Accidents are one of the most important public health concerns because of their high prevalence and considerable health outcomes. Although higher education institutions (HEIs) play an important role in health promotion and disease prevention, accidents are rarely investigated in this setting. Therefore, the aim of the present study was to address this gap by analyzing the frequency and characteristics of employee and student accidents at HEIs in Rhineland-Palatinate, Germany. A dataset of all accidents that happened to employees and students at HEIs in Rhineland-Palatinate from December 2014 to December 2019 and the characteristics of these accidents was provided by the responsible statutory accident insurance . Modified thousand-men quotas (the rate of injuries per 1000 people) were calculated to investigate the differences in frequencies and characteristics of accidents between employees and students, as well as between institutions. A total of 3810 accidents  were reported, of which 426 involved employees and 3384 involved students. The frequency and characteristics of the accidents varied between employees and students, as well as between institutions. Sports programs at HEIs for example imply high risks for unintentional injuries especially for students (as they make up the majority of participants). Other main findings are that medical students, as well as students of subjects including laboratory work, are at a higher risk to experience study-related accidents whereas employees seem to be at a higher risk when working in a technical field. The results call for the development of accident prevention concepts at HEIs and the implementation of interventions in respective institutions and target groups. In German law, the term “accident” is defined as a temporally limited incident that externally affects the body and leads to death or damage to one’s health. Accidents are grouped as either work or commuting accidents. A work accident happens as a result of an insured occupation, whereas a commuting accident happens on an insured person’s direct way to or from their place of occupation . It has As the World Health Organization (WHO) states , injurieAmong other data related to peoples’ health status, health determinants, health care, and accident and injury statistics for the European Union (EU) are collected by the European Health Interview Survey (EHIS) . The datA summary of data on German accidents, such as those that occurred (i) during leisure time (3.9 million), (ii) at home (3.2 million), (iii) at school (1.3 million), (iv) at work (1 million), and (v) in traffic (0.4 million), showed that around 9.37 million accidents happened in Germany in 2015. Almost 24,600 of these resulted in death [Because of their high prevalence and considerable health outcomes, accidents are one of the most important public health concerns . InjurieInstitutions of higher education are settings of public health relevance. Extraordinary situations can be observed there, where two life-worlds exist: those of work and those of study. The interaction of these two groups is highly essential to our future society. The Ottawa Charter for Health Promotion in 1986 emphasized the importance of a supportive environment to enable people to increase control over and improve their health. Therefore, aside from other institutions, HEIs are tasked to create a supportive environment that enables individuals to access information and acquire skills so that they can make healthy life choices . Based oAmong approximately 2.95 million students enrolled at German HEIs (winter term 2020–2021) , a consiRegarding the identification of groups with a higher risk of encountering accidents during their studies, cross-sectional anonymous surveys were carried out among medical undergraduate students at the Charité Berlin in 2009 and 2019 to assess whether they experienced needlestick and sharps injuries. In addition, an analysis of all needlestick and sharps injuries reported to the accident insurer from 2007 to 2010 was performed in one institution. This university is one of Germany’s major medical faculties and was educating more than 7000 undergraduate medical students in 2010. The survey was completed by 2131 students in total. The results showed an injury rate of 21.4% per year , with a rate of underreporting of more than 50%. The study concluded that undergraduate medical students are at a high risk of suffering from needlestick and sharps injuries. It emphasized the importance of using safe instruments and following university instructions to prevent such injuries . A totalThere is a more recent study in one institution of higher education, the Johannes Gutenberg University Mainz (JGU), which is the largest university in Rhineland-Palatine, Germany. The study is the only one to date that uses objective accident data. These data were provided by the Accident Insurance Fund of Rhineland-Palatinate and indicated that there were 1285 study-related accidents among students at the JGU from December 2012 to December 2018. The study also revealed that students in the medical faculty, chemistry faculty, pharmaceutical sciences, and geography and geosciences, as well as students who participate in study-related sports activities, administered by the General University Sports Department had a significantly higher proportion of work accidents in the context of their studies . The other group on which this study focuses is employees at HEIs, who are subdivided into two. The first group consists of science support staff working in the fields of management and technical support. The second consists of employees in the field of science who are in teaching positions . It is iWhile there has been no study that focused on science support staff and their injury rates, a few studies have examined groups of schoolteachers. This might be comparable to the group of employees at HEIs occupying teaching positions. An analysis of accident registration forms, for example, described the workplace accidents involving teaching staff in Rhineland-Palatinate during the academic years of 2012–2013 and 2013–2014 . During To address the above-mentioned knowledge gap, this study aimed to: (i) calculate for the first time the relative overall frequency of accidents involving employees and students at HEIs in Rhineland-Palatinate, Germany; (ii) investigate differences in the relative overall frequency of accidents between employees and students; (iii) examine differences in the relative overall frequency of accidents and the distribution of work and commuting accidents between different HEIs; and (iv) explore the differences between employees and students and further sociodemographic factors in terms of the relative frequency of work and commuting accidents.This information may be useful to determine particular institutions and groups that are at risk, thus helping in the development of health promotion concepts and the implementation of appropriate interventions.The German state of Rhineland-Palatinate has a great variety of HEIs. Consisting of state-run and private universities, as well as extramural research facilities, the higher education landscape of Rhineland-Palatinate covers a wide range of the technical, scientific, and humanistic spectrum . There aIn addition, the state has seven universities of applied sciences: the Bingen Technical University of Applied Sciences, offering degree courses in engineering, information and communications technology, and life sciences; the University of Applied Sciences Kaiserslautern, mainly providing courses in the engineering and science fields; the University of Applied Sciences Koblenz, which has a variety of faculties in the social and technical or administrative departments; the Ludwigshafen University of Business and Society, covering a range of degree programs in the fields of business management, social work, and healthcare; and the University of Applied Sciences Mainz, with its network of three schools of design, engineering, and business. Finally, the Trier University of Applied Sciences, with its three campuses offering diverse educational programs, such as engineering, economics, law, and design environmental studies, and the University of Applied Sciences Worms, with both business administration and technical bachelor’s and master’s study programs, are also universities of applied sciences. Additionally, there is the Catholic University of Applied Sciences Mainz, which offers courses in the fields of social work and social sciences, practical theology, and healthcare and nursing. The dataset for this work was provided by the Accident Insurance Fund of Rhineland-Palatinate . Together with 15 other local accident insurance funds, it makes up the German statutory accident insurance. The German social security system is composed of four obligatory insurances. One of these is the German Statutory Accident Insurance , which ensures that employees, children, and students are insured during their activities at the workplace and their places of education. In the event of a commuting accident or an accident at work resulting in the inability to work, treatment by a doctor, or even death, the institution is required to report the accident to its relevant local accident insurance fund . As the p-values were Bonferroni adjusted if cross tables exceeded a 2 × 2 size, by calculating alpha-values as p = 0.05/number of tests) were calculated. Analyses of variance (ANOVA) were used to assess differences for continuous variables in specific subgroups. Requirements  for the conduction of the respective analysis methods were tested and met. In addition, the mTMQ [The results presented in this paper are mostly descriptive. The total number of accidents and their types (work or commuting accidents) among employees and students at HEIs in Rhineland-Palatinate from December 2014 to December 2019 are presented. The general and specific reasons for the accidents are also differentiated. These characteristics are presented as absolute numbers and relative percentages. To test categorical variables for statistically significant differences, Chi² tests  during this period was added up, multiplied by 1000, and then divided by the average number of employees or students at the institution during the five-year period (denoted as n). N = 3810) = 4.78, p = 0.03. Significant differences were found too between the types of accident and gender , χ²  = 95.80, p < 0.001. The results of an ANOVA revealed no significant differences in the mean values of age at the time of accident  when the type of accident was used to divide into subgroups: F = 1.29, p = 0.26.The total number of reported study-related accidents from December 2014 to December 2019 was 3810. Employees were involved in 426 of these, and the remaining 3384 accidents involved higher education students. As shown in The calculated modified thousand-men quotas (mTMQs) for the different HEIs are shown in Referring to the characteristics of students’ accidents in At the University of Koblenz-Landau, 665 accidents were reported by students from December 2014 to December 2019. For example, work accidents accounted for 61% (n = 403) of these, and the main general reason  was injuries by falling. Two hundred sixty-two (39.0%) of the students’ accidents were reported as commuting related, mostly with the general reason of injuries by a bump or hit . In At Technical University Kaiserslautern, whose data are presented in At the JGU, a total of 771 accidents were reported by students from December 2014 to December 2019. The data is represented in From the data on employees’ accident characteristics, as summarized in At the University of Applied Sciences Trier, a total of 18 accidents were reported by employees from December 2014 to December 2019. Work accidents accounted for 72.2% (n = 13) of these, and the main general reason  was injuries by a bump or hit .At the University of Applied Sciences Kaiserslautern, a total of 13 accidents were reported by employees from December 2014 to December 2019. Work accidents accounted for 53.8% (n = 7) of these, and the main general reason was being injured by physical, chemical, or biological impact . All these cases involved damage through hazardous substances . Another three of the reported work accidents (42.9%) occurred because of a mechanical impact. Of the work accidents at the University of Applied Sciences Kaiserslautern, 14.2% (n = 1) were reported as injured by falling, specifically an employee who twisted their ankle. A total of 46.2% (n = 6) were commuting accidents, and 50.0% (n = 3) of these were classified as injured by falling. Three employees (50.0%) were involved in commuting accidents because of injuries by a bump or hit; more precisely, they collided with someone or something.p-values to counter effects of type I error accumulation) for type of accident (work vs. commuting) and institutions showed that significant differences in type of accidents were only found at the Johannes Gutenberg University Mainz and the University of Applied Sciences Kaiserslautern.A Chi² Test (2 × 13 matrix with Bonferroni adjusted This study aimed to gain more information about the relatively understudied topic of accidents (injuries) reported among adult employees and students in higher education institutions (HEIs). In particular, this was done by calculating for the first time the relative overall frequency of accidents involving employees and students at HEIs in Rhineland-Palatinate, Germany, to investigate the differences between the two groups. Another aim was to examine the relative overall frequency of accidents and the distribution of work and commuting accidents between different HEIs, as well as between their employees and students. This study used data on accidents provided by the Accident Insurance Fund of Rhineland-Palatinate , through which we calculated the modified thousand-men quota (mTMQ) for the different HEIs and their groups of employees and students.In general, we can say that more accidents involving students have been reported than accidents involving employees. However, we believe that this result is only consequential, as the total number of students at the HEIs covered in the present paper is always higher than the total number of employees. Furthermore, there were slightly more women than men involved in study-related accidents. The percentage of women at HEIs has increased over the last few years  , and theNevertheless, we could also call into question whether women might be at a greater risk, as our study showed that females had a significantly higher risk to experience commuting accidents. While several studies of unintentional injuries in children and adolescents reveal boys to suffer unintentional injuries more frequently than girls do ,27, therAnother noteworthy result regarding the socio-demographic variables might be that the age range of employees and students is not as far apart as one might have expected. A reason could be that many students have part-time jobs at the university, such as helping out at the library or doing research for their faculty. However, with a mean age of 37.7 years, the employee group might still cover mostly full-time staff. Regarding the age range of students going up to 55 years, mature students needed to be considered as well. Although they represent a minority in the student group, they might usually have more life and work experiences and more qualifications than adolescents, which might be a possible explanation for this collective to be less at risk of suffering study-related accidents. However, our study could not show a significant association between age and the type of accident. Further investigation needs to be done concerning the issue of mature students. However, as in terms of age, the collective of employees might be more representative for the collective of mature students, certain arguments for their risk to be higher than those of younger might apply as well. One example could be age as a risk factor for falls and falls with serious outcomes on ones’ health  and the JGU (279 of 660 work accidents within the five-year period presented), respectively. The second leading reason for work accidents at two of the institutions was injuries by a bump or hit , which were also the third leading reason for work accidents at the JGU . Regarding the more specific reasons for accidents  and based as well on the accident descriptions (included in the dataset provided but not further encoded and thus not further mentioned elsewhere), we can conclude that the majority of these work accidents happened in the context of HEIs’ sports programs. This conclusion is supported by the results of previous studies based on student surveys ,14. ThesThese results might be helpful as a guide for prevention programs focusing on certain sports and for ensuring that participants have a full understanding of the sport and its dangers. As sports programs at universities are normally provided per semester, students at HEIs are given the chance to try out new and different types of sports. This also implies the risk of rather careless behavior; one might not focus much on a sport’s safety instructions, as opposed to one who has been engaged with the sport for years, as they only intend to practice for half a year. It would be important for the prevention initiatives of HEI sports programs to tackle this problem and create awareness of safety between experienced and non-experienced sportsmen. The second leading cause of work accidents at the JGU was injuries by mechanical impact. For the two other HEIs discussed, it was the third leading cause of work accidents. The JGU is the only institution of the three that provides medical education, which apparently implies a higher risk of students suffering from needlestick injuries (NSIs). Previous studies have identified medical students as a group with a higher risk, similar to an anonymous electronic survey among surgical personnel, which showed that 22% of all surveyed medical students had a history of NSIs . Comparable results were observed in a study of study-related work and commuting accidents among students at the JGU, revealing that medical students have an increased risk for study-related work accidents. Almost three quarters of all accidents that occurred among medical students were NSIs . AnotherInjuries by mechanical impact do not occur to medical students only; they also have a high prevalence at HEIs that do not offer medical education. Therefore, we need to identify other student groups at risk. Regarding the educational programs at the University of Koblenz-Landau and Technical University Kaiserslautern (as well as at the JGU), subjects in the fields of chemistry, pharmaceutical sciences, geography, and geosciences are also offered. Evidently, part of the studies in these disciplines takes place in the lab and partially includes working with sharp objects, such as syringes or objects made of glass that are prone to break easily. This might explain the higher prevalence of injuries caused by mechanical impact. Furthermore, injuries by physical, chemical, or biological impact are common causes of accidents in the lab as a working environment. The accidents reported at the JGU and Technical University Kaiserslautern support this finding, with the discussed injuries being the fourth most common reason for work accidents. The main reasons for injuries by physical, chemical, or biological impact were damage through hazardous substances and burning oneself. Labs in academic settings were assessed in 1986 as having higher accident rates than others ,34. HoweThe above results should be a call to take action toward limiting these types of injuries. Increasing safety awareness in this context is important. Taking safety steps before starting to work and experiment, such as using appropriate containers and inspecting glassware to ensure that it is not cracked or broken, can have a major impact on the prevention of lab accidents. Support and teaching staff need to stress the importance of safe work and encourage students to refresh their knowledge of safety rules regularly. A similar conclusion was drawn by Walters et al. (2017); there is a need to improve awareness of chemical laboratory safety among students; further education and training on this should be part of students’ studies .In total, work accidents have been reported twice as often as commuting accidents, especially in HEIs mainly offering programs in the engineering and scientific fields. The wide field of engineering, for example, means working with different types of machines, which might increase the risk of work accidents. This profile is consistent with the occurrence of almost a third of all work accidents at the University of Applied Sciences Trier classified as injuries by mechanical impact or by physical, chemical, or biological impact. For the University of Applied Sciences Kaiserslautern, these categories accounted for six out of all seven employees’ work accidents. Our results show that there is a significant association between the person group (employees vs. students) and the type of accident (commuting vs. work), revealing that significantly more employees experienced a work accident.However, why do employees at the mentioned HEIs seem to be more at risk for work accidents? In the higher education context, it is possible that the theoretical part of learning and teaching sometimes outweighs the practical part; teaching staff might not be able to keep up with practice as much as other employees, who focus more on practice and have a relevant background. This study thus suggests a need to promote regular training and provide information on how to create a safe working environment, which could also serve as a good role model for students striving to work in the same field later in their career.Employees injured by falling also accounted for a major part of the work accidents in the accident reports of all three HEIs. Falls can result in fractures and other injuries, disability, and fear, and they can trigger a decline in physical function and loss of autonomy . AccordiIn addition to injuries by falling, the commuting accidents of employees at the German University of Administrative Sciences Speyer, the University of Applied Sciences Trier, and the University of Applied Sciences Kaiserslautern often involved injuries by a bump or hit. More specifically, employees suffered from these accidents by colliding with someone or something. We can see comparable results with the students. The most common causes of commuting accidents for students were injuries by falling and by bumps or hits as well. In addition to that, we were able to reveal students to have a significantly higher risk for experiencing commuting accidents. We can discuss whether students might be showing a less careful behavior in the context of commuting as they feel experienced and secure in the context of cycling or driving (this will be further discussed in the paragraph below). In contrast to that, students might behave more careful in the context of their study work as they are probably not as experienced and therefore more consequently following safety instructions.In our dataset, there was no particular coding of whether the commuting accidents were traffic-related or involved other reasons. A similar study on study-related accidents at the JGU revealed that more than 40% of commuting accidents were cycling related . As thisClearly, the prevention of bicycle accidents is important to reduce physical injuries and possibly serious injuries of the individuals concerned. A review of the medical records of patients with cycling-related injuries who were admitted to Sørlandet Hospital in Kristiansand (Norway) between 2012 and 2014 showed, among other things, that fractures and minor head injuries were most frequent. A total of 10% of cycling-related injuries reported were considered severe and critical for the adult group, with four adults showing significant sequelae after 12 months . Such a Preventing bicycle accidents is not only necessary to maintain people’s health but also to prevent the subsequent burden of medical costs. A Belgian study about minor accidents by bike  that used several electronic surveys analyzed the economic costs of 118 accidents. On average, EUR 841 was the estimated total economic cost, with 48% of the amount resulting from productivity loss. Furthermore, 27% of the total costs were intangible, representing an important burden related to minor bicycle accidents . PossiblAs bicycles are not the only relevant means of transportation, expanding the field of commuting accidents  might be helpful regarding prevention programs within the context of HEIs.A probably much larger number of commuting accidents than those caused by skateboards occur by driving. Multiple studies on car accidents involving young drivers, just like our group of students at HEIs, have been conducted. One British retrospective longitudinal study identified the factors contributing to crashes, such as challenging driving conditions, risk-taking behaviors, and inexperience. In particular, the combination of these factors has a major impact on young drivers’ accidents. For example, slippery roads because of poor weather are great risks to young drivers who are inexperienced and are likely to exceed the recommended speed .However, as this study focused on not only students but also employees who were involved in car accidents, more risk factors could be identified in commuting accidents and in the context of HEIs.The most important limitation of this study was the potential lack of reporting. The individuals involved in accidents might not go to the doctor at all after an accident, thinking that it is unnecessary and that they can treat their injuries by themselves. They might not know about the need for doctors to document such accidents and injuries for their cases to be classified as study or work related, as well as about the need for doctors to report the incident to the responsible local accident insurance funds. When at work or when studying at HEIs, employees and students, respectively, are more likely to be in contact with professional support and other staff who know about the reporting of cases. Therefore, we can assume that the accurate number of accidents, especially of commuting-related ones, was underestimated in the present study. Another limitation was the comparison of accident rates between employees and students, as their total numbers differed substantially. Having a look at In the present study, the aim was to address the gap of examination of work and commuting accidents in the context of higher education institutions (HEIs). The complete and objective accident data provided by the Accident Insurance Fund of Rhineland-Palatinate, Germany, helped identifying certain settings creating a higher risk for employees or students to suffer an accident. Sporting accidents are the major cause for work accidents among students, but also needlestick injuries (NSIs) and laboratory accidents  are important causes of injuries at HEIs, whereas employees could be identified to be at a higher risk when working in the field of engineering. For both parties, traffic-related commuting accidents played an important role. This evidence-based identification of potential risk groups is important as a guide for programs more individualized programs of health promotion at HEIs, making them more effective.


As the COVID-19 pandemic has shown, setting up studies in time to gather relevant, real-world data enables researchers to capture current views and experiences, focus on practicalities on the ground, and deliver actionable results. Delivering high quality rapid studies in healthcare poses several challenges even in non-emergency situations. There is an expanding literature discussing benefits and challenges of conducting rapid research, yet there are relatively few examples related to methodological dilemmas and decisions that researchers may face when conducting rapid studies. In rapidly-changing emergency contexts, some of these challenges may be more easily overcome, while others may be unique to the emergency, magnified, or emerge in different ways. In this manuscript, we discuss our reflections and lessons learnt across the research process when conducting rapid qualitative interview studies in the context of a healthcare emergency, focusing on methodological issues. By this we mean the challenging considerations and pragmatic choices we made, and their downstream impacts, that shaped our studies. We draw on our extensive combined experience of delivering several projects during the COVID-19 pandemic in both single and multi-country settings, where we implemented rapid studies, or rapidly adapted an existing study. In the context of these studies, we discuss two main considerations, with a particular focus on the complexities, multiple facets, and trade-offs involved in: (i) team-based approaches to qualitative studies; and (ii) timely and rapid data collection, analysis and dissemination. We contribute a transparent discussion of these issues, describing them, what helped us to deal with them, and which issues have been difficult to overcome. We situate our discussion of arising issues in relation to existing literature, to offer broader recommendations while also identifying gaps in current understandings of how to deal with these methodological challenges. We thus identify key considerations, lessons, and possibilities for researchers implementing rapid studies in healthcare emergencies and beyond. We aim to promote transparency in reporting, assist other researchers in making informed choices, and consequently contribute to the development of the rapid qualitative research. The field of rapid qualitative research has a long-standing history in social sciences  the COVID-19 pandemic. Throughout the process of data collection, analysis, and writing up these studies (between April 2020 and December 2021), all authors met on a regular basis to discuss their reflections on methodological choices within, and between study teams. These meetings provided the groundwork for this manuscript, as they allowed us to reflect on methodological dilemmas in each study. With time, the meetings enabled cross-study reflections and more theoretically-informed discussions around the suitability and feasibility of using rapid methods in our studies at the time and in the future, leading us to identify key points of comparison and learning. We further interrogated our understandings through repeated rounds of writing and reviewing related manuscripts. As our discussions and meetings continued, we identified a number of challenges and issues. Two issues were particularly important to our studies, which related to two of four commonly described features of rapid qualitative research, namely the process of implementing a team-based approach and ensuring rapid data collection . This interdisciplinary collaboration provided much-needed breadth in perspectives on the health crisis, enabling us to identify unique insights and speak to wider audiences. Further, collaborating across institutions meant pooling resources and expertise, and established important new links and relationships. This also enabled producing different types of outputs, including academic journal articles, written evidence submissions to public inquiries, and disseminating findings to policymakers. Nevertheless, our newly-formed interdisciplinary and inter-institutional collaboration also posed some challenges. For example, the rapid and urgent nature of this study meant that, in the initial stages, there was little time for the team to come together to fully figure out how to leverage the benefits of interdisciplinary working more fully, which was consolidated more as the study progressed.Second, an important part of the team readiness is whether the wider  infrastructure supports the rapid set-up of studies, with ethical approvals being a key element. For example, in the STEP-UP and SCIENTIST studies, we applied for ethics approvals to amend existing study protocols to address additional research questions and include additional participants. As opposed to designing and approving a completely new study, adapting an existing study enabled a quicker study set-up, participant recruitment, and utilized the resources that were already in place . In contrast, in the RECOVER-QUAL study, we were able to obtain very rapid ethical approval in some countries but the time to obtain local approvals varied considerably (7–67 days).Finally, the expertise of team members in terms of qualitative methods is important. In four of our studies, data collection was done by experienced qualitative researchers who each had expertise in conducting interviews with various participant groups. For these projects, we therefore did not often face the task of having to train junior researchers in the basic principles of qualitative research. However, in the RECOVER-QUAL and HOUSEHOLD studies, data collection was shared between interviewers from different countries. Each country led their own data collection, but with the same topic guide being implemented. Due to time pressures, the RECOVER-QUAL core research team prioritized training to all interviewers which focused on understanding the study aims and the topic guide, rather than how to conduct interviews. However, this was complemented by on-demand support for each, depending how much experience they had previously had with qualitative research. In the HOUSEHOLD study, we had one senior colleague providing significant hands-on support and training to an inexperienced qualitative researcher, both in relation to the study aims and the interviewing technique. This was challenging given the tight timelines for the study but the one-on-one training was personalized to meet the needs of the less experienced researcher.In contrast, across the majority of studies we had limited opportunity to involve other researchers, including more junior colleagues. We therefore did not have a chance to share the workload or speed up the data collection process. This was mainly related to how our research team, consisting of a few experienced qualitative researchers, operated before the pandemic.rapid qualitative methods. Rapid approaches were determined by the research questions being answered and, as such, we learned more about them through training, engagement with literature and extensive experience when conducting the studies. This involved not only learning the practicalities of conducting rapid data collection or analysis, but also being pushed to quickly examine our own assumptions of whether we believed rapid techniques were credible to us. While for some of the studies, wider study teams included members who have used rapid approaches before, we were not able to fully benefit from their expertise because of rapid timelines. Applying a rapid approach became easier, or more natural, the more studies we worked on, as we started becoming more confident in making, and assessing the consequences of, methodological decisions.Whilst our study teams had extensive expertise in qualitative methods, we were relatively new to the The fieldwork across all six studies was conducted by teams ranging in size; three studies had the fieldwork conducted by solo researchers, and three studies shared data collection between two or more researchers. In the SCIENTIST, HOUSEHOLD and RECOVER-QUAL studies data collection was shared between two or more interviewers, each conducting interviews in their native language. Sharing data collection had several advantages. First, it allowed sharing workload between the researchers, which in the context of rapid timelines was particularly beneficial. Secondly, using teams in multiple countries allowed us to access participants we would not be able to recruit otherwise. In addition, it enabled us to collect data in participants' native language, thus allowing them to express their thoughts more freely. Thirdly, given the specific context of the COVID-19 pandemic, it was useful to have researchers not only speaking the native language but also understanding the context of each country, specifically relevant COVID-19 policies, current affairs and legislation .via journal articles led by the same researcher.In contrast, in the STEP-UP, FACTS and (vast majority of) “HCP Policy and Experiences” studies data was collected by solo researchers. Having a single researcher collecting data was beneficial in particular for the “HCP Policy and Experiences” study, as it enabled the same researcher to build relationships with participants over time. This was important in retaining participants and collecting consistent data across the course of the study. Given that the researcher knew the participants and data so well, this also facilitated rapid analysis and dissemination of findings One of the strategies used in rapid qualitative research to speed-up the analysis and/or save cost is to not transcribe the audio recordings of interviews or focus groups, and analyse fieldnotes and/or recordings directly. Out of our six studies, the data were fully transcribed in three, not transcribed in two, and partially transcribed in one. The decision to transcribe or not was dependent on the study aims, timescale and resources, and had important downstream impacts on sharing workloads and the kinds of analysis possible.For example, in the SCIENTIST, RECOVER-QUAL and STEP-UP studies we were able to secure the resources to transcribe all interviews and rely on transcription to analyse data. The reasons for transcription were slightly different across these studies; the datasets for the RECOVER-QUAL and STEP-UP studies were always planned to be transcribed as the studies were not initially planned to be rapid. In the STEP-UP study, having all transcripts and interview notes also helped another researcher contribute to the rapid analysis as they could quickly and easily familiarize themselves with and code the data. Conversely, in the SCIENTIST study, once we started collecting the data, it became apparent that transcription would be very beneficial as the research team had limited experience of the study topic and data was richer than we initially expected. Here, having access to transcripts allowed us to get a greater understanding of the issues faced by the participants in a shorter amount of time than if we had only had recordings, while also allowing the in-depth analysis to be achieved more quickly.In the SCIENTIST and RECOVER-QUAL studies, data was charted against a priori categories identified based on the topic guide  to shorten the time needed for the analysis. However, data within each category was then coded inductively line-by-line to create sub-categories, and identify themes while ensuring that our analysis was grounded in data. Prior to transcription both RECOVER-QUAL and the SCIENTIST study collected interview summaries after each interview or batch of interviews. This enabled the research team to access data quickly prior to it being transcribed and translated into English but also enabled each interviewer to highlight key points from interviews to inform analysis from an early stage. Interview summaries were complemented by discussions within the whole research team to allow interviewers to explain the data collected in the context of what was happening with the COVID pandemic in their own country.In contrast, the HOUSEHOLD study was set up from the beginning to rapidly inform policy. Similarly, the FACTS study aimed to provide rapid qualitative results to support quantitative findings. As such, these two studies were the most rapid in our portfolio. Transcription was not carried out and this was seen as crucial in speeding up the analysis and the dissemination of results. This impacted the analysis; after each interview, we charted the data onto an a priori framework, including relevant quotes, and discussed the data with other researchers (if applicable). This was a very structured approach, allowing the team to quickly have an overview of the whole dataset. It was also possible as the studies had clear and contained research questions, with datasets analyzed with this lens in mind. This approach contrasted with the interview summaries collected in the studies above which were unstructured and led by each interviewer identifying what they thought was the key information. We felt that the less-structured initial approach was possible as we could still rely on more “traditional” qualitative analysis as a result of access to the transcripts, while the lack of transcripts in the latter studies “forced” us to be more driven by the pre-existing categories to ensure systematic approach to analysis.Finally, in the “HCP Policy and Experiences” study, notes from all 105 interviews were made by the interviewer summarizing the key points discussed, and case summaries were produced giving an overview of each participants' longitudinal experiences and narrative. Due to resource constraints, only a sub-set (73) of interviews were transcribed. The interviews which were considered particularly important or detailed were selected for transcription. This pragmatic approach had benefits as well as challenges. While transcripts are important, they are not the only source of data in an interview study. Keeping fieldnotes alongside interviews was helpful in capturing aspects of the interviews that were not necessarily captured by transcribing what was said; they also allowed capturing communication occurring before or after the recorder was turned on/off, or through other mediums . On the other hand, the verbatim transcripts provided a detailed record of the content of the interviews, and thus allowed for thematic coding and analysis of the data. Unstructured notes were helpful to inform interpretation, whereas time pressure meant that re-listening to all recordings was often unfeasible. These considerations became particularly pertinent when a new researcher joined the team to conduct further analysis of these data. This second researcher was less familiar with the interviews that were not transcribed, and while the notes helped give a rapid introduction and overview of the dataset, they found the verbatim transcripts particularly helpful. Therefore, when working with transcribed and non-transcribed data, and sharing data analysis with a researcher who did not collect the data themselves, there was a tendency to give more attention to transcribed interviews because they could be more easily coded and quoted.Timely and rapid data collection are two important features of rapid research; data needs to be collected quickly and at informative timepoint(s). We discuss here ways in which timeliness and rapidity became pertinent to our studies.Rapid research is often considered as research conducted within a short time, although the duration of the rapid studies also differs largely. Rather than focusing just on the overall timeline or duration of the study, we found considering the timeliness of the data collection a key and helpful aspect of rapid research. When conducting our studies, we became aware of the multidimensionality of the concept of timeliness. Here we discuss three aspects related to timeliness of data collection: (i) capturing the phenomena of interest in real time; (ii) complexities of mixed-methods studies; and (iii) ever-changing context of pandemics.real time. Although the benefit of “hindsight” can be of particular significance, gathering data as things are happening, rather than retrospectively, has great advantages especially when needed to inform policy and emergency responses. It allows exploration of issues as events unfold, and uniquely captures participants' insights, views, and sense making in the midst of their experiences prior to subsequent reflections and reinterpretations.Perhaps the most obvious dimension of timeliness is whether the data is being collected in a way that allows researchers to capture phenomena of interest in In the RECOVER-QUAL study, we were able to interview HCPs in the first few weeks of the pandemic (the first lockdown). As we were interested in how they were adjusting to the changes in care delivery, they could describe these changes almost as they were happening. Some participants commented how even a week could make a difference in how they felt about the situation, as it was changing very rapidly on the ground. In contrast, we interviewed some participants in later months, but still within the period of the first lockdown. This “delay” was due to ethical approvals taking longer in some countries. These later interviews were slightly different as participants had more time to adjust to the changes in primary care and, importantly, to process what was happening and how they felt about it. This meant that the interviews were to some extent retrospective and participants often described how they felt initially and how they felt at the time of the interview.In addition, the aim of the “HCP Policy and Experiences” study was to explore the experiences of HCPs during the COVID-19 pandemic, and how they changed over time. The first pilot interviews were conducted in February 2020 at the very start of the pandemic in the UK. To rapidly start the study and capture experiences “in real time,” participants were recruited through contacts/networks of the research team members. While this strategy enabled a prompt start and recruitment, recruiting a wider range of participants and purposeful sampling were more difficult. In this longitudinal study, participants were interviewed between 4 and 10 times throughout the first year of the COVID-19 pandemic. Interviews were scheduled depending on participants' availability and the pace of changes in their work , guidelines and the pandemic's impact on healthcare services. This allowed us to collect timely  data, which could identify trajectories of how HCPs' experiences changed over time throughout a rapidly-changing context.In contrast, in our STEP-UP study, we wanted to capture the impact of the pandemic on antibiotic prescribing and stewardship. However, we were reluctant to add burden and additional pressure on HCPs to participate in the study early in the pandemic when clinicians had other priorities. When we conducted the interviews in autumn 2020, we found that HCPs perceived their antibiotic prescribing as elevated early in the pandemic, and then returning to more usual in autumn. Although conducting the interviews later in the pandemic meant that we did not capture the perceived impact in “real time,” we were able to explore HCPs' reflections of the few months at the time when they seemed in a better position to reflect and share their experiences.Mixed methods research often poses challenges in integrating datasets. In the context of rapid research, this alignment between the timeliness of data collection and integrating datasets became even more important. Two of our studies, the FACTS and HOUSEHOLD studies, were qualitative studies conducted alongside quantitative components, thus making timeliness of data collection of the two components closely related.The FACTS study was a cohort study with a qualitative sub-study. The cohort study ran from October 2020 to January 2021, and aimed to examine the feasibility of regular self-testing for SARS-CoV-2 using LFTs in a university setting national public health policies such as those related to testing, quarantine requirements, and models of delivery in and access to primary and secondary care—became central for us to understand in order to interpret participants' experiences.In the HOUSEHOLD study, context became particularly pertinent to timely data collection. Specifically, as the study was conducted in Belgium and the Netherlands, we became acutely aware of the significance of the policy changes relevant to the study aims. Even though the study was being conducted at the same time in the two countries, the COVID-19 restrictions and regulations related to quarantine requirements in both countries were changing rapidly. This influenced interpretations of participants' views on quarantine and infection control measures. As a result, we allocated extra resources to collect data in both countries as closely as possible to each other. We also closely monitored changing guidelines to be ready to consider, albeit often at short notice, what it might mean for the data collection.In the “HCPs Policy and Experiences” study, we faced similar issues, especially as one of the aims of the study was to explore the impact of the changing COVID-19-related policies and guidelines for HCPs. We also included participants from different settings  where policies and practices often differed, and changed frequently, so we had to keep track of a vast number of contextual and policy shifts. We did this through linking policy or guidance documents to international monitoring of key policy and guidelines available online, and keeping a record of guideline documents and announcements ; particularly those related to any changes mentioned by participants in interviews. Although this added a large amount of additional work, this was especially helpful in informing our analysis. We could contextualize our year-long longitudinal data against a policy timeline of relevant guidelines and guideline changes that we constructed from tracking these in real-time.Finally, working with policy colleagues also allowed dissemination of findings in a timely manner, in relation to the ever-changing policy landscape. Therefore, in addition to traditional dissemination channels such as scientific publications, for three of the projects  we worked closely with policy partners to disseminate the findings in the form of policy briefs, summaries, or regular updates to policymakers  and the tempo (intensity) of data collection in tandem, to reflect on what “rapid” meant in our studies.Our studies ranged in timeframes, from days to a few months, with the longest, a longitudinal study, conducted over a year. Drawing on terminology from longitudinal research, we consider the study In our FACTS study, we faced a particularly rapid timeframe, which was planned for only 2 months (December 2020–January 2021). However, the study frame was shortened even more as the study had to pause for 2 weeks when university students and staff went on their Christmas break. This meant that recruitment and data collection had to be particularly condensed which resulted in 18 interviews being conducted across just 13 days, with many instances of interviews being conducted one after another. While we successfully completed data collection within this timeframe, it required significant re-organization of workload within the team related to other studies being conducted at the same time. The data collection and analysis were conducted by one person which put a particular pressure on the timely delivery. A team-based approach to data collection might have been particularly useful here to share this intense fieldwork.In contrast, the SCIENTIST study and the RECOVER-QUAL studies had different timeframes and tempos. The data collection timeframe for the SCIENTIST study was 5 months, with 21 participants. While we collected and analyzed data simultaneously, thus allowing for a rapid dissemination, the tempo of data collection was slower as it largely depended on access to and availability of the participants (scientists working on the COVID-19 advisory boards). Similarly, the RECOVER-QUAL study had a 4-month data collection timeframe, but the tempo of data collection in each country was more intense (2–6 weeks) to reduce diversity in experience within countries.Although a longitudinal design might at first seem contradictory to rapid research, based on our reflections from conducting two longitudinal studies (STEP-UP and “HCP Policy and Experiences” study), we examine how a longer timeframe may be employed together with a more intensive tempo of data collection, analysis and dissemination.The “HCP Policy and Experiences” study was designed from the outset as a longitudinal qualitative study that aimed to follow HCPs over a year and explore how the context  and their experiences changed over time during the pandemic. The value of a longitudinal design is that it allows researchers to explore what changes, or does not change, over time through multiple data collection points with  a smaller sample of participants. The timeframe (in our example—a year) might not as such match the typical shorter timeframes of rapid research. However, the tempo of data collection and analysis was intensified and enabled by using some rapid research techniques. The time for approvals, set-up and recruitment were shortened and intensified  by prioritizing resources and the study for approvals, and by recruiting participants through existing networks. Data collection was also intensified as we started collecting interviews as soon as participants were identified in the early stages of the emerging pandemic, and we arranged frequent interviews (depending on each participant's availability) over the first months of the pandemic when policy changes occurred rapidly. Finally, data was analyzed alongside data collection, with ongoing dissemination of the emerging findings on a weekly basis in the form of updates to policymakers, and preparing academic publications at points throughout data collection.In this manuscript, we described the most salient methodological issues that we faced when setting up and implementing six rapid qualitative studies during the COVID-19 pandemic. As others have highlighted, there is a need to openly discuss methodological choices in rapid research, to promote transparency in reporting, assist other researchers in making informed choices, and consequently move the field forward  for dealing with challenges related to more complex designs. In the field of rapid qualitative research, longer timeframes have been somewhat indirectly discussed in relation to some rapid qualitative approaches such as Rapid Feedback Evaluation or Rapid Cycle Evaluation. These approaches are considered as either having short study timeframes or having longer timeframes with built-in feedback loops/cycles for the continuous sharing of findings . The seven research sites outside of the UK also obtained ethical approval from their local organizations. FACTS—The study was approved by the University of Oxford Research Ethics Committee in October 2020 (CUREC ethics reference R72896/RE001). SCIENTIST—The study received ethical approval from the Ethics Committee of Antwerp University Hospital (20/13/150). HOUSEHOLD—The study received ethical approval from the Medical Ethical Committee Utrecht (NL) and Medical Ethics Committee UZA Antwerp (BE) (Reference number 20-185/D and 20/14/ 177 respectively). STEP-UP—The study was reviewed and approved by the University of Oxford Medical Sciences Inter-Divisional Research Ethics Committee (ref. R59812) and the NHS Health Research Authority (ref. 19/HRA/0434). HCP Policy and Experiences—The study was approved by the University of Oxford's Medical Sciences Interdivisional Research Ethics Committee (ref. R69302). Participants in all studies gave informed consent to participate in the research, and their consent was documented.MW led the writing of the first draft. All authors contributed to writing the first draft of the manuscript. All authors contributed to conception and design of the study, manuscript revision, read, and approved the submitted version.The RECOVER-QUAL, HOUSEHOLD, and SCIENTIST studies were part of the RECOVER (Rapid European COVID-19 Emergency Response research). RECOVER was funded by the EU Horizon 2020 research and innovation program under (Grant Agreement No. 101003589). FACTS study did not receive external funding. STEP-UP study was funded by the Economic and Social Research Council (ESRC) through the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders (Grant No. ES/P008232/1). It was also supported by the NIHR HPRU in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford and Imperial College London in partnership with UK Health Security Agency, the NIHR Oxford Biomedical Research Centre, and the NIHR under the Applied Health Research (ARC) program for North West London. HCP Policy and Experiences study was funded by the UKRI/NIHR 2019 nCoV Rapid Response Call through a grant (Grant No. NIHR200907) which supported AB and CP, with support from the NIHR HPRU in Emerging and Zoonotic Infections at University of Liverpool in partnership with UK Health Security Agency, and in collaboration with Liverpool School of Tropical Medicine and the University of Oxford. ST-C is funded by the NIHR HPRU in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with UK Health Security Agency.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 use of decapods (such as lobsters and crabs) and cephalopods (such as octopuses and cuttlefish) by humans for food, experimentation and education  is on the increase. Growing evidence that these species have feelings and can experience emotions has highlighted the need for a tool to monitor the welfare of these species in captivity. This study adapted a welfare monitoring tool, the Animal Welfare Assessment Grid, that has been successfully used with a variety of mammal and bird species, for use with decapods and cephalopods. This tool was then trialed at a zoological institution  and, for the first time, a public aquarium , with the intention of showing how data collected on invertebrates in a zoological environment can be both efficiently and easily applied to implement positive welfare. This study highlights how evaluating the welfare impact of management processes using animal-based indicators can lead to improved welfare outcomes.Consumer demand for invertebrates is on the rise as their numbers in the wild dwindle. However, with the growing conservation efforts of modern zoos and aquariums, and evidence from over 300 studies showing that invertebrates are capable of sentience, public interest, and moral concern for welfare of invertebrates have increased. The challenge for zoos and aquariums is in developing an objective and repeatable method for evaluating welfare that can be applied to invertebrates in zoological collections. Recently introduced into zoological collection management is the Animal Welfare Assessment Grid (AWAG). The AWAG helps to identify negative and positive welfare states, through assessing animal- and environmental-based indicators to make changes that lead to a better quality of life. Originally developed for the assessment of laboratory primates, the system has been successfully adapted to assess a variety of taxa across different environments, facilitated by the development of cloud-based software. In this study, the AWAG has been adapted to assess the cumulative lifetime experience of captive decapods and cephalopods at two different institutions, Marwell Zoo and National Marine Aquarium. This study has provided further evidence that the AWAG is adaptable and demonstrates the first time any objective scoring system has been successfully adapted for use in invertebrates. Through graphical representation, the results show that the AWAG identifies changes in welfare scores that can be attributed to specific events and can be used to predict the future vulnerability of species to welfare changes and suggest alternative management methods. This monitoring tool provides a versatile method of implementing practical welfare monitoring in zoos and aquariums. There is increasing global awareness of the concept of animal welfare, fueled by social media and resulting in growing public concern as evidenced by the increase in production of meat and dairy alternatives, reduction in the use of fur and leather in fashion, and boycotts of the animal entertainment and tourism industries ,2,3,4. TFollowing Brexit, where all non-human vertebrates and invertebrates lost legal protection previously afforded to them under EU legislation, the UK government proposed the development of an ‘Animal Welfare (Sentience) Bill’ (from now on referred to as ‘The Bill’). Initally, The Bill planned to recognise all non-human vertebrates as sentient, resulting in all new government policies being required to consider vertebrate animal sentience during their development. Sentience is described by Broom  as ‘the Decapod and Cephalopod use by humans, for food, experimentation and education  is on the increase . For exaAnimal welfare has no singular definition, however, it is generally considered to be ‘the state of the animal as perceived by the animal itself, with regards to its attempts to cope with its environment’ , includiThe Animal Welfare Assessment Grid (AWAG), a practical animal welfare monitoring tool based on the Five Domains , has beeCherax quadricarinatus at Marwell Zoo, UK (MZ), comprising approximately 108 individuals (n = 108), an individual shore-crab Carcinus maenas (n = 1) and a squat-lobster Galathea strigosa (n = 1) both housed at National Marine Aquarium, UK (NMA); and two species of cephalopod; a male cuttlefish Sepia officinalis (n = 1) and a female common octopus Octopus vulgaris (n = 1), both housed at NMA  ,33. TherThe cephalopod AWAG includes an alternative factor to ‘Presence of Injury’: observable clinical signs . Clinical signs are defined by observations that require veterinary consultation; any ‘Observable clinical signs’ will be an indicator of negative welfare .Four animal-based factors were created within the psychological parameter class with the aim of assessing behavioural abnormalities: natural behaviour, abnormal behaviour, response to social disruption, and routine management . With liThe risk of contra-specific ‘Social disruption’ is relatively high in zoos/aquariums ,35. ThisSeven factors were assessed within the environmental parameter class: water quality, housing/enclosure, group size, enclosure complexity, nutrition, accessibility, and contingent events . ‘Water ‘Housing/enclosure’ is species-specific, and considers the size of the enclosure, lighting, shelter, drainage, noise levels, and substrate, and how these allow behaviours, group size, and structure to replicate that of the natural environment. An excessive group size limits resources and shelter availability; this can increase aggressive behaviour and competitive exclusion, as shown in crayfish . EnclosuIn the UK the primary purpose of zoos and aquariums is to exhibit and preserve animal life for the purpose of conservation, academia, and public interest . Many ofFive factors were assessed within this parameter class: isolation/restraint, effect of intervention, impact of veterinary procedures, change in daily routine, and sedation/anaesthesia . Apart fThe crayfish at MZ were assessed daily. The shore-crab and cuttlefish were scored daily for 37 days and the squat lobster and common octopus at NMA were scored daily for 36 and 38 days, respectively, throughout the 86-day assessment period. For each species, average daily scores were calculated for all factors within each parameter, using the AWAG software. At the end of each day, the average daily parameter scores were plotted on a radar chart to generate a convex polygon for each day. The area of the convex polygon equated to the cumulative welfare assessment score (CWAS), an overall welfare score. Collectively, the daily CWAS scores were used to present the welfare state over the total trial period. Days on which the assessment was not completed were averaged to show trends in the data.Summaries of the AWAG scores, including how individual parameter scores vary over time, daily radar charts and CWAS graphs over the 86-day trial period for each species are shown below. The increased physical parameter scores shown across both taxa similarly stem from a change in general condition because of presence of an injury . Within the decapods, change in physical condition was attributed to a change in the environment . Within the cephalopods, the octopus showed an increase in the average score of the psychological parameter when the physical parameter was affected. The cuttlefish was affected by all but the procedural parameter.The cumulative welfare scores for each species were plotted against time, as shown in 3 and/or pH levels.The CWAS plotted against time for MZs crayfish showed large variation throughout the entirety of the study . The shore crab also presented considerable variation in CWAS over time . The high scores in the data  correlate with environmental parameter changes (due in most part to housing and enclosure complexity), as the individual was moved from an off-show holding area to on-show display tank, and physical parameters (due to presence of injury). The score then remained elevated.The squat lobster average scores remain close to optimal  with all parameters scoring below 2, the data retain a similar shape throughout the assessment.Scores were taken on 38 days of the trial period for NMA’s common octopus . The AWAG was successfully adapted to monitor the welfare of the invertebrate species observed in the study. This is the first time this system has been used to assess invertebrates and, as far as the authors are aware, the first time any objective welfare scoring system has been successfully adapted for use in invertebrates. This is a significant result given the need to monitor the welfare of those invertebrate species evidenced as sentient and consequently included within the new Animal Welfare (Sentience) Bill.Given the relative paucity of information relating to the needs of invertebrate species to maintain good welfare, the study findings also highlight several key areas relating to the welfare of decapods and cephalopods in captivity. This is well illustrated by how the cumulative welfare score for red-clawed crayfish responds to changes in water quality. The trend produced by the AWAG shows various points where increasing scores (indicating a deterioration in welfare) correlate with deviations in water quality parameters outside of the species preferred range. The sensitivity of crayfish to poor water quality is well documented . The behThese observations and the corresponding change in cumulative welfare score help confirm the validity of using the system for welfare monitoring in this species. These findings also suggest another potential use for the AWAG. Given this example shows the AWAG is capable of detecting changes in welfare due to behaviours observed both in captivity and the wild, it may be possible to use the AWAG as a predictive tool for assessing the welfare of wild animals where parameter values  are known. This would be an interesting area for further investigation.The cumulative welfare score for red-clawed crayfish also reflected changes in group size due to the impact of increased aggression within the group. This aggression was likely to be due to competition over limited resources within the captive environment. This provides valuable information for animal managers to help prevent poor welfare within crayfish colonies. The cumulative welfare score may act as an early indicator of increased competition over resources. Management interventions, such as provision of the lacking resource or reduction in group numbers, can then be made before welfare is significantly compromised. This is also a good example of how the AWAG can be used to assess group welfare and supports the findings of previous studies . When asThe cumulative welfare scores for the shore crab highlighted the importance of the physical environment to decapod welfare. This is reflected in the Housing and Environmental Complexity factors under the Environment parameter in the AWAG. Both factors are scored relative to the resources available and complexity in the wild. The cumulative welfare score shows a significant difference between the shore crab off-show holding facilities and the on-show display tank. This highlights the difference in environmental complexity when comparing on-show and off-show areas. This difference is a frequent finding in zoos and aquaria and often occurs due to a heavy emphasis on functionality (such as ease of cleaning) in the historical design of off-show areas. Improving the interactive complexity of off-show areas should contribute to improving overall welfare . InteresScheel  suggestsSeveral limitations of using the AWAG were noted as a result of the study. The number of cephalopods used in the study is too low to be confident that the system works in all cases. However, the information is included here given its importance due to the lack of data for cephalopod welfare assessment. Next, it was noted that the scoring system assumes that signs of fear in response to an aversive stimulus, in this case moving away or hiding from keepers during routine events, suggests a negative welfare impact, when it may be an indicator of better welfare than those that do not move or hide, possibly because of physical impairment, however in the scores recorded such an impact of physical impairment on behaviour was not seen. Additionally, when monitoring at group level some factors had to be estimated for practical reasons, for example food intake. Finally, care needs to be taken not to assume a direct link between cumulative welfare score and environmental parameters for all species, for example some crayfish are capable of tolerating changes in water quality.As found in previous studies, the findings show that the AWAG can be used in different institutional settings. Although the system has been used in several zoos, the authors believe this is the first trial of the system in a public aquarium. As others have also noted though, the system cannot be used to compare different taxa or institutions due to the difference in factors scored . HoweverTo conclude, this study has shown that the AWAG can be successfully adapted and applied to decapods and cephalopods in zoo and aquaria environments, presenting for the first time an objective scoring system for use in invertebrates. The AWAG can easily identify changes in welfare scores that can be attributed to specific events, thus presenting a practical method of assessing the welfare of invertebrates. The importance of this monitoring tool is that it highlights changes in cumulative welfare trends, providing evidence for prompt management interventions that can promote the positive welfare of species in zoological collections.With invertebrates, insects in particular, being hailed as the ‘food of the future’, and the growing evidence for sentience, it is crucial that we continue to expand our methods for accurately assessing invertebrate welfare.


The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource  used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA. Osteoarthritis (OA) is one of the most common chronic degenerative diseases affecting a wide range of the population, as well as one of the most frequent causes of disability in the elderly. Symptomatic osteoarthritis is estimated to affect, in Italy alone, at least 4 million people, with a public annual cost of approximately EUR 6.5 billion ,2. TotalIn 2019, 118,673 hip replacement surgeries were performed in Italy, and this number is increasing at a rate of approximately 2.7% per year: in 2017 and 2018, the number of surgeries were 112,375 and 115,308, respectively ,5. This In fact, using resources for acquiring important information for the entire activity of healthcare organizations is crucial in the era of value-based healthcare. Tools for management accounting might be regarded helpful for information gathering in the context of healthcare, in order to accomplish this purpose. The costs of medical treatments calculated using Activity Based Costing (ABC) tend to have more accuracy in the computation of resource consumption than standard cost accounting systems, among other techniques of cost calculation or reimbursement, such as Diagnosis-Related Groups (DRG) . FurtherIn addition, the use of the TDABC method estimates the practical capacity  of each element providing capacity (operator and equipment) and the average time required for each element to carry out the action, on the basis of observation, data collection, and questionnaires. The improved process consistency makes TDABC particularly appropriate for the surgical area .This “bottom-up” accounting method makes it possible to identify transparent analyses of the entire care cycle by adding up the individual costs of all the resources used by a single patient .Furthermore, this model allows to redesign the process in order to reduce costs, incorporate new activities in the care cycle, make changes and, above all, it allows to compare the best pathway and offer the patient the best available solution, identifying areas for improvement in terms of time, goods consumed, and the activities carried out.Clinical management, including medical professionals and support employees, would greatly benefit from this development in healthcare since it would make it easier for them to quickly assess a treatment’s efficacy and resources usage. TDABC’s process mapping might reveal which processes offer the most value, if waste can be reduced, and whether resources are being underutilized from the standpoint of redesigning the delivered healthcare process to create high value for the patient. According to numerous authors ,14,15,16A recent systematic review concluded that TDABC can help overcome a key challenge associated with current cost accounting methods and should be gradually incorporated into functional systems .Additionally, the information gathered and the methods used to identify expenses improve the transparency in the business management that enable, as shown by the research by Demeere N. et al. , an inteThe goal of this pilot study is to understand the true cost of a total hip replacement using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint.During 2019 a prospective experimental case study  was condUsing the TDABC, details regarding all the activities, consumables, and participating healthcare professionals were gathered. Seven steps have been methodologically introduced, as is specifically mandatory for the use of this tool , and theAll procedures were performed in accordance with ethical standards, and the study protocol was approved by the Internal Review Board of authors’ affiliated Institution (authorization number 22/2022).(1) Inclusion criteria: patients 60–80 years old, suffering from primary hip arthritis with indication for THA. Patients with concomitant femoral neck fractures, cemented prostheses, intraoperative fractures, or systemic complications  were excluded.To comprehend how patients move through the care cycle and quantify the usage of human resources by activity, a process map for primary hip replacement was created from the entrance in the operating room to the exit (2).Direct observation, interviews, and multidisciplinary care plan validation sessions with frontline personnel were used to build process maps with time estimates for each stage. The necessary resources for each process step (such as staff and consumables like implants) were noted (3).We calculated the overall expenses over a patient’s cycle of care after estimating the cost of providing each service based on the time needed for each resource type (4).The questions performed to the healthcare staff are listed in the (5) The average price stated by the regional fee schedules as compensation for services rendered in pre-hospitalization was used as a reference point to determine the cost of pre-hospitalization exams . The cosFinally, to define the total cost of hip arthroplasty, from the admission to the patient’s discharge, all the calculated expenses  were added up.Ninety patients who met our inclusion criteria were included in this study. The cementless prosthetic implant was the same for each patient and the surgical team was the same for all operations. The average of actions and time spent on these patients made up the process map shown in -Three orthopaedic surgeons (one involved for 55 min and two involved for 39 min);-One anaesthesiologist ;-One nurse dedicated to the anaesthesiologist ;-One surgical nurse (involved 85 min);-One general nurse (involved 85 min).The healthcare delivery process of THA in the hospital analysed involved seven healthcare professions, in particular:The pre-operative tests, including blood tests, chest X-ray, pelvic X-ray, ECG, and anaesthesia evaluation reached a total cost of EUR 90.29 per patient, according to the regional fee.The total cost related to the personnel involved in the THA implantation procedure is EUR 201.34 and it is shown in detail in The cost of the consumables charged for each operation performed by healthcare professionals was grouped by stage, and it represents an expense of EUR 97.02 .The cost of each consumable item is listed in the The final cost of the implanted prosthetic device was EUR 3029.208 according to the regional tender, and it is analysed in The cost of an active operating room used for major hip surgeries, minus material and labour expenses, was calculated by Cinquini et al. , who estThe average inpatient stay was 3.7 days. On 2007, the Italian Ministry of Economy and Finance estimated the average cost of hospitalization to be EUR 674 per day . The finThe total cost of THA from pre-operative tests to discharge is EUR 6002.06. It is presented in detail in The world health system is facing an unprecedented period of change and crisis. The ongoing war in Eastern Europe and the post-COVID crisis have also caused an increase in national healthcare spending, predictably far greater than inflation. This unsustainable health care expenditure has increased the demand for providing high quality care while reducing the costs of delivering these outcomes. The main finding of this pilot study is that the TDABC methodology can also be applied in an Italian public hospital and provides a complete and detailed description of the patient’s path, of the staff involved, and an accurate understanding of the operation costs.The value of health care, defined by health outcomes achieved for every dollar spent , can be An accurate understanding of costs is important for the effective implementation of cost saving strategies. Elective orthopaedic surgeries are often standardized and in order to increase the efficiency of such surgical procedures it is essential to develop process maps for each step of care in the total joint replacement. In this way, we will be able to identify redundancies and welfare inefficiencies, whose financial impact was not previously detectable due to the lack of detailed analysis of the processes obtained with traditional accounting methods. On the other hand, the times and consumables used are certainly different, depending on the surgeon’s background, on the adhesion of the operating team to the most recent evidence-based scientific literature, or to guidelines. It is crucial to point out that regardless of the structure or volume of surgeons, standardization is associated with better processes and outcomes for patients undergoing THA and thus process mapping can also help improve procedures, increase productivity, and raise the number of hip replacement surgeries performed. The mapping of the clinical path, in fact, allows us to understand the connections between the activities, operators, roles, and responsibilities of the care delivery cycle. In addition, this allows service providers to have a better awareness of the costs related to certain services and allows them to evaluate the effects of changes to support systems and procedures.The TDABC has been described by a number of authors as a managerial tool that promotes collaboration between medical professionals and support staff by outlining every step of the value-creation process ,18,19. IOur results agree with the literature showing that the largest and most common direct cost is the purchase price of the implant . This isHaas et al.  recentlyTherefore, with a view to improving the efficiency or comparing costs with other institutes and methodologies, these data highlight the importance of rationalizing purchases and, where possible, reducing hospital stays.While directly decreasing medication and personnel costs may not be feasible, indirectly lowering costs by reducing length of stay must be an area for improvement. It is proven that the common reasons why patients need to stay an extra day in hospital after joint replacement are outdated customs, unscientific fears and, at best, problems related to pain and social support, all potentially responsive to initiatives of quality improvement . StrategFinally, to achieve higher-value care for patients undergoing THA, TDABC costs must be linked to patient experience, quality of life, and functional outcomes, which is the object of our future research. Nevertheless, this study is an important step toward introducing clarity into the cost conundrum of THA and will hopefully stimulate further research into this increasingly important topic.Obviously, this study has limitations. First of all, as a pilot experiment it is a small-scale preliminary observational study undertaken to decide how and whether to start a large-scale project, which could aim at collecting data from multiple institutes in order to integrate and compare the results obtained in a public hospital with those obtainable in a private or university hospital. Secondly, it is important to underline that TDABC does not contain all expenses calculations usually included in a DRG-based reimbursement: it is a method to determine the cost of the process. The object cost is the healthcare delivery process of total hip replacement in the hospital. From this perspective, it may appear that the TDABC process does not fully account for all indirect and THA-related costs , nor time spent caring for the patient outside the hospital, such as medication, rehabilitation, and social support, but it does account for facilities, equipment, information technology, and most other traditional “overhead” costs . In addiTime-Driven Activity-Based Costing provides an accurate assessment of costs in the field of hip replacement. The implementation of this methodology gives us more precise and detailed expense advice, a clear path of the patient, and information on the times and staff involved in each activity.A careful choice of the prosthetic device among the wide range of offers on the market and a premeditated planning of the discharge can drastically reduce the hospital costs of a THA, without cutting staff or medications.


This research aims to explore how work demands and resource variables affect the burnout and satisfaction of employees of family businesses in the context of the pandemic (COVID-19) and the moderation effect of fear of COVID-19 on this relationship. A sample of 214 Chilean family business employees is used for hypotheses testing. Results indicate that the demands and resources partially explain the burnout and satisfaction of employees of family firms during the pandemic. Employees’ fear of COVID-19 moderates the relationship between resources-demands and burnout-job satisfaction in family firms. This work contributes to understanding how these organizations can manage adverse scenarios to survive and continue operations. Job satisfaction and burnout are two related variables that inform about employees’ psychosocial risk and occupational health in the workplace . The mosThe impact of the so-called psychosocial risks on the health of workers and, by extension, the productivity of organizations can be affected by external shocks, such as the case of the health emergency and its social, economic, and political consequences caused by the COVID-19 pandemic .The COVID-19 pandemic has caused an unprecedented economic impact worldwide due to the closure of businesses, the cessation of any non-essential activity, and the reduction of mobility during the different confinements, which has led to the closure of many companies and a large destruction of employment .In this context, the JD-R model has proven to be reliable even under highly stressful scenarios as the COVID-19 pandemic e.g., . HoweverFor this reason, in this research, we aim to respond to the questions of how demands and resources variables affect the level of burnout and satisfaction of employees of family businesses in the context of the pandemic (COVID-19) and how fear of COVID-19 affects the influence of demands and resources variables on the level of burnout and employee satisfaction in family firms.To answer these questions, a partial least squares structural equation analysis (SEM-PLS) was implemented using variables of organizational support, workload, and job insecurity to explain burnout and satisfaction in 214 employees of Chilean family businesses. Data were collected at the peak of the pandemic in Chile in terms of deaths and sanitary restrictions. To determine how fear of COVID-19 affects the relationships in the model, a multigroup analysis (MGA) was performed by grouping individuals into three categories: high, medium, and low, according to their level of fear of the pandemic. The results suggest that the demands and resources model partially support the predictions. Workers’ fear of COVID-19 was also found to have a moderating influence on the relationship between resources-demands and burnout-job satisfaction in family firms.In this way, we contribute to family firm theory by making progress in the understanding of how these organizations can manage adverse scenarios to survive and continue operations . ParticuThis article is organized as follows: The next section provides a discussion of the theoretical framework supporting the hypotheses. Then, the methods section informs the research design as well as data collection and data analysis procedures. Hereafter, results are presented and discussed. Subsequently, findings are discussed in light of previous literature and conclusions are stated. Finally, theoretical contributions and practical implications are presented, and the research limitations are acknowledged.The JD-R model has been shown to be reliable in different settings. Recently When these variables are tested in relation to work satisfaction additional support has been found in relation to the model’s ability to explain occupational health at the workplace. Despite their interest, these models have hardly been considered in the specific context of family businesses, and no study has been observed that analyzes the impact that COVID-19 has had on them.The JDCS and JD-R model has recently been used to test occupational health in highly stressful work environments, proving again to be reliable e.g., . AccordiH1a. Resources (support) reduce the level of burnout of employees in family businesses.H1b. Resources (support) improve job satisfaction of employees in family businesses.H2a. Demands (workload and job insecurity) will have a positive effect on burnout levels of employees in family businesses.H2b. Demands (workload and job insecurity) will have a negative effect on job satisfaction levels of employees in family businesses.With the development of the COVID-19 pandemic, several studies have explored the consequences of this disaster on people’s mental health e.g., . PreviouIn relation to the direct effect, this research agrees that fear of COVID-19 has a negative influence on people’s mental health, level of stress, and generally on people’s mood. Thus, Fear of COVID-19 has also proven to have an indirect effect on variables assessing psychological risk. In this way, Taken together, people have differences in the level of fear of COVID-19, and empirical results in recent research suggest that fear of COVID-19 would have a moderating effect on the relationships proposed by the JD-R model. It supports the following two hypotheses.H3a. Workers’ fear in disaster situations  will have a moderating effect on the role of resources and demands on burnout of employees in family businesses.H3b. Workers’ fear in disaster situations  will have a moderating effect on the role of resources and demands on job satisfaction of employees in family businesses.Data were collected through an online questionnaire applied in January 2021. The questionnaire includes questions about variables of interest, namely: burnout, insecurity, satisfaction, support, workload, and fear of COVID-19, as well as demographic data. The Burnout Assessment Tool (BAT) of 22 items representing the four dimensions of burnout: exhaustion, mental distance, emotional impairment, and cognitive impairment was used to assess the level of burnout . The jobM = 43.29; SD = 11.94), and the number of men (n = 105) and women (n = 109) is balanced. Most of the respondents have a technical or professional higher education degree.The sample contains 214 observations of family business employees from Chile surveyed after 10 month the pandemic in this country. The age of the respondents ranges from 22 to 81 years, with an average of 43  test was used. All constructs have a KMO greater than 0.600; moreover, excepting Workload, the KMO is greater than 0.700, which are considered acceptable . The conA partial least squares structural equation model (SEM-PLS) was used to test the proposed hypotheses, using burnout and satisfaction levels as dependent variables, organizational support as an explanatory variable of resource, and workload and job insecurity as independent variables of demand. To evaluate the moderating effect of fear of COVID-19, a MGA was used considering three subsamples: individuals with high, medium, and low fear of COVID-19 .R2 = 0.412) and Stone-Geisser’s predictive relevance test  indicate that the structural model for the dependent variable burnout is relevant and predictive . It is possible to confirm the significance of both models  are one of their main goals , and COVIn relation to job demands, this study’s results confirm the theoretical predictions that workload and insecurity positively influence burnout, as well as confirming that job insecurity negatively influences job satisfaction. This is in line with previous studies on psychological risk at work e.g., . Job demIn relation to job resources, results provide empirical support to the idea that job support positively influences job satisfaction. Similar to the prediction on job demands, these results reinforce previous literature in relation to the importance of this for an organization to keep psychological risk under control . KarasekIn relation to how fear of COVID-19 affects the influence of demands and resources on burnout and job satisfaction in family firms, overall, the proposed moderating effect is confirmed. It is interesting to see that despite the fact that the whole sample analysis did not provide empirical support to the predicted negative influence of support on burnout, this relationship is confirmed when responses from people with high levels of fear of COVID-19 are analyzed. Similarly, a moderating effect of fear of COVID-19 is also observed for the relationships between insecurity and burnout, support and satisfaction, as well as for the relationship between insecurity and satisfaction. These results are in line with recent research indicating that people are heterogeneous in terms of their level of fear of COVID-19 and that this heterogeneity is important in people’s mental health assessment . This isOverall, the results discussed in the previous section confirm the JR-D model predictions for family business workers facing the shock of the COVID-19 pandemic . This isThis study makes contributions for theory and practice. In terms of theoretical contributions: First, contributions are made to the literature on how family firms face severe external shocks and survive . Family The study also shows the importance of observing workers’ heterogeneity in terms of fear of COVID-19 as it is a driver which can increase or decrease the impact of the resources and demand variables on psychological risk. Finally, this study contributes to the very scant research on Latin American family firms, a region where these organizations are particularly prevalent . Chile wThis article also has important practical implications. Family business owners and managers can benefit by learning how they should manage workload, send the correct signals about business continuity to enhance workers’ perception of job stability, and provide enough job support in order to keep psychological risk at work under control. This is not only important for business policy but also for public policy, since government authorities have much to do in terms of providing the correct information and certainty about what these firms need to do to continue operations in a safe way. This will be important for the business’ operation but also for their workers’ occupational health. Practitioners can also learn about the importance of considering the asymmetries on the level of fear of COVID-19 that people present. This is important in order to develop differentiated policies that address the specific needs of groups of people with different levels of risk of presenting occupational health problems.This research has some limitations that can be considered as a starting point for future work. The development of the pandemic demonstrated that countries have very different capacities and resources to deal with this type of event. It is possible that the best prepared countries will be able to maintain an economic flow that will allow companies to survive in these uncertain contexts. Thus, the economic situation of the country during the COVID-19 pandemic may influence workers’ perceptions and their fear of the pandemic. Future research can use samples from different countries to contrast results, for example, between developed and emerging economies. The findings of this study can even be analyzed among autonomous states belonging to the same country to understand the differences within a decentralized governmental system.This study has not considered how family firms monitor and cope with employees’ fear of disastrous events . It would be interesting to study the behavior of family firms in terms of the mechanisms they use to manage employees’ negative perceptions, insecurities, and fear, which can compromise the survival of the firm. Moreover, the way family businesses act toward their employees in times of crisis can influence the reputation of the firm and threaten one of the main competitive advantages of the family business. In this vein, an avenue of research can turn its attention to the strategies that family firms implement for managing human resources during disasters  and how these strategies affect the reputation of the company.Considering the heterogeneity of family businesses, some of them may be better prepared than others to face the pandemic or may be in sectors that have not been negatively affected by this event. Analyzing the differences in the capabilities of family businesses to cope with the pandemic may serve as an example for other family businesses to adopt successful strategies to survive during adverse events.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.