Implementation Challenges Research Articles

Management Practices and Implementation Challenges in District Education Directorates in Ghana

Background: Subnational actors and organizations are crucial mediators of policy implementation due to their proximity to schools. However, in low- and middle-income country contexts, little is known about their management practices and factors that shape the adoption of these practices to improve education delivery. Purpose: We explore the management context of five District Education Directorates in Ghana, and the factors that enable or constrain them to plan and implement policy. Participants: Forty-three interviews and focus groups with regional and district education officials, district political actors, and basic education school headteachers and teachers. Research Design: A qualitative study of semistructured interviews, focus groups, and education policy and planning documents. Analysis: To understand how policy implementation happens within complex, multitiered bureaucracies, our theoretical framework uses four management functions described in Williams et al. (2021) to explore two different paradigms of how to change public bureaucracies: target setting and prioritization; measurement and monitoring; accountability and incentives; and problem-solving. We coded and analyzed our data based on this framework and developed district-wide narrative memos to synthesize the findings. Findings: We identify three areas of (mis)alignment in management practices: across bureaucratic levels and among actors; around clear and consistent priorities for learning; in expected actions and availability of resources. These (mis)alignments can constrain or be leveraged by districts to improve education delivery in Ghana. Implications: We argue for better prioritization of goals toward learning and the efficient allocation of funds for management practices typical of effective organizations.

Enhancing the Role of the Special Branch of Aisyiyah (PCIA) Malaysia in Providing Education and Financial Literacy Services for Indonesian Migrant Worker Families

The purpose of this qualitative study is to investigate how Indonesian migrant worker families might benefit from improved financial literacy and educational services provided by the Special Branch Leadership of Aisyiyah (PCIA) Malaysia. Using a phenomenological research methodology, the study explores participants' lived experiences and perspectives about PCIA Malaysia's role. In order to address social concerns, the research equalizes engagement between practitioners and service partners by implementing the Community-Based Participatory Research (CBPR) technique. A group from Muhammadiyah University in Makassar carried out the study, which also included semi-structured interviewing, thematic analysis, case study design with purposive or snowball sampling, and the definition of important research topics. Results from Kuala Lumpur's community involvement initiatives highlight issues like poor financial literacy and restricted access to education. Financial issues arise as a result of implementation challenges, even though members are knowledgeable about financial planning. Financial literacy programs, more PCIA leader involvement, and educational awareness campaigns are suggested remedies. The report emphasizes the critical role that PCIA plays in resolving the various issues that Indonesian migrant worker families confront, with a focus on areas such as community involvement, financial literacy, education access, and training programs. A focused approach, proactive community involvement, and continual assessment are necessary for success in order to provide long-lasting beneficial results.

Pajak Karbon sebagai Instrumen Kebijakan untuk Mendorong Transisi Energi dan Pertumbuhan Ekonomi yang Berkelanjutan

Energy transition and sustainable economic growth have become global priorities in addressing climate change. Carbon taxation has been recognized as one of the effective policy instruments in reducing carbon emissions and promoting the use of clean energy sources. However, the implementation and impact of carbon taxation are still subject to debate, particularly in the context of economic growth. Therefore, this research aims to investigate the role of carbon taxation in energy transition and economic growth, as well as identifying the associated benefits and challenges. The concept of carbon taxation and its impact on energy transformation are the main focus of this study. Within the concept of carbon taxation, the appropriate tax rate and effective design are crucial keys. Carbon taxation can provide economic incentives to reduce carbon emissions and encourage the use of clean energy sources. However, its implementation faces challenges such as uneven social impacts and international coordination. Case studies of countries adopting carbon taxation are also conducted to illustrate the real-life experiences and impacts of this policy. Carbon taxation has great potential in driving energy transition and sustainable economic growth. Through carbon emission reduction, increased utilization of clean energy, technological innovation, and revenue for investment, carbon taxation can bring significant benefits. However, challenges in implementation and international coordination need to be overcome. Inclusive supportive policies, proper tax design, and strong international cooperation are some recommendations to optimize the benefits of carbon taxation.
 Keywords: carbon taxation, energy transition, economic growth, carbon emissions, clean energy sources.

Compliance, livelihood support, and challenges of the Pantawid Pamilyang Pilipino program of the local government unit

The 4Ps aim to strengthen the social protection system and reduce poverty in Philippines. Thus, this determined the 4Ps compliance in health and nutrition and education in a component city in Southern Negros Occidental, Philippines as assessed by the implementers and exit beneficiaries relative to designation and beneficiary location. It also profiled the livelihood support among beneficiaries in terms of medium enterprise development and employment facilitation. Likewise, it identified the challenges in the 4Ps implementation. Also, it investigated the difference in the compliance when grouped to demographics. Using the descriptive-comparative design, 151 implementers and 270 beneficiaries responded to the researcher-made questionnaire and checklist. In analysis, mean, standard deviation, and Kruskal Wallis were employed. Meanwhile, the researcher adhered to the Philippine Health Research Ethics Board. Generally, the compliance is very great. Regarding the livelihood support, few beneficiaries received the seed capital of P15,000.00 and employment facilitation fund of P5,000.00. The lack of vehicle, supplies, venue, and inaccessible roads were among the logistics and personnel issues. In knowledge and communication, challenges are on illiteracy, language barrier, lack of training on family and child-related issues. The inability to use ATM cards and pawning were issues too. Meanwhile, there was no difference in the compliance when grouped to demographics. Hence, the findings are instrumental in the continuous improvement of the program’s compliance.

Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries.

The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.

Minimizing Cost Overrun in Rail Projects through 5D-BIM: A Conceptual Governance Framework

Integration of 5D Building Information Modeling (BIM) into large rail projects has the potential to significantly enhance cost management and control. Nevertheless, 5D-BIM implementation has encountered difficulties stemming from technical, functional, and governance-related factors. This paper builds a conceptual framework to support financial decision making, enhances project management, and promotes efficient project delivery. The framework encompasses a set of interrelated elements that include project governance, BIM policies and standards, digital platforms, BIM LOD, cost-estimation classification, and continuous improvement. The proposed framework acknowledges the significance of project governance in guiding and organizing the implementation of 5D-BIM. Additionally, BIM policies and standards ensure the adherence to quality standards for the produced BIM models. Digital platforms serve as the basis for multiple users to generate, access, share, and exchange project information. BIM LOD promotes collaboration and coordination among all project stakeholders. Cost-estimation classification aligns the estimation process with the development of project scope and financial decision making. Continuous improvement plays a vital role in optimizing processes, enhancing efficiency, and achieving higher-quality outcomes. Moreover, it fosters stakeholder satisfaction, improves project performance, and nurtures a conducive environment for innovation and learning. The study analyzes the framework utilization in Victorian rail projects and identifies key implementation challenges. The main technical hurdles encountered were the lack of current horizontal infrastructure standards for data exchange and the lack of compatibility with current cost-management standards. Increased project complexity and the absence of clear project governance strategies and processes also posed organizational challenges. A further validation of the framework in real-world rail projects was recommended to achieve the implementation goals.

Implementation successes and lessons learnt from a randomised controlled trial of a complex school-based intervention

Background The UK has seen a recent shift towards children’s mental health being supported and treated in school settings. Several current school-based interventions focus on autism and social skills, with education professional involvement in their delivery increasing. The study of these interventions poses specific implementation challenges. This paper discusses implementation successes and learnings from the I-SOCIALISE research study which delivered and evaluated efficacy of LEGO® based therapy (now Play Brick Therapy) for autistic children and young people delivered in schools. Detailed Methods and results of the trial are reported elsewhere. Methods The I-SOCIALISE study was a pragmatic large-scale NIHR-funded cluster randomised controlled trial. Children and young people, their parents/guardians, and schoolteachers or teaching assistants were recruited from mainstream schools in the UK. They completed outcome measures and were randomised to receive either 12-week of LEGO® based therapy and usual support or usual support only. Various methods to achieve successful recruitment and retention were used and learnings were documented. Results The study recruited to time and target with successful delivery of this complex intervention in schools. Several lessons were learnt about recruitment methods, data collection, participant burden and retention, blinding, and the importance of relationships with key school contacts. Main recommendations based on these learnings are provided. Conclusions This study demonstrated that it is possible to undertake large scale, robust evaluation of pragmatically delivered complex school-based interventions. Recommendations are made to address the logistical challenges of undertaking research in this setting which are intended to facilitate future research.

Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis.

Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care. This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.

Competence-based language curricula: implementation challenges in Africa

Abstract Drawing on a case study design, this article examines the real-life adaptive challenges secondary school teachers of English in Uganda face while implementing the 2020 English language competence-based curriculum innovation. Findings indicate that scarcity of instructional materials, time constraints and large class sizes, limited planning and stakeholders’ support, dissonance between local culture and learning styles significantly underlie complications ESL teachers face adapting and implementing competence-based curricula innovations in English language classrooms in low-income contexts in the global south. The experiences of teachers in Uganda resonate across most global south ESL educational contexts. They illustrate the universality of challenges teachers face and are likely to face when implementing competence-based curricula in sub-Saharan Africa and the wider global south where the teaching and learning of English is premised on facilitating acquisition of English language for meaningful interaction.

Personal data store ecosystems in health and social care.

This paper considers how the development of personal data store ecosystems in health and social care may offer one person-centered approach to improving the ways in which individual generated and gathered data-e.g., from wearables and other personal monitoring and tracking devices-can be used for wellbeing, individual care, and research. Personal data stores aim to provide safe and secure digital spaces that enable people to self-manage, use, and share personal data with others in a way that aligns with their individual needs and preferences. A key motivation for personal data stores is to give an individual more access and meaningful control over their personal data, and greater visibility over how it is used by others. This commentary discusses meanings and motivations behind the personal data store concept-examples are provided to illustrate the opportunities such ecosystems can offer in health and social care, and associated research and implementation challenges are also examined.

Towards an emotive-relational model of FLP: mapping the connections between family language policy and parental wellbeing

ABSTRACT This paper addresses the emotive-relational dimensions of family language policy (FLP), in the context of Hungarian families in Australia. The study explored parental experiences of family language policy implementation efforts and challenges. The research used an online survey (N = 80) which collected quantitative and qualitative data. Survey data were analysed using SPSS software to generate descriptive and t-test statistics. The results demonstrate that parents experienced emotional challenges around all three elements of family language policies: (i) ideologies; (ii) language practices and (iii) language management. This paper identifies six main emotive-relational dimensions of FLP: (i) linguistic-ideological, (ii) discursive; (iii) personal/relational; (iv) socio-relational; (v) agentive and (vi) pragmatic. The methods and the results of this study can be useful for researchers investigating the interconnectedness of language maintenance and parental subjective wellbeing. The findings inform current theoretical models and methods of researching family language policy and its complex dimensions. This paper concludes with an empirically tested emotive-relational model of FLP, which informs future research directed at exploring the emotional aspects of FLP from parents’ point of view as language planners.

Analysis of the Development Trends and Key Challenges of Zero Carbon Buildings in Tropical Islands

In the context of global climate change, particularly in tropical island regions, the construction sector, a notable contributor to CO2 emissions, necessitates a concentrated effort towards enhancing energy efficiency and reducing emissions. This study delves into the evolution and the inherent challenges associated with the development of zero-carbon buildings in such environments. It commences with an examination of key global agreements and China's significant progress in its dual carbon strategy, with a specific focus on energy and emission reduction in the construction sector. The discourse then transitions to an in-depth analysis of the current state of zero-carbon building research in tropical islands, spotlighting the advancements made by Hainan's construction industry in the low-carbon transition and the deployment of zero-carbon technologies. The paper further articulates the emergence of zero-carbon buildings as a pivotal trend in future construction practices, underscoring the crucial role of integrated system design in realizing these objectives. Despite their theoretical and practical viability, zero-carbon buildings encounter significant implementation challenges in the unique context of tropical islands. These challenges include the need for precise system integration, the quantification of design parameters' impact on building performance, and the refinement of operational strategies for zero-carbon buildings. The study also highlights the critical need for targeted research and innovation in building materials and technologies, specifically adapted to the distinctive climatic conditions of tropical islands. This comprehensive analysis provides an extensive exploration of zero-carbon buildings in tropical settings, shedding light on the primary challenges and potential solutions, thereby offering valuable insights to foster sustainable growth in the construction sector.

Industry 5.0 and sustainable manufacturing: a systematic literature review

PurposeIndustry 5.0 (I5.0) is eventually set to supersede Industry 4.0 (I4.0), despite the fact that I4.0 continues to gain ground in emerging nations like India. Now India is aspiring to be a global manufacturing hub, and I5.0 offers enormous potential to position India as a forerunner in intelligent and collaborative manufacturing systems. Therefore, this research article aims to understand the relationship between I5.0 and sustainable manufacturing (SM) thoroughly; pinpoint its impact and implementation challenges; analyze its impact on Triple-Bottom-Line (TBL) sustainability; and present an inclusive framework for I5.0 implementation for Indian manufacturing enterprises.Design/methodology/approachThe coexistence of two industrial revolutions raises questions, which necessitates debates and explanations. Thus, the systematic literature review (SLR) approach is used to address this issue and this study used Web of Science, Scopus, Science Direct and Google Scholar databases. Following a critical SLR, 82 research papers have been cited in this article, and the majority of cited articles were published from 2010 to 2022, to ensure a focused analysis of pertinent and recent scholarly contributions.FindingsI4.0 is considered to be technology-driven, however, I5.0 is perceived to be value-driven. I5.0 is not a replacement or a chronological continuation of the I4.0 paradigm. The notion of I5.0 offers a distinct perspective and emphasizes the necessity of research on SM within the TBL sustainability boundaries. I5.0 introduces a new TBL: resilience in value creation, human well-being and sustainable society. Indeed, I5.0 seems to be economically, socially, and environmentally sustainable while manufacturing products with high productivity.Practical implicationsTheoretical implications pertain to restructuring business models and workforce transformation, whereas practical implications underscore the significance for manufacturing enterprises to embrace I5.0 for their sustainable development. By understanding the nuanced relationship between I5.0 and SM, enterprises can navigate implementation challenges, maximize TBL sustainability and embrace an inclusive I5.0 framework for high productivity and resilience.Originality/valueThe existing literature presents the general notion of I5.0 but lacks in-depth TBL sustainability analysis. This research used a systematic and rigorous SLR approach that evaluates the existing literature, enables an in-depth understanding, identifies research gaps and provides evidence-based recommendations for the decision-making process. Furthermore, this research aims to stand on an unbiased assessment, exploring theoretical and practical implications of I5.0 implementation for manufacturing enterprises and suggesting future research avenues.

Surveying Quality Management Methodologies in Wooden Furniture Production

Furniture production is a specific industrial sector with a high human labor demand, a wide range of materials processed, and short production runs caused by high customization of end products. The difficulty of measuring the aesthetic requirements of customers is also specific to furniture. This review of academic papers identifies and explains effective quality management strategies in furniture production. The reviewed literature highlights a range of quality management methodologies, including concurrent engineering (CE), total quality management (TQM), lean manufacturing, lean six sigma, and kaizen. These strategies encompass a variety of pro-quality tools, such as 5S, statistical process control (SPC), quality function deployment (QFD), and failure mode and effects analysis (FMEA). The strengths of these quality management strategies lie in their ability to enhance efficiency, reduce waste, increase product diversity, and improve product quality. However, the weaknesses concern implementation challenges and the need for culture change within organizations. Successful quality management in furniture production requires tailoring strategies to the specific context of the furniture production industry. Additionally, the importance of sustainability in the furniture industry is emphasized, which entails incorporating circular economy principles and resource-efficient practices. The most important finding from the literature analysis is that early detection and correction of poor quality yields the most beneficial outcomes for the manufacturer. Therefore, it is essential to strengthen the rigor of quality testing and analysis during the early stages of product development. Consequently, a deep understanding of consumer perspectives on required furniture quality is crucial. The review identified two research gaps: (1) the impact of unnecessary product over-quality on the efficiency of furniture production and (2) the influence of replacing CAD drawings with a model-based definition (MBD) format on quality management in furniture production.

EVOLVING TAX COMPLIANCE IN THE DIGITAL ERA: A COMPARATIVE ANALYSIS OF AI-DRIVEN MODELS AND BLOCKCHAIN TECHNOLOGY IN U.S. TAX ADMINISTRATION

This paper aims to provide a comprehensive review of the integration of artificial intelligence (AI) and blockchain technology in U.S. tax administration. It explores how these technologies are revolutionizing tax compliance and fraud detection, offering a comparative analysis with traditional methods. The paper highlights the potential benefits of these technologies in enhancing efficiency, accuracy, and transparency in tax administration, aligning with the U.S. government's objectives of ensuring fiscal integrity and public trust. The review also examines international best practices and proposes how the U.S. can leverage these technologies to maintain its global leadership in financial governance and innovation. The study is structured around four key objectives: assessing the current integration of AI and blockchain in tax administration, evaluating their effectiveness in enhancing tax compliance, identifying implementation challenges, and developing strategic recommendations. Employing a comprehensive literature review approach, the study synthesizes findings from various sources to provide an in-depth understanding of the role and impact of these technologies in modern tax systems. The results reveal that AI and blockchain significantly improve tax compliance and administration efficiency but also introduce challenges such as data privacy concerns and the need for robust regulatory frameworks. In conclusion, the study underscores the transformative potential of AI and blockchain in tax administration, recommending continuous research and development, coupled with stakeholder education and engagement. These efforts are crucial for overcoming operational challenges and fully harnessing the benefits of these technologies in modernizing tax systems. The paper concludes with strategic recommendations for policymakers, tax authorities, and researchers, emphasizing the importance of a balanced approach that fosters technological innovation while maintaining legal compliance and adherence to fundamental principles.
 Keywords: Artificial Intelligence, Blockchain, Tax Administration, Tax Compliance, Digital Transformation, Financial Governance.

Enhancing Arabic Speaking Skills: A Societal Approach at an Indonesian Islamic Boarding School University - Implementation Challenges and Remedies

The research explores the implementation of teaching speaking skills to first-semester Arabic language students at the University of Islamic Boarding School in Indonesia, using a social approach. It aims to comprehensively describe the process, covering objectives, the roles of lecturers and students, discussion themes, teaching methods, media, and evaluation. The study employs a descriptive qualitative method with data collected through observation, interviews, and documentation. Insights from the findings highlight the sociological perspective of learning objectives, emphasizing the lecturer's role in fostering social interactions through discussions. Both the lecturer and students' roles are examined in a societal context, underlining the lecturer's societal responsibilities and students' readiness for societal engagement. Discussion themes include social elements such as good behavior, Islamic education, and youth. The teaching method involves a conversational approach with cooperative learning strategies. Classroom media is limited to books and boards, while dormitories are equipped with LED TVs broadcasting Arabic-language religious speeches. Challenges faced by students are categorized into internal (lack of personal motivation) and external problems (shortage of classrooms and inadequate bathroom facilities). The study provides insights into the practical and sociological aspects of teaching speaking skills in an Islamic educational environment.

Team-based learning in Indonesian midwifery education: Implementation research.

This study aims to implement team-based learning (TBL) and assess the impact on faculty members and students within midwifery education in Indonesia. Proctor's Framework for Implementation Research serves as the guiding approach in investigating the role of implementation strategies in implementing TBL within the context of midwifery education. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was utilized to assess the outcome. In this study, the implementation of TBL has demonstrated significant reach, with broad participation among both faculty and students in two schools. The efficacy of TBL is evident through enhanced student knowledge, engagement and active learning. Adoption of TBL was observed in both schools, with faculty and students expressing interest and active participation. High levels of implementation fidelity were maintained, even though with challenges related to preparation and implementation. These findings suggest that TBL can be successfully integrated into midwifery education, with positive implications. Regarding maintenance, faculty members have expressed their intention to continue using TBL in various topics for future lectures. The implementation of TBL in Indonesian midwifery education has shown substantial reach and efficacy. Faculty and students are highly interested in adopting TBL for future use. Despite some implementation challenges, the study suggests that TBL can be effectively incorporated with minor adjustments, emphasizing its feasibility and potential impact. This research contributes to understanding TBL's applicability in various educational settings, especially in low-resource institutions.

Optimizing intracranial electric field distribution through temperature-driven scalp conductivity adjustments in transcranial electrical stimulation

Transcranial electrical stimulation (TES) is a promising non-invasive neuromodulation technique. How to increase the current intensity entering the skull and reduce scalp shunting has become a key factor significantly influencing regulatory efficacy. In this study, we introduce a novel approach for optimizing TES by adjusting local scalp temperature to modulate scalp conductivity. We have developed simulation models for TES-induced electric fields and for temperature-induced alterations in scalp conductivity. Two common types of stimulation montage (M1-SO and 4 × 1 montage) were adopted for the evaluation of effectiveness. We observed that the modulation of scalp temperature has a significant impact on the distribution of the electric field within the brain during TES. As local scalp temperature decreases, there is an increase in the maximum electric field intensity within the target area, with the maximum change reaching 18.3%, when compared to the electric field distribution observed under normal scalp temperature conditions. Our study provide insights into the practical implementation challenges and future directions for this innovative methodology.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury

BackgroundTelerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PurposeThe aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. Study designProspective, open-label, nonrandomized comparative clinical study. MethodsThe study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. ResultsIn the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. ConclusionsWe determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.

Investigation of artificial intelligence in SMEs: a systematic review of the state of the art and the main implementation challenges

AbstractWhile the topic of artificial intelligence (AI) in multinational enterprises has been receiving attention for some time, small and medium enterprises (SMEs) have recently begun to recognize the potential of this new technology. However, the focus of previous research and AI applications has therefore mostly been on large enterprises. This poses a particular issue, as the vastly different starting conditions of various company sizes, such as data availability, play a central role in the context of AI. For this reason, our systematic literature review, based on the PRISMA protocol, consolidates the state of the art of AI with an explicit focus on SMEs and highlights the perceived challenges regarding implementation in this company size. This allowed us to identify various business activities that have been scarcely considered. Simultaneously, it led to the discovery of a total of 27 different challenges perceived by SMEs in the adoption of AI. This enables SMEs to apply the identified challenges to their own AI projects in advance, preventing the oversight of any potential obstacles or risks. The lack of knowledge, costs, and inadequate infrastructure are perceived as the most common barriers to implementation, addressing social, economic, and technological aspects in particular. This illustrates the need for a wide range of support for SMEs regarding an AI introduction, which covers various subject areas, like funding and advice, and differentiates between company sizes.