Context Of Challenges Research Articles

The Ligurian Experience in the Management of Lung Cancer: Organizational Models and New Perspectives

Background: Lung cancer is an oncological threat worldwide, including in Italy. New organizational approaches based on a network of cancer centers and multidisciplinary and technological innovation are required. The experience in the Liguria region, in northwestern Italy, in the management of lung cancer is presented with a focus on the organizational model. Methods: A retrospective observational analysis was conducted for the period from January 2019 to December 2023 using administrative regional data. Results: Of the total surgery treatments in Liguria, most were carried out at the IRCCS San Martino (about 47%), which is the hub’s center. Most cases involved males aged ≥65 years (p < 0.001). Passive mobility showed a decrease in recent years. Considering the type of access to clinical structures, almost all that were finalized to receive chemotherapy were from the day hospital regimen (99%). Conclusion: A comprehensive approach must be carried out for cancer patients to maintain high levels of care quality. In this challenging context, the Liguria region has implemented new organizational approaches based on the networking of cancer centers and multidisciplinary and technological innovation.

Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya’s social health insurance model

ObjectivesTo analyse the potential of the Social Health Insurance (SHI) model to support the achievement of Universal Health Coverage (UHC) in Low and Middle-Income Countries (LMICs) through a policy analysis...

Teachers’ experiences during the COVID-19 pandemic in Portugal: the role of personal, professional and coping variables in inclusive practices

ABSTRACT In July 2018, Portugal implemented an educational framework focused on inclusion, prompting schools and teachers to rethink their education and student engagement approaches. Over time, schools adapted by transforming their perspectives on education, learning and student well-being. However, the onset of the COVID-19 pandemic in March 2020 introduced significant personal, contextual and global challenges. School closures and enforced confinement necessitated new educational practices, intensifying inclusion challenges. This study examines how personal variables and teachers’ experiences during the second lockdown affected the perception of the adoption of inclusive practices. Data was collected online using self-report questionnaires, with 137 teachers from Portuguese public and private schools participating voluntarily and anonymously. The study employed descriptive and multiple linear regression analyses, alongside univariate analyses of variance, to assess how confinement impacted teachers’ perceptions of inclusive practices. The findings indicate that factors such as teaching experience, gender and experiences during the second lockdown significantly influenced the perception of the adoption of inclusive practices. These results underscore the importance of considering proximal contexts during crises to enhance the adoption of inclusive practices.

Understanding professional challenges and coping strategies within the resilience process that support teacher well-being.

Teaching is an immensely complex profession with a variety of challenges. This qualitative study explores challenges that teachers face and how teachers cope with these challenges to maintain their well-being. The study is based on the Aligning Well-being and Resilience in Education (AWaRE) model and aims at identifying relevant teacher challenges and coping strategies to contribute to an evidence-based understanding of well-being and resilience within the teaching profession. We analysed teachers’ coping strategies in challenging situations based on semi-structured interviews with N=29 teachers from schools in Switzerland. Results showed that social factors at diverse levels such as school management, parent interaction and class composition represent the central contextual challenges, while social support systems from school management and colleagues and cooperation among teachers are significant contextual resources. Problem-solving was used as a frequent coping strategy. The results of this study provide implications for understanding the ways to support a successful resilience process among teachers and designing interventions to enhance teachers’ resilience.

Mapping evidence of postgraduate research supervision experiences at higher education institutions in Africa: A scoping review protocol

Background The evolving landscape of the African higher education sector necessitated by global higher education reforms and the need for research informed responses to address contextual challenges is partly dependent on effective postgraduate research supervision. A wide range of postgraduate research supervision models and practices are documented globally. In the African context, the experiences of postgraduate research supervision are not clearly understood from the experiences of all stakeholders. Aim The proposed scoping review aims to map evidence on the range of postgraduate research supervision experiences at higher education institutions in Africa. Methods The methodological framework proposed by Arksey and O’Malley will be used to conduct the review. Relevant articles will be sourced from different electronic data bases namely; ERIC, Web of Science, EbscoHost and Scopus. A combination of search terms and Boolean operators will be used to obtain the relevant articles based on the inclusion criteria stipulated within the Population, Context and Concept (PCC) framework of study identification for this review. Results Studies reporting on postgraduate research supervision experiences from the perspective of academics, students and support staff in the African higher education context will be included. The results may also provide insights postgraduate supervision experiences from varying postgraduate research disciplines. Conclusion The findings will provide consolidated empirical evidence on experiences of postgraduate supervision in the African higher education context, thereby providing holistic insight on postgraduate research supervision practices, models currently used, implementation challenges and highlight research gaps. This may inform recommendations that advance knowledge within this field, particularly in the African higher education context.

The Meaning of Being a 'Good Nurse' in the ICU During the COVID-19 Pandemic.

Intensive care unit (ICU) nurses were at the forefront of patient care during the coronavirus (COVID-19) pandemic. To date, no studies have explored what it meant to be a 'good nurse' in this unique and challenging context. As such, the aim of this study was to construct the meaning of the 'good nurse' in ICUs during a pandemic. Semi-structured interviews were conducted with 25 ICU nurses from three ICUs in Kuwait, who had worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology. The analysis showed that the good ICU nurse was defined by their sense of duty, which motivated compassionate and dedicated patient care. However, the nurses' attempts to demonstrate virtue also had negative consequences for them. Selflessness led to unsustainable self-sacrifice, empathy led to emotional labour, and efforts to remain patient and respectful led to exhaustion as the nurses found themselves under increasing pressure. Attempts to remain mentally strong may have partially protected them from stress, but also deprived them of an outlet for authentic emotional expression and support. Ultimately, their efforts to preserve their quality of patient care despite the numerous challenges of the pandemic came at an increasing cost, and resulted in moral distress and impaired well-being.

Transitioning Adolescents to Adult HIV Care in the United States: Implementation Lessons from the iTransition Intervention Pilot Trial

Although every youth in pediatric/adolescent HIV care will need to transition to adult-oriented care, there are no existing evidence-based interventions to optimize health through this process. Healthcare transition poses a persistent challenge to the health of youth living with HIV, which may result in gaps in care engagement, medication adherence, and viral suppression. Our process evaluation of iTransition, a multilevel mobile health (mHealth) intervention, included iterative interviews with youth, providers, and Transition Champions. These data, along with team meeting notes, highlight the important role the intervention plays in addressing healthcare transition-related challenges, positioning it to fill a critical gap for both youth and providers. It also highlights important individual (e.g., competing priorities of youth and providers), clinical (e.g., electronic health record integration), and contextual (e.g., clinical policies during COVID-19 pandemic) challenges to intervention reach and implementation. More work is needed to refine interventions to support care continuity for youth living with HIV as they transition to adult-oriented care.

Protein quality evaluation: FAO perspective.

United Nations agencies have a unique role in achieving the Sustainable Development Goals (SDGs) and aligned global nutrition targets by 2030. According to the latest estimates the world is moving backward in its efforts to end hunger, food insecurity and malnutrition in the presence of a more challenging and uncertain context, including climate change, war conflicts and other challenges. Shifts to plant and novel foods such as insects have been suggested to have good nutritional quality, as well as less environmental impact compared to "traditional" animal source foods. In the context of changing food systems, considering the nutritional quality of foods is essential and accurately assessing protein quality of foods is particularly important, given the large variability in amino acid composition and digestibility between dietary proteins. Indeed, protein quality estimates have the potential to inform policies and programs for actions to improve nutrition throughout the world and have been discussed during past and recent expert consultations. Recently, the Food and Agriculture Organization of the United Nations has been working with the International Atomic Energy Agency and international experts to review and update evidence and related methods on protein quality assessment and to develop a Protein Digestibility Database to aid dialog on the evaluation of protein quality and protein sufficiency in different populations.

Enhancing Human Resource Quality in Lombok Model Schools: A Culture-Based Leadership Approach with Tioq, Tata, and Tunaq Principles

This research explores the role of culture-based leadership in enhancing the quality of human resources in Sekolah Penggerak (model schools) in North Lombok, Indonesia. The study specifically focuses on the cultural wisdom of Tioq, Tata, and Tunaq (3T) inherent to the Sasak community and its integration into the leadership practices of elementary school principals. Employing a qualitative multi-case study approach, the research investigated how 3T influenced the leadership styles and effectiveness of principals in five selected elementary model schools. Data were collected through interviews, observations, and societal outcomes. The research underscores the importance of local cultural values in shaping effective leadership and promoting sustainable educational development. The study contributes to the literature on educational leadership by presenting a new model of leadership that integrates local cultural wisdom. This model can serve as a valuable reference for other regions in Indonesia and similar cultural contexts. The implications suggest that educational leadership development programs should incorporate local cultural values to address contextual challenges and improve the quality of education holistically.

‘In God We Trust. All Others Must Bring Data’: Unpacking the Influence of Human Resource Analytics on the Strategic Recognition of Human Resource Management

ABSTRACTExisting literature underscores the potential of human resource analytics (HRA) to enhance the strategic recognition of human resource management (HRM) within organisations. However, there has been limited focus on how HRA practitioners attempt to realise this potential. Our study investigates how HRA practitioners use HRA in their daily work to enhance their strategic recognition. Drawing on practice theory and a range of qualitative data, including expert interviews and observations, our analysis not only shows that implementing HRA offers opportunities for improved strategic recognition but also reveals that HRM practitioners showcase the strategic relevance of their analytics capabilities through four forms of tactical manoeuvring: capturing contextual challenges, using guerilla tactics, busting myths and running stealth projects. Our findings contribute to the literature on HRA and the broader discourse on HRM's role and its strategic recognition.

Enhancing Pedagogical Competencies through Continuous Training: A Professional Approach

Professional growth through the process of continuing Professional Development (CPD) is significant for the improvement of teachers’ professional competency and for better preparation to meet diverse and challenging contexts of educational environments. In this quantitative study, the research seeks to examine the effects of CPD on teaching confidence, classroom management, and student achievement. Using a survey technique, information was obtained from 200 educators in primary, secondary, and tertiary institutions on the extent to which they self-identified enhancements in the areas of subject content knowledge, classroom management, integration of technology, and student interest. The results presented enhanced competencies after participation in CPD with greater enhancements in the application of technology. Among the types of activities, workshops and/or online training were identified as the most beneficial for CPD practices, while the frequency of participation in such practices was found to be a definite factor in competency improvement. However, there are challenges including restricted access and the issue of resources especially if the environment that the research is being conducted is not well endowed. As such, the study calls for more frequent, varied, and accessible and sustainable CPD in ways relevant to educators’ contexts to help inform policymakers and institutions on the ways to promote 21st Century teachers and learning.

An Investigation Into the Perceived Effectiveness of GitHub Repositories to Teach Programming

The utilization of Git for version control and collaboration has long been the staple of the software development industry. To ensure that Computer Science students are industry-ready, academics adopt the use of platforms like GitHub in their teaching in different ways to expose students to these tools. In earlier studies, GitHub has been integrated for the purposes of student management, collection of assessments and facilitation of collaborative programming exercises. This paper explores the use of lecturer-provided GitHub repositories as a tool to support the teaching of core aspects of a programming curriculum. The pedagogical approach constructivism required students to learn core concepts by following repositories to build simpler applications. Thereafter, students are assigned more complex applications to develop. Students were required to work in pairs and submit their repositories for evaluation. This study adopted a case study approach supported by a combination of a student survey and a focus group discussion among lecturers and the teaching assistant involved in the course. Key findings included that integrating GitHub repositories presents several opportunities for collaboration, knowledge enhancement, self-directed learning, and reduced stress. However, this approach also resulted in team and technical challenges becoming prevalent, with students finding their own ways to overcome these challenges. Additionally, lecturers observed varied levels of engagement, reliance on lecturer-provided code, and occasional contextual challenges related to Internet connectivity. Lecturer-provided repositories can be enhanced in terms of structure, the inclusion of more comments explaining code, and through the inclusion of images and video. Recommendations are provided for academics who are looking to integrate GitHub into their teaching practice as well as suggestions for future work.

Using professional development to promote inclusive education in Latin America: possibilities and challenges

ABSTRACT Drawing on evidence from a series of projects that explored the value of professional development in promoting inclusive practices in Latin American countries, this paper concludes that there is untapped potential in schools that can be mobilised. It points to a series of promising approaches that builds on this potential. The paper also throws light on the changes that are needed in order to use these approaches and the sorts of contextual challenges that are likely to inhibit such efforts. A series of strategies that are required in order to make effective use of professional development to promote inclusion within Latin American contexts are suggested. These recommendations have significant implications for the various key stakeholders within national education systems. In particular, for those who administer school systems, this means adjusting their priorities and ways of working in response to improvement efforts that are led from within schools. It is suggested that the ideas presented about the value of professional development for promoting inclusive practices are relevant to other parts of the world, not least because of the emphasis placed on the importance of contextual analysis.

The PRE-registration podiatry: Accessible recruitment and employment (PREPARE) project: A commentary on the novel approach to the podiatry workforce crisis in Glasgow.

The profession of podiatry is facing significant workforce challenges and urgent solutions are required to increase workforce capacity. Apprenticeship models are available in England but as yet, not available in Scotland. This paper explores the local context of the current workforce challenges and summarises a novel solution collaboratively developed in Glasgow. A collaborative initiative between NHS Greater Glasgow and Clyde and Glasgow Caledonian University developed the PRE-registration Podiatry: Accessible Recruitment and Employment (PREPARE) Project. Creative use of vacancy savings are being used to employ a limited number of individuals on a whole-time Band 5 Annex 21 basis at the start of their podiatry degree for the duration of their studies. Academic timetables were consolidated with no change to module or learning outcomes with candidates spending 3days per week on academic studies and 2days per week employed within the host podiatry service during term time. If academic milestones are achieved, substantive Band five opportunities are available once registration is achieved. This project opens opportunities for graduate level study to the support workforce and others not in a position to pursue traditional models of full-time education. To date, two additional health boards in Scotland have adopted this model and it has the potential to be a national approach for Scotland. High applicant numbers were achieved demonstrating increased interest in podiatry from this approach. This project has the potential to have a transformative impact on educating and training the future workforce, potentially being adopted by other professions facing similar workforce challenges.

Voices From the Frontline: A Reflexive Thematic Analysis Illuminating Perioperative Practice Realities in Southern Ethiopian Teaching Hospitals.

Despite national efforts, gaps persist in Ethiopian perioperative care. This reflexive thematic analysis aimed to investigate the contextual challenges faced in delivering perioperative care. In-depth interviews were conducted with 20 healthcare professionals, including anesthetists, nurses, and surgeons, to gain a frontline perspective of perioperative practice realities. The analysis revealed eight interconnected themes: systemic infrastructure vulnerabilities, workforce expansion uncertainties, workforce demoralization, fragile perioperative safety culture, hierarchical structures and communication barriers, financial barriers to care, fragmented information systems, and fragile governance with sociopolitical instability. Local deficiencies in resources and equipment were amplified by global challenges, creating a precarious care environment. While workforce numbers increased, concerns persisted about competency and training quality. Systemic pressures and unmet professional needs contributed to staff demoralization. Inconsistent safety practices and top-down quality improvement initiatives hindered sustainable progress. Rigid hierarchies and departmental silos impeded effective teamwork and resource coordination. Financial constraints created significant barriers to care access and ethical dilemmas for providers. Incomplete digitalization and inconsistent documentation practices compromised continuity of care and data-driven improvements. Overarching sociopolitical instability and weak governance cascaded into healthcare system disruptions. The findings underscore the need for a multifaceted approach to strengthen perioperative care, including improving infrastructure, enhancing workforce development, fostering a culture of safety, breaking down hierarchical barriers, addressing financial accessibility, implementing robust information systems, and building resilient governance structures amidst adversity.

Feasibility, Acceptability, and Preliminary Effectiveness of a Reflective Supervision Professional Development Series Within Early Care and Education

ABSTRACT The positive impacts of Reflective Supervision (RS) are becoming increasingly evident. This approach may be especially important for early childhood teachers, who must deliver academic curricula and attend to children’s social-emotional development while maintaining high-quality program standards in increasingly challenging environmental contexts. However, to effectively provide RS to early childhood teachers, supervisors must first be trained in this approach. This paper describes the results of one such innovative training effort using data from a statewide, community-based program evaluation and a pilot open trial in the United States. Participants (N = 83 supervisors) were offered foundational training in RS followed by monthly skill-building sessions. We used a concurrent mixed methods approach, integrating observational, survey, and interview data collected simultaneously to assess feasibility, acceptability, and preliminary effectiveness of the RS professional development series. Data integration was achieved through contiguous narrative and joint display approaches. Research Findings: The RS series was feasible to implement, acceptable to participants, and led to improved reflective supervisory competencies. Practice or Policy: The RS series may represent an opportunity to effectively support the early care and education workforce, and in turn, benefit children. We discuss some differences between samples that may be useful for future implementation efforts across early care and education settings.

The Role of Informal Social Networks in Supporting Parents With Learning Disabilities: A Systematic Review

ABSTRACTBackgroundParents with learning disabilities are often assessed as lacking the capacity to parent effectively; however, ecological models of parenting indicate that support from informal social networks (ISNs) can help them successfully maintain family life. This systematic review examined evidence regarding (1) parent and child outcomes associated with support from ISNs and (2) perceptions of the roles of ISNs for parents with learning disabilities.MethodsPeer‐reviewed quantitative and qualitative literature was identified through a search of six databases, and a narrative synthesis was subsequently conducted.ResultsTwenty‐six articles were included in the review. Findings of the quantitative synthesis provided preliminary evidence for a positive relationship between support from ISNs and parental mental health, positive parenting practices and child wellbeing. The qualitative synthesis indicated that parents benefited from ISNs through their provision of practical and emotional support and learning skills. Network characteristics that divided supportive from unsupportive members were also identified.ConclusionParents with learning disabilities receive the same positive outcomes from ISNs as other parents, although unique contextual and social challenges may affect their experiences. Future research should explore interventions to build ISNs of parents with learning disabilities that acknowledge their existing strengths as parents and community members.

Enhancing ambidextrous green innovation: the role of green supply chain integration, knowledge capabilities and technology dynamism in manufacturing

PurposeIn the context of the environmental degradation challenge in manufacturing firms, greening the supply chain (SC) is the most widely endorsed method to mitigate the adverse repercussions of climate change. Based on organizational learning and resource dependence theories, the aim of this research is to know how green supply chain external integration (GSCEI) and green supply chain internal integration (GSCII) influence ambidextrous green innovation (AGI). It also examines the mediating roles of green absorptive capacity (GAC) and green knowledge integration capability (GKIC), as well as the moderating role of green technology dynamism (GTD).Design/methodology/approachTo assess the hypothesized model, data were obtained with 386 questionnaires from managers employed in manufacturing firms in Pakistan applying a cross-sectional approach. A partial least square structural equation modeling technique was implemented to evaluate the data.FindingsThe results revealed that GSCEI and GSCII substantially impact AGI. Moreover, GAC and GKIC serve as mediators between GSCEI and AGI. GAC and GKIC also intervene in the relationship between GSCII and AGI. GTD was significant as a moderator for the correlation between GSCEI and AGI. However, it does not moderate the relationship between GSCII and AGI.Practical implicationsThis research offers significant comprehension and an innovative approach for manufacturing organizations to curb environmental corrosion by stimulating AGI through green SC integration. It suggests to practitioners that integrating internal knowledge with external partners expands communication and collaboration to ensure that resources connected with environmental preservation flow smoothly.Originality/valueThis research is a valuable addition to the field, as it explores for the first time the missing link among the studied constructs. It opened the black box of how knowledge-related capabilities facilitate knowledge resources to elicit AGI, an area that has not yet been explored.

Process evaluation of an urban piped water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo

Major investments in water supply infrastructure will be required to achieve Sustainable Development Goal (SDG) 6. Safely managed water services are also central to global cholera and diarrhoeal diseases prevention strategies. However, evidence remains scarce on how to efficiently improve piped water services in complex settings where infrastructure investments are most needed. We conducted a process evaluation of a large-scale water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo, in parallel to a pragmatic trial. Considering three evaluation domains–context, implementation, and population response–, we assessed the validity of the programme’s theory of change and underlying assumptions. Information sources included construction works documentation, operational and billing records from the water utility, and household surveys. The evaluation covers the period 2014–2021. Trial results are not within the scope of this manuscript. The programme did not achieve expected improvements in the water supply service during the evaluation period. Out of 16 assumptions underlying the theory of change, six remained valid, seven partially valid, and three turned out to be invalid. Contextual challenges included extreme flooding in 2020 and the Covid-19 pandemic, which disrupted construction works. Issues related to electricity supply and the rise of Lake Tanganyika emphasise the need for cross-sectoral approaches and consideration of climate change in the planning of water supply infrastructure. Implementation challenges underlined the importance of capacity strengthening alongside infrastructure improvements. Population response elements suggest that affordability and informal practices such as tap sharing should be taken into account. The programme was a good example of early engagement with researchers and provides unique insights into the implementation of large-scale infrastructure improvements in a complex, low-income setting. Pragmatic evaluation approaches should be adopted for the generation of scientific evidence from complex programmes in order to optimise future infrastructure investments contributing to progress towards SDG6.

Ulwaluko: A critical site for black theological reflection

Ulwaluko is an essential rite of passage for men in the Xhosa community in South Africa. This particular initiation rite of passage is a critical part of the transition from boyhood to manhood. In a post-apartheid South Africa, this African practice has received criticism for promoting gender and sexual exclusion with some calling for a halt to the practice. Using Simon Maimela’s theological anthropology and Jackson’s concept of modern slavery as human plasticity, I attempt to expose how post-apartheid constitutionalism has epistemically distorted the theological anthropology of this rite of passage. This is done acknowledging Ulwaluko theologically within the context of African holism. This, I argue, has had significant ethical implications for society. Recognising it as a site of black theological reflection using Maimela’s theological anthropology, I argue that this particular practice can positively influence discourses on morality in South Africa.Contribution: This article makes a theological contribution by situating African and black theology of liberation discourse within the epistemic framework of Ulwaluko as an initiation rite of passage. Recognising the prevalence of initiation rites of passage in South Africa, this discourse attempts to contribute towards thinking about the creation of humanity from these spaces of formation. This I do in the very challenging contexts within which Ulwaluko is practised.