Context Of Challenges Research Articles

Healthcare workers’ perspectives on a prescription phone program to meet the health equity needs of patients in the emergency department: a qualitative study

ObjectivesPeople experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes.MethodsWe conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis.ResultsOur analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts.ConclusionsOur findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.

Digital Accessibility Education in Context: Expert Perspectives on Building Capacity in Academia and the Workplace

The social model of disability, accessibility legislation, and the digital transformation spurred by COVID-19 expose a lack of accessibility capacity in the workforce, indicating persistent gaps in academic and professional education. We adopt a socio-cultural lens to examine how the context of education and training influences teaching and learning in university and workplace sectors, and how expert educators manage and negotiate these contextual factors to build accessibility capacity. This article reports qualitative research with 55 experienced educators using an expert panel method and focus groups. Analysis highlights the important disconnects and contextual challenges that educators must navigate and negotiate to affect and embed cultural change. We find that faculty and workplace cultures frequently perpetuate precarity in accessibility education, individualising the responsibility to ‘heroes’ or ‘champions’, while disciplinary and role-based silos limit the scope for raising awareness and developing widescale competency. Conversely, centres of excellence and communities of practise can cultivate and sustain links between education and research, engage expert users, and promote interdisciplinary and cross-role learning environments, where accessibility is increasingly recognised as a shared endeavour. We conclude that greater collaboration between academia and industry can enhance pedagogical understanding, to transform accessibility educational practices and build and sustain capacity for the future.

Embarking on a cultural transformation within a school of nursing

Schools of Nursing across the country are encountering fiscal, programmatic and leadership challenges exacerbated by chaos and fragmentation in health care systems. This article focuses on the transformation journey of the School of Nursing at the University of Minnesota highlighting the complex context of higher education, challenges faced, and strategies executed that focused on significant and sustained culture change. Recommendations are offered to enable all schools to embark on their own transformative journeys.

Perioperative capacity and contextual challenges in teaching hospitals of southern Ethiopia: explanatory sequential mixed-methods research

BackgroundPrevious Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia.MethodsA quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table.ResultsThe survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals’ radiology services and blood products were only available 25–50% of the time, while anesthetic agents and essential laboratory services were often available 51–75% of the time. Perioperative management protocols were used rarely (1–25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians.ConclusionThe study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.

Mixedness in conflict: The impact of Yugoslav wars on intermarriages in the Western Balkans

AbstractThis paper examines the phenomenon of intermarriages in the Western Balkans, shedding light on their intricate relationship with the region's tumultuous history, ethnic diversity, and socio‐political dynamics. Through a comprehensive exploration of interethnic unions across different areas, the study delves into how these marriages have historically served as symbols of coexistence and integration, particularly during the mid‐20th century, when they were encouraged by the newly‐formed states to unite the different nations living in them. However, the rise of ethno‐nationalism and the Yugoslav Wars significantly impacted these marital patterns, underscoring the complex interplay between politics, culture, and traditional norms. The paper highlights the decline in mixed marriages post‐war, persistent ethnic tensions, and varying dynamics in different locales, suggesting that comprehensive approaches are needed for sustainable peace and unity in the Western Balkans. Through this lens, intermarriages emerge not just as personal unions but as potent symbols and potential catalysts for broader societal transformations, albeit within a context of considerable challenges and the need for nuanced, multifaceted approaches to fostering lasting interethnic harmony.

Controlled mitral valvuloplasty using steerable catheter- waist- formed balloon system: A clinical case series.

As the general population ages, the incidence of degenerative mitral stenosis (MS) among patients has increased. Percutaneous mitral valvuloplasty (PMV) has emerged as a well-established option for mitral rheumatic stenosis with specific characteristics. However, a blank therapeutic space must be filled with the treatment options for degenerative or rheumatic mitral stenosis in patients with many comorbidities and contraindication for valvuloplasty. We here present a comprehensive overview of the current possibilities, despite their scarce success. That is the reason why we propose a case series to facilitate a better understanding of our innovative technique in this challenging clinical context.

Enhancing Finger Vein Authentication through Deep Learning: A Comparative Study of U-Net and Sequential Models

The use of finger veins as biometric authentication is becoming increasingly popular. However, low-quality finger vein images pose challenges, necessitating innovative approaches for accurate authentication. This research investigates the potential of deep learning techniques in addressing this issue, focusing on two prominent architectures: U-Net and the proposed Sequential Model. The study conducts a comparative analysis of the performance of these models in low-quality finger vein image authentication scenarios. U-Net, known for its image segmentation capabilities, is explored for feature extraction, while the Sequential Model, incorporating a modified VGG16 architecture, brings temporal context through LSTM layers. The research presents an in-depth evaluation of both models based on accuracy, recall, precision, and other relevant metrics. The findings shed light on the suitability of each approach for enhancing the reliability of finger vein authentication in challenging data quality contexts.

Infection prevention and control in Dutch general practices before and during the COVID-19 pandemic and its implications for pandemic preparedness and seasonal respiratory epidemics: a qualitative study on lessons learned

BackgroundThe COVID-19 pandemic has prompted a re-evaluation of infection prevention and control (IPC) in general practices, highlighting the need for comprehensive IPC implementation. This study aimed to evaluate healthcare workers’ (HCWs) experiences and perspectives regarding IPC in general practices before and during the COVID-19 pandemic, and its implications for post-pandemic IPC implementation.MethodsThis qualitative study involved semi-structured, in-depth interviews during two time periods: (1) prior to the COVID-19 pandemic (July 2019-February 2020), involving 14 general practitioners (GPs) and medical assistants; and (2) during the COVID-19 pandemic (July 2022-February 2023), including 22 GPs and medical assistants. Data analysis included thematic analysis that addressed multiple system levels.ResultsFindings indicated a shift towards comprehensive IPC implementation and organisation during the pandemic compared to the pre-pandemic period. Since the Omicron variant, some general practices maintained a broad set of IPC measures, while others released most measures. HCWs’ future expectations on post-pandemic IPC implementation varied: some anticipated reduced implementation due to the desire to return to the pre-pandemic standard, while others expected IPC to be structurally scaled up during seasonal respiratory epidemics. Main contextual challenges included patient cooperation, staff shortages (due to infection), shortages of IPC materials/equipment, and frequently changing and ambiguous guidelines. Key lessons learned were enhanced preparedness (e.g., personal protective equipment supply), and a new perspective on care organisation (e.g., digital care). Main recommendations reported by HCWs were to strengthen regional collaboration within primary care, and between primary care, public health, and secondary care.ConclusionHCWs’ experiences, perspectives and recommendations provide insights to enhance preparedness for future epidemics and pandemics, and sustain IPC in general practices. For IPC improvement strategies, adopting an integrated system-based approach that encompasses actions across multiple levels and engages multiple stakeholders is recommended.

Coping and resilience among the youth during the extended COVID-19 restrictions: Exploring lessons learnt from coaching-based interventions

According to research across various countries, the mental health and psychosocial well-being of the youth have been deeply impacted by the COVID-19 pandemic. Hence, it is imperative to address the rising problems and develop resources for future preparedness. Applying insights from their previous mixed methods research, the authors integrate a coaching framework within a qualitative approach to design an intervention to support young participants. This research had three aims: firstly, to explore the experiences of the youth affected by the extended pandemic restrictions; secondly, to utilise coaching to help participants explore their coping strategies; and thirdly, to synthesise the lessons learnt for future applications. Purposive sampling was utilised to invite participants from the target group of 21–35 years. Participation was voluntary and the ethical practices of research followed. Sixteen participants joined the in-depth interviews and research sessions from May to June 2021. These participants included seven Indians and nine Thai young adults. Thematic analyses of data revealed that while the participants experienced both challenges and stresses, they also reported strategies of adjustment to the extended pandemic restrictions. The emerging themes were consolidated and discussed within the theoretical frameworks of coping and resilience. The participants’ feedback on coaching confirmed its usefulness as an intervention in a challenging context. The implications of these findings are discussed to rethink the paradigms to support the psychosocial well-being of the youth dealing with challenges for future preparedness.

New technology and working methods to improve healthcare for suspected malignant skin lesions: Implementation of teledermatoscopy in comprehensive healthcare

AbstractBackgroundSuspected malignant skin lesions are common and challenging in terms of diagnostic accuracy and lead time. Efficient use of teledermatoscopy has the potential to improve these factors.ObjectivesThis report aims to explore the implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system.MethodsA stepwise implementation started in 2012 in the Stockholm Region, Sweden, serving 2.4 million inhabitants across approximately 240 primary healthcare centres. The full‐scale implementation occurred from May 2021 to February 2023, utilising a double‐reading teledermatoscopy system. The RE‐AIM framework (reach, effectiveness, adoption, implementation, maintenance) guided the evaluation, including measures such as participant engagement, referrals, diagnoses, staff participation, and centres going on post‐implementation. Descriptive statistics were used.ResultsIn the full‐scale implementation period, 10,862 referrals were transmitted, with 17% recommended for biopsy or excision. Among these, 282 (15%) were confirmed melanomas and 516 (28%) non‐melanoma skin cancers. Challenges were observed during the stepwise phase, particularly in engaging primary healthcare and establishing dermatologic consultation capacity. However, all centres and 1263 primary care physicians participated in the fully scaled implementation. Challenges included contractual compliance, adopting a collective system perspective, effective management transition of referrals, cost allocation, and communication improvements. Six months post‐study, most centres used the system, with around 1500 monthly referrals.ConclusionsThe evaluation revealed the overall satisfactory performance of the teledermatoscopy system in terms of reach, effectiveness, adoption, implementation, and maintenance during the fully scaled phase. Results underscore the effectiveness of a stepwise implementation to successfully address contextual challenges. The findings emphasise the system's potential for a broader patient outreach. In conclusion, implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system is an organisational challenge but has the potential to improve healthcare quality for suspected malignant skin lesions.

Organizational resilience and transformational leadership for managing complex school systems

IntroductionIn the context of global challenges facing educational institutions, this study explores the dynamics between transformational leadership, collective teacher efficacy, and organizational resilience in school systems. Specifically, it examines the mediating role of collective teacher efficacy in the relationship between middle leaders’ transformational leadership and organizational resilience.MethodsThe study involved data collection from 103 middle-leaders and 506 randomly selected secondary school teachers across Israel. Structural equation modeling was used to analyze the data, focusing on the mediating role of collective teacher efficacy in the relationship between transformational leadership and organizational resilience.ResultsThe analysis revealed that collective teacher efficacy fully mediates the relationship between middle-leaders’ transformational leadership and organizational resilience. Middle-leaders’ transformational leadership positively impacts collective teacher efficacy, which in turn enhances organizational resilience. The study’s findings suggest that educational institutions can significantly increase their organizational resilience by fostering transformational leadership and strengthening collective teacher efficacy.DiscussionThe implications of these findings are both theoretical and practical. Theoretically, the study expands the understanding of the interplay between leadership styles and organizational resilience in educational settings. Practically, it provides insights for educational policymakers and practitioners aiming to enhance the resilience of schools by promoting transformational leadership and collective teacher efficacy.

The transformative potential of local stakeholder engagement in the reintroduction of a contested species

Wildlife translocations for conservation purposes are carried out in complex socio-political environments where diverse stakeholders are key to shaping outcomes. Nevertheless, social feasibility and participatory processes are often not fully integrated into the delivery of legitimate and effective conservation actions. We investigated how stakeholder engagement can be delivered in practice and how this delivery is linked to the transformative potential of conservation translocations. We studied the proposed reintroduction of hen harriers Circus cyaneus to southern England in the context of chronic conflicts surrounding the conservation of this species in the UK. We aimed to (a) identify the perspectives of key local stakeholders, focusing on project desirability and drivers, and (b) examine how social engagement processes during project development and implementation could shape reintroduction success. We adopted a qualitative approach comprising participant observation and sixteen semi-structured stakeholder interviews, which we analysed thematically using the Framework Method. Perspectives on the translocation project were overall positive, especially regarding the potential return of hen harriers. However, there were also tensions between the perceived suitability of the local context for reintroduction, and the unsuitability of the national context, due to chronic disagreement among conservationists over hen harrier management. Engagement activities, timing, team composition and the project's open, on-the-ground approach fostered stakeholder engagement and initiated collaborative processes, holding socio-ecological transformative potential for hen harrier management and possibly broader biodiversity conservation. Even within challenging national contexts, therefore, honest stakeholder engagement could enable the alignment of interests, challenging entrenched conservation conflicts at different scales through a bottom-up dynamic.

3D printing for the reinterpretation of architectural heritage: Proposal of a model

3D printing for the reinterpretation of architectural heritage stands out as one of the most efficient ways of using contemporary printing technologies in terms of architecture. The aim of the study is to present a comprehensive methodology on how to use 3D printing techniques for reinterpretation of architectural heritage. In this context, the scope of the study consists of pioneering information obtained from literature studies focusing on the details of the use of three-dimensional printing techniques in the promotion, preservation and remodeling of cultural heritage and architectural heritage components. The method of the study was determined as identifying leading themes through literature research and presenting a method proposal by grouping conceptually related themes. The unique value of the study is important in that the model to be created offers a potential to affect mass production tools, offices and local governments by incorporating contemporary architectural heritage products into a modeling process that can produce more innovative and faster solutions. The findings of the study show that the different techniques used can respond to different detail scales and different contextual challenges. Each modeling method and strategy creates different feedback mechanisms, mediating the recognition of the architectural heritage element by larger user groups or the more effective protection of the architectural heritage element. In the model presented as a result of the study, which mediates the gathering of the techniques used in different sample projects on a common working ground with a series of successive strategies, a comprehensive basis for which 3D printing solution will be used for which problem is presented and solution suggestions are offered for a case-oriented 3D printing strategy.

An Exploration of Ethiopian Technical and Vocational Training Institute English Teachers’ Views and Classroom Application of Student-Centered Learning Principles

This study examined the perceptions and practices of Federal Democratic Republic of Ethiopian Technical and Vocational Training Institute English teachers regarding student-centered learning. Interviews, focus group discussion and classroom observations revealed that while teachers generally hold positive attitudes towards student-centered approaches, their actual classroom practices often remain teacher-centered, heavily relying on textbooks and overlooking trainees' interests. The study identified several challenges, including a lack of practical skills for implementing student-centered methods, the constraints of summative assessments, and the need for continuous formative feedback. Addressing the gap between theory and practice will require professional development that integrates practical experience and the implementation of flexible policies that support teacher autonomy and curricula tailored to trainees' needs. These findings provide valuable insights into the contextual challenges faced by educators and suggest ways to better align teaching practices with the evolving demands of the workforce through ongoing improvement and localized responsiveness.

Home Sweet Home? The Mediating Role of Human Resource Management Practices in the Relationship between Leadership and Quality of Life in Teleworking in the Public Sector

Remote work in pandemic times has become a strategic alternative for organizations and has persisted in the post-pandemic context, remaining present in hybrid models of work arrangements, blending in-person work and telework. Thus, this paper proposes a model to identify the relationships between leadership, human resource management (HRM) practices, and quality of life in teleworking (QoLT) for civil servants. For this purpose, a structural model was tested in which HRM practices mediated the relationship between leadership and QoLT. The relationships assumed in the analysis of the tested mediation model were significant, confirming all four hypotheses researched. The novelty of the tested mediation model is the greatest contribution of this work, demonstrating the crucial role that HRM practices play in the relationship between leadership and QoLT. As practical implications, this research has yielded a diagnosis, allowing for a better understanding for public managers of how leadership and HRM practices are related and how they influence quality of life in the challenging context of teleworking. The findings suggest that leadership has a strong impact on HRM practices, highlighting the crucial role of leadership in shaping teleworkers’ perceptions of HRM practices. Additionally, leadership significantly influences the quality of life in telework, amplifying this impact through the perception of HRM practices. Therefore, leaders should be attentive to how relationship-building, training and development, and performance and competency evaluation in HRM practices are implemented and executed, as they profoundly influence the promotion of quality of life, considering the complex and challenging environment of telework, including workload, social distance, and work–family conflict.

Participation, assertion and aspiration-indigenous teacher agency in higher education

ABSTRACT Educational research often silences teachers’ voices, distorting perspectives. This article delves into the marginalized voices of educators and administrators, focusing on Indigenous agencies within higher education (HE) in the state of Jharkhand, India. Employing the narrative interview method of oral history, it elucidates life stories through lived experiences amidst conflicting educational paradigms. Drawing from the author’s doctoral research, the article provides a historical and socio-political context of colonial legacies and contemporary challenges faced by Indigenous communities in India self-identifying as ‘Adivasi.’ Synthesizing an analytical framework through a ground-up approach, agency theories uncover new themes within HE’s temporal, spatial, and personal-social space. The findings describe counter-strategies against systemic denial of Indigenous agency within HE, contributing to discussions on the requirement of context-specific epistemic frameworks for India’s Tribal communities to assert their voices and choices in HE.

Globalization and the global trending dimensions of the labor market in a challenging context: Aspects and insights

Abstract This paper presents, describes and analyzes globalization and the global trending dimensions of the labor market and business in a challenging context. The research method started with an initial literature review then it focused on data analysis, interpretation and description, the research focus as well on creating frameworks illustrated in the part of analysis to analyze and illustrate some results and ideas. The research question is “how could globalization lead the labor market to a challenging context with and within the global trending dimensions? The results showed that globalization structured the labor market and economies and extended their global dimensions by facing facts such as skills, inflation, trade options, different economic sectors and societies, wage effects and even immigration. However, it always faces the question of employment and unemployment that affect the economy and the global society since it divided the world between developed and developing economies. In conclusion, globalization has led the labor market to a challenging context with global trending dimensions, negotiations and political adjustments are important to balance social and economic needs in order to avoid a global crisis, the labor market and its trends are important for both economic and social development.

Introducing Empowered Consent to Deal With the Current Challenges in Applied Sport Psychology

There has been a paucity of literature discussing how to address consent procedures as part of ethics, practitioner development, and best practice in applied sport psychology. Several researchers have addressed ethical challenges (e.g., out-of-session contact, overidentification, time, and space). However, none have substantially considered the sport-specific issues related to consent, which sits at the heart of best practice. The scarcity of discussing consent is limiting sport psychology’s potential to establish itself as a more recognized profession. This article highlights some contextual issues that challenge the idea and efficacy of informed consent. It proposes adapting consent procedures in the collaboration between sport psychology practitioners and clients to better address the current contextual challenges in applied sport psychology. In doing so, the current paper introduces Empowered Consent, which is specifically designed to empower athletes and address challenges related to choosing interventions, contractual obligations, visibility in the environment, and staff trying to gain insights into confidential information. The author offers a model to enhance applied practice for those collaborating with athletes and other clients in sport.

A research on destress mechanism of underlying roadway for gas outburst prevention in deep, low‐permeability coal seam

AbstractGas outbursts pose a significant threat in the mining of deep low‐permeability coal seams. As mining depth increases, there is a rise in coal and gas dynamic disasters, rendering the gas outburst prevention technology from shallow mining areas unsuitable for deep coal seam exploitation. Addressing the challenges posed by deep, highly gassy coal seams, this study introduces a gas outburst prevention technology integrating destressing in the close distance underlying roadway with gas drainage. The article investigates the relevant technical parameters and assesses the feasibility of this approach. First, it establishes destressing model for the underlying roadway to derive an analytical solution for stress distribution in the coal seam. Second, appropriate technical parameters are designed considering the seepage characteristics of gas in the coal seam. Finally, the gas drainage technical scheme is implemented at Qujiang coal mine to verify its on‐site effectiveness. Field test results indicate an increase in gas permeability within the coal seam following destressing in the underlying roadway, accompanied by significant improvements in the efficiency of gas drainage and the advancement speed of the coal roadway. Specifically, the driving speed of the coal roadway has escalated from 40 m/month to 150 m/month. These outcomes demonstrate the potential of this technology as a promising approach for preventing gas outbursts in the challenging context of deep, low‐permeability coal seams, facilitating swift coal roadway excavation.

Multisectoral approaches for sustainable food and nutrition security actions in Ethiopia

Ethiopia has demonstrated a commitment to tackling the high burden of Food and Nutrition Security (FNS) challenges by developing and implementing various policies, strategies, and programs. Despite the efforts, the current FNS situation is of significant public health concern observed by various nutrition indices. The narrative review aimed to appraise multisectoral policy, strategic and programmatic initiatives aimed at addressing FNS challenges and identify entry points for enhancing coherent and integrated FNS approaches. The review involved broad literature research using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. A total of 1,086 articles and grey literature were identified. Out of this, 47 full-text articles and documents met the selection criteria and were included in this review. Evidence was synthesized in themes to characterize the successes and challenges of key FNS policies, strategies, and programs and identify potential areas of improvement to enhance multisectoral actions and address FNS challenges. Overall, Ethiopia has made considerable progress in enhancing FNS through the implementation of a range of FNS policies, strategies, and programs such as the National Nutrition Program (NNP), Productive Safety Net Program (PSNP), and Agricultural Growth Program (AGP) among others. These efforts have resulted in notable achievements, such as the reduction of the prevalence of undernourishment from 47.0% in 2000 to 24.9% in 2020 and the reduction of stunting among children under five years from 57.4% to 35.2% over the same period. Nonetheless, the pace of progress has been hindered by various contextual and programmatic challenges such as climatic shocks, poverty, high inflation, political instability, limited access to production resources, inadequate coverage of FNS interventions, inadequate financing, and inadequate multisectoral coherence and integration. A comprehensive and integrated multisectoral FNS approach focusing on enhancing commitment, planning, coordination, financing, capacity building, and accountability across sectors and levels is imperative. Strengthening coherence across various sectors, alongside the operationalization of robust multisectoral monitoring and evaluation systems highlighted in the National Food and Nutrition Strategy, constitutes the most suitable entry points for ensuring sustainable advancement in mitigating the prevailing FNS challenges in Ethiopia. Key words: Food and nutrition security, policy and program, multisectoral approaches, Integration, Ethiopia