International Setting Research Articles

Measures to increase the retention of migrant healthcare professionals in Germany

Abstract Background The shortage of skilled workers in the healthcare sector is a pressing issue in Germany that has been worsening in recent years. It is often compensated by the deployment of specialists from abroad. However, this is accompanied by various challenges. This article synthesizes challenges from nine years of research and proposes approaches to solutions that have proven successful in practice in Germany as well as in international settings. Methods The insights presented here condense the results from a total of six research projects (four on physicians and two on nursing). The research projects are based on exploratory qualitative interviews, quantitative questionnaires, mixed-methods designs, and the generation and testing of measures that can help with the integration of foreign skilled workers. Results The main challenges for migrated skilled workers are inadequate language and communication skills, lack of knowledge about the national healthcare system, disease and therapy concepts, unfamiliar forms of inter-hierarchical and inter-professional collaboration, a lack of understanding of administrative and bureaucratic processes and social integration. The following measures have proven successful in Germany and abroad: increasing social integration of physicians (e.g. through partner or peer programs), streamlining systems, establishing professional structures for the integration of foreign skilled workers, and creating a positive work environment. Conclusions Compared to findings from international studies, in Germany the hurdles of administrative processes, the peculiarities of the healthcare system (e.g. social medicine), and learning the language are considered to be the highest. It is important to counteract these challenges with appropriate measures in order to prevent a migration of healthcare professionals already in Germany to (mostly English-speaking) foreign countries. Key messages • In Germany the hurdles of administrative processes, the peculiarities of the German healthcare system (e.g. social medicine), and learning the German language are considered to be the highest. • It should be considered to no longer leave the migration of healthcare staff to individual integration efforts, but to create appropriate government structures that focus on their social integration.

What long-term health outcomes can we anticipate for children who have been in social care?

Abstract The concept of cumulative disadvantage suggests that setbacks in one area of life not only lead to further challenges within that domain but also increase vulnerability to adversities across different domains, as highlighted in life course studies. In the context of children with a history of childhood social care (CSC) experience, research consistently shows poorer long-term health outcomes compared to peers without such experiences. This disparity persists into middle age and can affect subsequent generations, underscoring the enduring impact of early-life adversity. Dr Viviane S. Straatmann, a social epidemiologist based in Sweden and enriched by her experience in studying the health and social life of vulnerable children in diverse international settings, will offer insights from life-course and intergenerational epidemiological studies. She will explore the intricate web of disadvantages preceding children’s entry into social care, shedding light on the complex interplay between early-life adversity, cumulative disadvantage, and long-term health outcomes. Participants will engage in reflective dialogue on pertinent questions, such as how cumulative disadvantage informs interventions for children with CSC backgrounds, the potential mechanisms underlying the contribution of early-life adversities to long-term health disparities, and the ways intergenerational studies can inform strategies for breaking the cycle of disadvantage.

Entrepreneurial alertness, international performance, and the role of effectuation in SME internationalization

ABSTRACT By shedding light on the often-overlooked early stages of opportunity development initiated by entrepreneurial alertness and its performance outcomes in an international setting, this study examines the interplay between alertness and two decision-making logics, effectual flexibility and causal prediction, in the context of small- and medium-sized enterprises (SMEs) internationalization. Leveraging structural equation modeling on a data set of 680 manufacturing SMEs across five countries, this study uncovers distinct effects: effectual flexibility moderates, while causal prediction mediates, the positive relationship between alertness and the international performance of SMEs. The research makes noteworthy contributions to international entrepreneurship literature by linking alertness with performance in the international context and disentangling the nuanced pathways through which SMEs can achieve success in the global arena.

International Promotion Strategies and Students' Desire to Participate in Martial Arts Program in a Selected University in Beijing, China

Martial arts programs have long been celebrated for their holistic approach to physical, mental, and social development. In the context of modern education, universities worldwide have recognized the significance of incorporating martial arts into their offerings as a means to promote student well-being and holistic growth. As such, understanding the factors that influence students' desire to participate in martial arts programs has become increasingly vital for universities seeking to enhance student engagement and satisfaction. Research in various contexts has shed light on the diverse nature of students' motivations and the factors that contribute to their engagement in martial arts training. Studies such as those by Choi et al. (2021), Gutiérrez-García et al. (2018), and Kudláček et al. (2019) have explored the physical, social, psychological, and physiological effects of martial arts participation among diverse populations. These studies highlight the importance of considering a wide range of factors, including physical fitness improvements, social interactions, psychological outcomes, and individual preferences, when designing martial arts programs tailored to students' needs. The integration of social media platforms into martial arts education and promotion has revolutionized the way practitioners engage with the sport. Research suggests that social media plays a pivotal role in facilitating martial arts learning through various means such as video sharing, exchange of teaching materials, and interactive teacher-student communication (Xie et al., 2022). Furthermore, to propel the entry of Chinese martial arts events into the Olympic Games, scholars advocate for leveraging social media platforms to promote events and organize competitions, thus enhancing global visibility and participation (Xie et al., 2022). Indeed, community involvement is paramount in promoting martial arts, as evidenced by studies indicating the influence of social media marketing activities, user experience, and sport attachment on participation intentions (Xie et al., 2022). By harnessing the power of social media, martial arts organizations can expand their reach, attract new participants, and foster a sense of community among practitioners (Xie et al., 2022). Scholars emphasize the intrinsic connection between Chinese martial arts and broader cultural and philosophical concepts, advocating for leveraging international platforms to promote cross-cultural exchange and appreciation (Jennings, 2014; Wang, 2010). However, strategic considerations and challenges abound in international promotion efforts, necessitating a comprehensive approach involving government leadership, interdisciplinary cooperation, and tailored communication strategies (Yu, 2016; Qiao, 2016). By incorporating martial arts into educational settings, students not only enhance their physical fitness and self-defense skills but also develop a deeper appreciation of Chinese heritage and values (Shi, 2009; Chen, 2013). As part of this broader landscape, students' desire to participate in martial arts programs emerges as a complex interplay of various factors. Perceived benefits, such as physical fitness improvements and mental well-being, serve as strong motivators for participation (Dahle, 2017; Gutiérrez-García et al., 2018). Additionally, the social dimension of martial arts training, characterized by communal settings and supportive relationships, plays a pivotal role in fostering continued engagement (Choi et al., 2021; Anam et al., 2024). Moreover, the motivational climate within martial arts programs, shaped by clear goals and supportive environments, influences students' intrinsic motivation and long-term commitment (Silva et al., 2019; Xie et al., 2022). Individual characteristics and preferences contribute to students' desire to participate in martial arts programs, as they are drawn to specific styles, disciplines, and cultural backgrounds (Maor, 2019; Alsarve & Tjønndal, 2019). By tailoring programs to accommodate diverse interests and needs, organizers can foster inclusivity and enhance engagement among students (Maor, 2019; Alsarve & Tjønndal, 2019). The intersection of social media, international promotion strategies, technological innovations, and students' motivations underscores the dynamic and multifaceted nature of the martial arts landscape. Understanding these interconnections is vital for stakeholders seeking to promote and sustain the practice of martial arts in an increasingly interconnected and diverse world. Moreover, the promotion of martial arts programs on an international scale presents unique opportunities and challenges, particularly in multicultural university environments like Beijing, China. Understanding how international promotion strategies intersect with students' desire to participate in martial arts programs is essential for universities aiming to attract and retain diverse student populations. Research in this area can provide valuable insights into effective promotional approaches and program design considerations that cater to the needs and interests of both local and international students. Therefore, this study aims to investigate the relationship between international promotion strategies and students' desire to participate in martial arts programs at a selected university in Beijing, China. Thus, the researchers seeks to contribute to a deeper understanding of the factors influencing students' engagement in martial arts training within the context of international higher education settings. Through empirical investigation and analysis, this study aims to provide actionable recommendations for university administrators and program organizers to enhance student participation and satisfaction in martial arts programs.

Decision-Based Learning as an Approach for Teaching Statistics in a Peruvian University

Many students find learning statistics difficult, especially novice learners. Instructors also struggle to teach statistics due to many challenges, such as students’ misconceptions, lack of math skills, negative attitudes, and deficient instructional methods. A new pedagogical approach called Decision-Based Learning (DBL) has been developed to help instructors and students; however there are limited studies about teachers’ and students’ experiences with this method, particularly in international settings. For this project, a group of Peruvian university professors were trained to use DBL. This qualitative study sought to understand the experiences of one Peruvian statistics instructor and her students implementing DBL pedagogy and software. The DBL software was created to help instructors easily implement DBL. Findings identify specific benefits and challenges participants faced when using DBL. Benefits included the growth of students’ confidence in solving statistical problems and instructor satisfaction. Challenges included time-consuming instructor initial preparation and students’ learning transfer issues.

Ethics in Global Plastic Surgery Missions.

Delivering ethical care in global plastic surgery is challenging due to the unique complexities of resource-limited settings. Additionally, the rise of medical tourism has highlighted the importance of informed consent and awareness of the potential risks that are associated with seeking medical care in foreign countries. This article aims to consider core medical ethics principles and apply them in the context of delivering global plastic surgery. This article examines the application of the four core medical ethics principles in a framework set forth by Beauchamp and Childress, namely autonomy, beneficence, nonmaleficence, and justice, in the context of delivering plastic surgery in international settings. A literature review was performed, where all potential global plastic surgery articles were reviewed to better understand the application of the four core medical ethics framework in this context. Increased communication between visiting surgeons and local healthcare providers; heightened education of surgeons traveling to low-to-middle-income countries regarding local medical practices, resource availability, and cultural norms before providing surgical education; and a greater emphasis on collecting and publishing data analyzing short- and long-term outcomes in low-to-middle-income countries are all likely to improve the success of international medical missions, ensuring that all patients receive medical treatment in a manner that upholds Beauchamp and Childress' four core medical ethics principles. Providing plastic and reconstructive surgery abroad can be done ethically if the four main principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) are used.

Development of an Emergency Department Safety Checklist through a global consensus process.

Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. Athree-round modified Delphi consensus processwasconductedwith a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.

Encounters and disencounters in becoming creative workers: motivations and experiences of postgraduate East Asian students in an elite UK university

In this paper, I examine the motivations and experiences of international postgraduate students from East Asia in a creative industries-related (digital media) master’s program in the United Kingdom/UK. Grounded on the landscape of neoliberalisation and internationalisation of Higher Education/HE in Anglophone contexts, on the emergence of the creative industries (including in HE settings), and on notions of coloniality and locality, I examine the encounters and disencounters between international students’ expectations and professional aspirations, and their experiences in a digital media degree in a highly ranked UK university. From interviews with seven former students, two main findings emerged from this study: an interest in becoming creative media workers and an articulation of different values attributed to Western/UK HE. These findings highlight encounters and disencounters between participants’ expectations and the degree, and shed light on the diversity across an apparently homogenous student body and on how different geo-onto-epistemologies (i.e. the indissociable links between localities, realities, and knowledges) around creative industries and HE mediate these students’ expectations and experiences. Such findings can be relevant to the creative industries HE community, especially to those interested in the generative pedagogical and curricular potential of (dis)encounters in international and intercultural creative industries HE settings.

Board Gender Diversity and Workplace Safety: Evidence From Quasi‐Natural Experiments

ABSTRACTResearch Questions/IssueThis paper examines the impact of board gender diversity on workplace safety in an international setting from 2002 to 2019. Utilizing gender quotas on corporate boards as a quasi‐natural experiment, we explore the causal effects of gender diversity on workplace safety, highlighting the significant influence of corporate board gender quotas on corporate policies.Research Findings/ResultsUsing a sample of 13,124 firm‐year observations from 48 countries, our findings reveal that gender quotas on corporate boards are linked to higher rates of work‐related injuries. The association is particularly strong in financially constrained firms, as well as in those with high workloads and low investments in workplace safety. In contrast, this effect is mitigated in firms located in countries with strong institutional frameworks and high union representation. The results hold across various regression specifications and remain robust when considering different measures of workplace injuries, board gender diversity, and additional control variables.Theoretical ImplicationsOur study draws on gender behavior theory, social role theory, and gender socialization theory, with findings particularly aligning with gender behavior theory. It advances understanding of how changes in corporate governance structures related to board diversity influence workplace safety. This research underscores the importance of further empirical work to expand this area of study, suggesting valuable directions for future research through cross‐sectional and longitudinal analyses.Practical ImplicationsThe findings provide critical insights for policymakers considering the implementation of gender quotas in boardrooms. Additionally, this research highlights the need for further exploration of unexamined aspects within governance studies, which will significantly influence future policy debates, legislative processes, and corporate practices in promoting gender diversity and enhancing workplace safety.

The Instruments Used to Counter Illicit Financial Flows at the International Level and Their Application to Matters of Taxation

Tax-related illicit financial flows (TIFFs) deprive states of much-needed public resources and hinder revenue mobilization from achieving sustainable development efforts. Currently, there is no conceptual clarity on the phenomenon of TIFFs, with different definitions and approaches adopted within different regional and international settings. To address the existing gaps, this study starts by mapping the diverse qualifications of TIFFs with particular regard to the different legal statuses that can be attached to behaviour deemed illicit. This requires a clarification of the conceptual differences between tax evasion and tax avoidance, and more specifically, between criminal law and (criminal) tax law. While the international tax law agenda has prioritized countering tax avoidance, the issue of tax evasion remains inadequately addressed within the existing framework. In this regard, this study concludes that when it comes to aligning the notion of tax crimes as predicate offence for existing criminal law, countries should be allowed to keep their de minimis qualifying rules to ensure flexibility and respect national sovereignty, thus ensuring proportionality and the respect for taxpayers’ fundamental rights.

Attempting an Ontology of Participatory Film

In this video-essay, participatory filmmaker, Paul Cooke, and social anthropologist, Stephanie Schwandner-Sievers, discuss in detail images from two activist-focussed, participatory video projects Cooke has run with young people in South Africa and Lebanon. They ask whether participatory film can communicate their creators’ activist intentions to audiences often far removed from the original context of production. They challenge themselves to answer this question by deliberately juxtaposing their respective disciplines’ distinct philosophical approaches to ontology. Bazin’s foundational discussion of the ontology of the photographic image (as a universally relatable ‘essence’ encapsulated in the image) is juxtaposed with anthropology’s ‘ontological turn’ (a radical cultural-relativist focus on people and contextually situated meaning). The video-essay reflects on whether the young participant filmmakers’ aesthetic choices generate images which speak for themselves or, alternatively, whether the transfigurations these images undergo through different registers of representation and curation – as the films move from community showcasing event to international film festival or academic setting – change their originally-intended meanings. In identifying tensions between proximity and distance, intimacy and exploitation, the potentials and limitations of mediating local activists’ voices to remote audiences through film is left up to the spectator for final arbitration.

Twenty years of action learning in the journal Action Learning: Research and Practice

ABSTRACT This paper provides a thematic analysis of research papers published in Action Learning: Research and Practice over the past 20 years. The analysis concentrates on the different contexts in which action learning has taken place and on the variations of action learning that have been presented in different papers. Contexts discussed in this paper are different international settings for action learning, and the use of action learning in healthcare, for social action, for small and medium-sized enterprises, and in higher education. Variations and developments of action learning are critical action learning, virtual action learning, and action learning research.

Analysis of a newly developed multidisciplinary program in the Middle East informed by the recently revised spina bifida guidelines.

This paper describes the development and characteristics of a multi-disciplinary spina bifida clinic in Qatar considering the recently revised and globally available Guidelines for the Care of People with Spina Bifida (GCPSB). A retrospective chart review was performed on individuals in Sidra's multidisciplinary spina bifida clinic database from January 2019 to June 2020. Their electronic health records were reviewed for demographics, as well as neurosurgical, urologic, rehabilitation, and orthopedic interventions. There were 127 patients in the database; 117 met inclusion criteria for diagnoses of myelomeningocele, meningocele, sacral agenesis/caudal regression, and/or spinal lipoma. Generally, Qatar is following GCPSB recommendations for multidisciplinary care. Consanguineous relationships, difficulties with access to urological and rehabilitation supplies and equipment, school access, and variable timing of neurosurgical closure were areas that demonstrated differences from GCPSB recommendations due to barriers in implementation. The GCPSB recommendations are applicable in an international setting such as Qatar. Despite a few barriers in implementing some of the recommendations, this new multi-disciplinary spina bifida clinic demonstrates alignment with many of the GCPSB guidelines.

Board Responsibility for Irresponsibility: The Link Between Board Structure and Corporate Scandals

Based on an international data set that comprises over 6,100 companies located in 44 countries in the years 2002–2018, this paper analyzes the relation between corporate scandals and board structures besides further firm-related, political, nation-level economic, and cultural variables. We identify board structure variables that are positively associated with a firm’s corporate scandals, namely high CSR efforts and busy board members. There are also variables that are negatively associated with this kind of behavior, namely qualified and skilled boards. No clear evidence can be determined from a board’s gender diversity, independent board members, and board size.

Three Lessons for Adapting Mental Models for Unfamiliar Foreign Environments

Managers’ reliance on established mental models for decision-making, without adapting them to the relevant context, presents risks when integrating into a foreign market. As the mental models may be calibrated to other, more familiar, contexts, they can lead to misunderstandings and errors when applied in unfamiliar international settings. We introduce a framework on how managers can use disruptive stimuli as a driver to update mental models. Building on it, we provide three lessons – Experience it!, Feel it!, and Repeat it! – through which managers can enhance their market integration, and avoid pitfalls arising from misalignment with the environment.

Feasibility and success of a non-sedated brain MRI training protocol in 7-year-old children from rural and semi-rural Colombia.

Brain magnetic resonance imaging (MRI) is a crucial tool for clinical evaluation of the brain and neuroscience research. Obtaining successful non-sedated MRI in children who live in resource-limited settings may be an additional challenge. To present a feasibility study of a novel, low-cost MRI training protocol used in a clinical research study in a rural/semi-rural region of Colombia and to examine neurodevelopmental factors associated with successful scans. Fifty-seven typically developing Colombian children underwent a training protocol and non-sedated brain MRI at age 7. Group training utilized a customized booklet, an MRI toy set, and a simple mock scanner. Children attended MRI visits in small groups of two to three. Resting-state functional and structural images were acquired on a 1.5-Tesla scanner with a protocol duration of 30-40minutes. MRI success was defined as the completion of all sequences and no more than mild motion artifact. Associations between the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Movement Assessment Battery for Children (MABC), Behavioral Rating Inventory of Executive Function (BRIEF), Child Behavior Checklist (CBCL), and Adaptive Behavior Assessment System (ABAS) scores and MRI success were analyzed. Mean (SD) age at first MRI attempt was 7.2 (0.2) years (median 7.2 years, interquartile range 7.1-7.3 years). Twenty-six (45.6%) participants were male. Fifty-one (89.5%) children were successful across two attempts; 44 (77.2%) were successful on their first attempt. Six (10.5%) were unsuccessful due to refusal or excessive motion. Age, sex, and scores across all neurodevelopmental assessments (MABC, TVIP, ABAS, BRIEF, CBCL, NIH Toolbox Flanker, NIH Toolbox Pattern Comparison, WPPSI) were not associated with likelihood of MRI success (P=0.18, 0.19, 0.38, 0.92, 0.84, 0.80, 1.00, 0.16, 0.75, 0.86, respectively). This cohort of children from a rural/semi-rural region of Colombia demonstrated comparable MRI success rates to other published cohorts after completing a low-cost MRI familiarization training protocol suitable for low-resource settings. Achieving non-sedated MRI success in children in low-resource and international settings is important for the continuing diversification of pediatric research studies.

Multidisciplinary care meeting practices across diverse international settings.

Multidisciplinary care (MDC) meetings improve the quality of cancer care by providing a space for interdisciplinary communication. The Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool assesses MDC meetings as part of the Service Integration module. We aimed to evaluate the characteristics of MDC meetings at institutions that completed PrOFILE. From 2019 to 2021, 112 institutions from 23 countries collected data by utilizing the abbreviated version of PrOFILE. Within a secondary data analysis, we descriptively analyzed the characteristics of MDC meetings stratified by income level. Participating institutions were located in low-income countries (LICs) (n = 6), lower-middle-income countries (LMICs) (n = 34), upper-middle-income countries (UMICs) (n = 55), and high-income countries (HICs) (n = 17). Of the 112 participating facilities, 79% reported having MDC meetings. The existence of an MDC varied with income, with 50% of LICs and 100% of HICs hosting MDCs. The frequency of MDC meetings also differed, with 100% of MDCs in LICs occurring weekly, while 53% of MDCs in HICs occurred monthly. Specialties regularly represented at MDC meetings across all participating institutions were hematology/oncology (93%), pathology (52%), radiology (60%), general surgery (57%), and radiation oncology (51%). All MDC meetings in LICs reported representation from these specialties. Availability of test results and discussion of new cases did not vary with income. Residual disparities were identified for the following characteristics: discussion of new and interesting cases, inclusion of patient preferences, and ability to meet urgently. The existence and components of a functional MDC meeting may vary between countries' income levels. Variation in certain components, such as access to tests, may be due to differences in resource distribution, but other factors such as inclusion of patient preferences and ability to meet urgently can be optimized in all settings to foster high-quality teamwork and communication.

Global overview of national regulations for antibiotic use in aquaculture production

The intensification of aquaculture industries around the globe has led to increased susceptibility and exposure to diseases. To ensure the well-being of animals and the profitability of the industry, many aquaculture farms resort to antibiotic treatments. However, with the increasing presence of antimicrobial resistance (AMR), it has become important to regulate and limit the use of antibiotics, especially in animal production and regarding the antibiotics that are deemed as critically important for human health by the World Health Organization (WHO). This review describes how AMR mitigation strategies have developed over time in international settings and how they relate to aquaculture. Furthermore, we analyzed how different countries and regions abide by these statutes, as well as the antibiotic standards from a selection of certification schemes. Our results show that the role of aquaculture has been inexplicitly addressed in international guidance documents and that there is a need to further increase the activities of aquaculture operations in combating AMR, with an emphasis on alternatives to antibiotic use. We also found that most countries and regions allow the highest priority-, or critically important antibiotics in aquaculture, which could have detrimental effects on animal, environmental, and public health. As a result, most countries fail to comply with the recommendations and standards set by international organizations and certification schemes.

Trade Wars, Nominal Rigidities, and Monetary Policy

Abstract This paper shows that the outcome of trade wars for tariffs and welfare will be affected by the monetary policy regime. The key message is that trade policy interacts with monetary policy in a way that magnifies the welfare costs of discretionary monetary policy in an international setting. If countries follow monetary policies of flexible inflation targeting, trade wars are relatively mild, with low equilibrium tariffs and small welfare costs. Discretionary monetary policies imply much higher tariffs, high inflation rates, and substantially larger welfare costs. We quantify the effects of a global trade war among major economies using estimates of trade elasticities, economic size, net foreign assets, and trade openness. We find large welfare benefits of an inflation targeting monetary policy for all countries.

China’s New Pattern of Rule of Law on UAS

China as the world’s prominent market for Unmanned Aircraft Systems (UAS) has just passed a new regulation on UAS. The new regulation is expected to form a new pattern of rule of law on UAS in China. With the need for harmonisation of laws internationally, this article highlights the three aspects out of China’s new UAS legislation against an international setting.