround feedback form after each Round that incorporates both Likert scale questions and an open-ended comment section. During consenting, participants will be invited to participate in a focus group session to provide detailed feedback on the Rounds. The flow of participants in the study is shown in Each Round will follow the format outlined by the Schwartz Centre . A steerFacilitators will emphasize that the purpose of the Rounds is not to solve organizational problems or clinical management issues, but to provide a psychologically safe space where staff can speak freely about the social and emotional aspects of working within health care settings. Patient and staff confidentiality will be highlighted, and participants will be informed that they are to maintain confidentiality of the content of Rounds. To ensure the privacy and confidentiality of the staff, confidentiality will be discussed at the beginning and closing of each Round as well as in the panelists’ preparatory sessions and focus groups. Each Round will take approximately 1 hour. Facilitators will allow time for participants to ask questions and engage in open discussion, to provide opportunity to reflect on the stories shared, and to discuss their experiences of hearing the stories of their colleagues.The Rounds will be held in-person during lunch or another time suitable for participating staff. Staff will also be invited to participate as Round panelists. A panel of speakers, usually 2-4 staff members from different work areas, will spend a combined 15 minutes presenting a patient story or talking about a topic related to their work. Panelists will have an opportunity to practice their story with the facilitators before the Round is conducted. They will be debriefed after each Round to help achieve closure and identify any immediate feedback or concerns.Immediately after the completion of each Round, participants will be required to complete the Schwartz Centre Evaluation. After each Round, facilitators will complete a brief fidelity checklist and the research team will meet to discuss any immediate feedback. After the completion of 2 Rounds, an online survey link for the postrounds survey will be emailed to participants with a request to be completed within 1-2 weeks. Participants will be asked to complete surveys at baseline, after completing the Rounds, and at 3 months after the Rounds; attend at least two out of three Rounds; and provide immediate postround feedback. In addition, 3 participants per Round will be invited to participate as a panelist and share their stories and experiences in health care, making up the content of the Round.To test the recruitment, delivery, and assessment procedures and inform any necessary adaptations prior to commencement of the study, the research team conducted an in-house pilot Round with the consultation liaison team. The 3 panelists, a psychologist, psychiatrist, and a psychiatric registrar, in discussion with the facilitators, agreed on the Round topic “When compassion is hard to find when caring for patients and their families.” The pilot Round was attended by 21 participants from a variety of nonclinical and clinical disciplines and their feedback on the Round as well as the study procedures was used to fine-tune the recruitment and data entry processes and incorporated in the study protocol. The participants’ feedback was overwhelmingly positive with 100% (21/21) of attendees reporting that the pilot Round gave them new insights into the perspectives and experiences of their co-workers, 86% (18/21) reporting new insights into the perspectives and experiences of their patients, 67% (14/21) reporting feeling better prepared to handle tough or sensitive situations, 76% (16/21) feeling less isolated in their work, and 95% (20/21) stating that they planned to attend future Rounds.Qualitative and quantitative data will be collected by the research team through the self-report questionnaires, Rounds attendance sheets, postround feedback forms, and focus groups transcripts. Data will be deidentified and each participant will be given a number or pseudonym. All deidentified and identifiable data will be stored electronically on REDCap and Griffith University Research Space, where only the research team will have access to the data. All hard copy documents will be stored in a locked cabinet at Griffith University where only those that require direct access will be able to access it. Electronic information will be kept on encrypted devices. All data will be stored for 5 years and then destroyed in compliance with Griffith University and Mater Health policies. Upon study completion, deidentified data will be kept on the Griffith University repository after the final ethics report has been submitted.t tests, chi-square tests (or other suitable nonparametric tests), and analysis of variance will be used to compare survey data across time points and groups. Post hoc analyses will be conducted to compare differences between specific time points.Qualitative data from the open comment section of the standard postround evaluation form and focus groups transcripts will be thematically analyzed by 2 members of the research team . QuantitParticipants will complete an online survey via REDCap at preround, postround, and 3-month follow-ups, which will collect demographic information and measures of staff well-being, compassionate care, and organizational factors. Demographic data will include age, sex, ethnicity, profession, length of time in profession, workload and typical roster, and length of employment at the Hospital.Staff well-being will be measured using the Maslach Burnout Inventory–Human Services Survey (MBI-HHS) . The MBIIn addition to these outcome measures, participants will be asked to complete the standard Schwartz Rounds Evaluation Survey at the end of each Round. This survey includes 10 questions answered with no, yes, or not sure; a question asking the participants to rate the Round overall as either poor, fair, neutral, good, or excellent; a free text question asking the participants to list 2 ways in which the Rounds will change how they related to or communicate with patients or colleagues; and an open comment section. During this session, attendees discussed challenging social and emotional aspects of patient care.Today’s discussion gave me new insights into the perspectives and experiences of my co-workers.Today’s discussion gave me new insights into the perspectives and experiences of patients or families.As a result of this discussion, I feel better prepared to handle tough or sensitive patient situations.As a result of this discussion, I feel less isolated in my work with patients.As a result of this discussion, I feel more open to expressing thoughts, questions, and feelings about patient care with colleagues.I plan to attend Schwartz Center Rounds again.The discussion was well-facilitated.Today’s discussion suggests that changes may be needed in departmental or institutional policies or practices.Today’s program was free of commercial bias.Please rate today’s program overall.List 2 ways in which today’s discussion will change how you relate to or communicate with patients or colleagues (if any):(Example)(Example)Additional comments, including ideas for future topics: Focus groups will be conducted after the completion of the Rounds, to give participants the opportunity to provide detailed feedback on the Rounds. Focus groups will be facilitated by an external member of the research team with prior experience in facilitating groups and adequate knowledge of the topic and the purpose of the group. Conversation openers developed by the research team will be used -16. FocuThe impact of conducting Rounds in the context of COVID-19 challenges was discussed regularly during the study conception and planning. Research team considered the use of virtual Rounds in the planning stage but decided to proceed with the in-person Rounds, in view of the confidentiality and sensitivity and strong participants’ preference for in-person attendance that was indicated after the pilot Round.Rounds planning included considerations of the reduced staff participation due to COVID-19–related quarantine, sick and family leave, low staffing levels on Hospital wards, and difficulties in accessing adequate room space to conduct the Rounds safely in accordance with COVID-19 social distancing requirements. The study COVID-19 risk mitigation plan specifies the personal safety and hygiene measures to be followed by the research team and participants, in compliance with Queensland Government and Mater Health COVID-19 guidelines. The measures include social distancing and may include mask wearing and rescheduling of the Rounds during acute lockdowns, in keeping with the government and organizational directives at the time the Rounds are scheduled.Possible risks to participants include a potential risk of unintended psychological harm to some participants, if they experience emotional distress in response to Rounds content. This risk will be minimized by having 2 researchers (GH and TE) facilitate the Round and 2 members of the research team (JM and AT) attend each Round to focus on participants and monitor for emotional distress. Contact information of the research team will be provided to discuss issues and, an external advisor, experienced in the running of Rounds in Australia, will be engaged in a consultative role. Prior to Rounds, all participants will be given brochures on the Hospital employee assistance program to access counseling and support if needed. In the event of harm occurring through damaged networks with peers or the organization, confidentiality will be emphasized.f), α level of .05, power of 0.80, and correlation among repeated measures of 0.5. Therefore, it is calculated that a total sample size of 24 will be required for the study to be adequately powered to detect a significant difference (P<.05) between the time points. Approximately 10-15 participants will be selected from interested staff, to participate in 2 focus groups. This number of participants will ensure that 5-8 participants will take part in each focus group, in keeping with the recommended size for focus groups, and to ensure an even spread between professions, consistent with previous research recommendations [Participants will be recruited via a convenience sample. The required sample size was calculated using a power calculation for a repeated measures analysis of variance (one group measured across three time points) study using G*Power with effect size of 0.25 .This study was funded by the Griffith University Health Group collaboration grant in October 2020 and approved by the Mater Hospital Human Research Ethics Committee on January 13, 2021. Recruitment commenced in July 2021 and was completed in September 2021. Data collection commenced in July 2021, with projected completion by March 2022. Data analysis will commence in April 2022 and the results are expected to be published in the second half of 2021. The trail has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12621001473853).The key goals of this study are to evaluate the feasibility and efficacy of the Rounds in improving compassionate care, staff well-being, and organizational culture in a tertiary, metropolitan Australian hospital where the cultural background might be different to that of the North American or United Kingdom settings. Although the Rounds are currently being conducted in several other Australian locations, this study is, to our knowledge, the first pilot research study of Schwartz Rounds in Australia.Another important feature of the study is the Rounds delivery during the current COVID-19–related challenges where this type of staff wellness intervention could be crucial in mitigating staff burnout and improving patient care and organizational culture. Furthermore, the implementation of the Rounds in unit-based format may demonstrate the feasibility and benefits of the Rounds in the most acutely affected departments such as the ICU as well as those with secondary overflow and staffing issues such as the gastroenterology department. Unit-based Rounds may also be more acceptable to staff and more likely to enhance teamwork and sense of shared purpose than the hospital-wide Rounds due to their smaller size and more cohesive group composition.The use of the mixed methods, combining qualitative data from 2 different sources with quantitative data from the MBI-HHS, SCCCS, and CoCB-v2, will enhance the methodological rigor of the study and the confidence in its findings. The study findings have the potential to provide novel insights into the factors underpinning the feasibility and efficacy of the Rounds and their mechanism of action, and may inform the refinements of the Rounds in future studies.Key limitations of the study are related to the relatively small sample size and a lack of a control group, which may lead to statistically insignificant findings in some outcome measures and limit the study’s generalizability. However, given the pilot and exploratory nature of the study, its primary role is the assessment of the feasibility of the intervention and study procedures, with qualitative data providing additional valuable insights into these areas.The results of the one-off pilot Round conducted in January 2021 provided a promising early indication of the potential value of Rounds in Australian settings, and during significant COVID-19–related challenges. The study is, to our knowledge, the first to evaluate Schwartz Rounds in a unit-based format during the COVID-19 pandemic and the first to include the departments potentially acutely affected by COVID-19. We anticipate that the results of the study will have a more wide impact as Schwartz Rounds are increasingly being adopted in different health care settings as well as in universities and other educational settings.