Key Recommendations Research Articles

The Urgency of Stakeholder Cyberspace Collaboration to Support Indonesia’s National Defense

In today's interconnected digital world, stakeholder collaboration in cyberspace is crucial for national defense. Advances in information and communication technology have transformed daily life but also introduced complex cyber threats like cyber warfare, cybercrimes, and cyber terrorism, challenging security and stability. The objective of this study is to emphasize the importance of collaboration among diverse stakeholders in enhancing national defense against cyber threats. The methodology involves analyzing existing literature and case studies to understand the impact of collaboration on cybersecurity maturity and national defense strategies. The research findings, derived from SWOT and PESTLE analyses, have highlighted the strengths and weaknesses in collaboration, underscoring the significance of leveraging strengths and addressing weaknesses to establish a robust defense framework. To enhance national defense against cyber threats, a holistic approach is essential, combining political collaboration, economic partnerships, social awareness programs, technological advancements, legal harmonization, and environmental resilience strategies. Key recommendations include fostering regular communication among stakeholders, pooling resources for cybersecurity investments, promoting cybersecurity education, integrating advanced technologies like AI and IoT security solutions, and aligning legal frameworks across jurisdictions.

Gaps in the Global Regulatory Frameworks for the Use of Artificial Intelligence (AI) in the Healthcare Services Sector and Key Recommendations.

Artificial Intelligence (AI) has shown remarkable potential to revolutionise healthcare by enhancing diagnostics, improving treatment outcomes, and streamlining administrative processes. In the global regulatory landscape, several countries are working on regulating AI in healthcare. There are five key regulatory issues that need to be addressed: (i) data security and protection-measures to cover the "digital health footprints" left unknowingly by patients when they access AI in health services; (ii) data quality-availability of safe and secure data and more open database sources for AI, algorithms, and datasets to ensure equity and prevent demographic bias; (iii) validation of algorithms-mapping of the explainability and causability of the AI system; (iv) accountability-whether this lies with the healthcare professional, healthcare organisation, or the personified AI algorithm; (v) ethics and equitable access-whether fundamental rights of people are met in an ethical manner. Policymakers may need to consider the entire life cycle of AI in healthcare services and the databases that were used for the training of the AI system, along with requirements for their risk assessments to be publicly accessible for effective regulatory oversight. AI services that enhance their functionality over time need to undergo repeated algorithmic impact assessment and must also demonstrate real-time performance. Harmonising regulatory frameworks at the international level would help to resolve cross-border issues of AI in healthcare services.

Contemporary Practice and Considerations for Real-World Data Source Identification and Feasibility Assessment.

There has been rapid growth in the variety and number of real-world data (RWD) sources, as well as the number of regulatory documents that provide guidance for assessing the suitability of RWD sources for pharmacoepidemiology studies. This study aims to assess differences in RWD guidance and variability in current practice for identifying and assessing RWD for studies with regulatory purpose. Key criteria for feasibility assessment were mapped against relevant regulatory guidance documents across US, EU, and Asia-Pacific regions. An online survey was designed and deployed to International Society for Pharmacoepidemiology members to understand current practice. Findings were summarized and used to inform key considerations and recommendations. Eleven RWD guidance documents were identified and mapped against 14 RWD assessment criteria. Variability was seen across these documents in guidance for these criteria. Between December 2022 and January 2023, 37 survey respondents reported having used RWD for post-marketing commitments (34, 92%) and/or background epidemiology (28, 76%). RWD were mostly identified through literature (33, 89%) and data landscaping (26, 70%); guidance documents referenced included: Food and Drug Administration (20, 54%), European Network for Centres for Pharmacoepidemiology and Pharmacovigilance (17, 46%), European Medical Agency (16, 43%), and Structured Process to Identify Fit-For-Purpose Data (11, 30%). Challenges for conducting feasibility assessments included RWD accessibility, ability to complete validation, and RWD provider responsiveness. Existing guidelines are used extensively by researchers, but key criteria for RWD identification and feasibility assessment are not reflected consistently and challenges remain. Recommendations have been made reflecting study findings.

Energy transition in the retail sector: Revealing decision-making behaviours for energy efficiency retrofits of Dutch shopping centres

Shopping centres hold significant energy retrofit potential in the retail sector. However, their complex multi-stakeholder governance structure complicates decision-making for Energy Efficiency Retrofits (EER). Although literature identifies some barriers linked to EER, they are often scattered and not identified within a process perspective that considers their contextual complexities. This study addressed this gap by examining stakeholders’ behaviours, barriers, and relations during EER decision-making processes, to detect stakeholders’ needs to catalyse the energy transition. Qualitative research was conducted on three representative Dutch shopping centres case studies. The cross-case analysis uncovered the decision-making process for EER and new barriers attributed to this building typology. Amongst other, detected barriers can be attributed to limitations with governmental and internal regulations, lifecycle conflicts, proposed interventions being out of scope, and existing technical challenges. The study also revealed causal relationships among stakeholders, showcasing varying interpretations of barriers and highlighting the roles of owners, property managers, and public authorities in overcoming them. Furthermore, the findings indicate the key role that different contextual variables play in the EER decision-making process, such as ownership type, governance structure, and leasing structure. This study offers insights and recommendations for shopping centre owners, property managers, and policymakers, to support them in navigating the energy transition of the retail building stock. Key recommendations include decentralizing decision-making, optimizing governance structure, streamlining sustainability advisors, and acknowledging the collaborative roles of property managers and policymakers in providing effective and holistic solutions.

MHealth learning strategies to support behaviour change in individuals using wheelchairs and/or scooters: a systematic review.

The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population. Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates. A quality assessment was conducted on each included article. Nine articles describing studies with diverse study designs met criteria to be included in this review. Several interactive application intervention features, such as participant collaboration and goal setting, and key technical features to support mHealth app development and utilisation were identified. Results found intuitive and simple designs of mHealth apps, with the ability to customise to support learning styles and preferences, support usability and acceptability by participants. More research is needed to evaluate best practices to support initial training of end-users, mHealth apps' ability to support long-term behaviour change and maintenance, and the understanding of active ingredients in complex interventions that include mHealth apps. Both interactive mHealth application intervention and technical features support healthy behaviour change among individuals using wheelchairs and scooters.

Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis.

Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.

Barriers, Challenges, and Opportunities in the Adoption of the Circular Economy in Mexico: An Analysis through Social Perception

This study explores the transition toward sustainable economic models through the circular economy (CE) in Mexico. Utilizing a mixed-methods approach, this research incorporates a comprehensive literature review and analyzes responses from 42 stakeholders, gathered through surveys and focus groups. These stakeholders comprise a diverse group including PhD students, professors, researchers, industry professionals in sustainability and the environment, and government advisors and coordinators from the Mexican Secretary of Environment. This representative sample provides a broad perspective on the barriers, opportunities, and societal perceptions regarding CE. The findings reveal significant challenges such as economic barriers, regulatory inadequacies, and a lack of awareness and education, all of which hinder the adoption of CE practices. Despite these challenges, there is a generally optimistic view among stakeholders about CE’s potential to positively impact societal needs, suggesting robust opportunities for innovation and policy enhancement to foster sustainable development. Key recommendations include intensifying educational programs to elevate public understanding and engagement, formulating supportive policies that facilitate CE adoption, and promoting intersectoral collaboration to leverage collective expertise and resources. Additionally, the research underscores the necessity of integrating CE principles into urban planning and policy frameworks to effectively address specific local challenges such as waste management, pollution, and urban sprawl. By providing a detailed analysis of the current state and potential of CE in Mexico, this paper contributes valuable insights to the global discourse on sustainability. It proposes strategic actions to overcome existing hurdles and capitalize on opportunities within the CE framework, charting a path forward for Mexico and serving as a model for other regions facing similar sustainability challenges

The neglected importance of managing biological invasions for sustainable development

Abstract Biological invasions have substantial and rising social‐ecological impacts threatening human livelihoods and communities and hampering progress towards a just and equitable world. Currently, biological invasions are not adequately recognised and included in the UN Agenda 2030. Using a literature review conducted in Web of Science, we highlight the bias in available literature of biological invasions related to the UN Agenda 2030 and its Sustainable Development Goals. We find abundant scientific literature towards environmental and biodiversity related sustainability targets while other especially provisioning targets are less well represented. Subsequently, we discuss the risks of neglecting biological invasions within sustainable development and how invasive alien species can have changing and adverse effects through time counteracting the intended benefits at the time of introduction. Finally, we provide key recommendations for action at the international scale to ensure that biological invasions are adequately considered in sustainable development. Those recommendations include (1) acknowledgement of biological invasions as a key threat to sustainable development, (2) a call for stronger multilateral exchange under the umbrella of an adequately financed coordinating body and (3) appropriate implementation and resource provisioning for international monitoring, data infrastructure, data exchange and use of adequate indicators of biological invasions to streamline decision making based on a solid evidence base. Read the free Plain Language Summary for this article on the Journal blog.

Addressing Racial Disparities in the Hypertensive Disorders in Pregnancy: A Plan for Action from the Preeclampsia Foundation's Racial Disparities Task Force.

Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal mortality in the United States, with Black women and birthing people disproportionately having higher HDP-related deaths and morbidity. In 2020, the Preeclampsia Foundation formed a national Racial Disparities Task Force (RDTF) to identify key recommendations to address issues of racial disparities related to HDP. Recommendations are centered around the Foundation's three pillars: Community, Healthcare Practice, and Research. Healthcare practices include adequate treatment of chronic hypertension in Black women and birthing people, re-branding low-dose aspirin to prenatal aspirin to facilitate uptake, and innovative models of care that especially focus on postpartum follow-up. A research agenda that examines the influence of social and structural determinants of health (ssDOH) on HDP care, access, and outcomes is essential to addressing disparities. One specific area that requires attention is the development of metrics to evaluate the quality of obstetrical care as it relates to racial disparities in Black women and birthing people with HDP. The recommendations generated by the Preeclampsia Foundation's RDTF highlight the strategic priorities and are a call to action that requires listening to the voices and experiences of Black women and birthing people, engaging their communities, and multi-sectoral collaboration to improve healthcare practices and drive needed research.

Study on HR Analytics and Metrics for Improving the Employee Performance with Special Reference to MP

HR analytics is formed as the interpretation of data patterns that help decision-making and operation getting more out. HR analytics is formed as the process of measuring the impact of HR metrics, such as time to get use of person for money and retention rate, on business operation. We are taking employee data of computer-based training and compare their process of evaluating employee performance by other employee related entities to determine their performance and suitability. The research analysis for HR Analytics in present scenario is a study provides practical information for HR managers aiming to adopt HR Analytics and how data analysis is helpful in forecasting and making future decisions, especially in Special Reference to MP. We are focusing on the computer-based analysis of employee performance is an attempt to assess the efficiency or effectiveness and performance of an enterprise. In this work, we collect data based on primary and secondary data. The objectives for data collection are calculating the performance of employee and take decision. The HR analytics finds that the useful decision- making processing of employee performance that is necessary to implement key recommendations contained in improving performance and to enhance the business operation.

The gendered dimensions of small-scale fishing activities: A case study from coastal Kenya

Although women contribute substantially to the small-scale fisheries sector globally, in many countries there is a severe lack of gender-disaggregated data on fishing activities. This gender data gap hampers a comprehensive understanding of small-scale fisheries dynamics with implications for fisheries management and food security. In this study, we investigate women's and men's engagement in small-scale fishing through a case study in coastal Kenya, a region characterized by a high dependence on fisheries for local livelihoods and nutritional needs. We applied a mixed method approach, combining participant observation, photography, semi-structured interviews on gender identities (n = 11) and gendered fishing practices (n = 28), an individual survey (n = 141), and pebble games (n = 35). Our results reveal a marked gendered division of labor across the seascape, with women mostly fishing in intertidal areas and men beyond the reef. Further, we find that women's fishing practices are characterized by less fishing gear, less catch, a lower functional diversity of catches, less fishing effort, and less income than those of men. However, women's catches contribute significantly to local diets, accounting for up to 50% of the fish and seafood consumed in fisherwomen-headed households. Despite women's fishing activities appearing less productive and profitable that those of men, they are important for achieving food security in Kenyan coastal communities. Results from this study contribute to broadening our understanding of the gendered dimensions of small-scale fishing and highlight relevant information for developing gender-inclusive management strategies. We conclude by providing key recommendations for fisheries research, management, and governance.

Oil rents and environmental sustainability: Do green technologies and environmental technological innovation matter?

Sustaining the environment is essential for Saudi Arabia, especially given the country’s high dependence on oil rents. While these rents have historically fueled economic growth, they have also contributed significantly to environmental degradation. Sustainable resource use and a transition from conventional to renewable energy sources are essential for achieving carbon neutrality and keeping the upsurge in global temperature below 2°C. In addition, sustainable practices help to preserve ecosystems, biodiversity, and natural resources, which are essential for the survival of all living organisms. Consequently, this study fills a significant empirical gap by investigating the moderating effects of technological innovation, environmental innovation, and green energy technologies in the oil rents and environmental sustainability nexus in Saudi Arabia from 1990 to 2022. Although there are significant direct associations between oil rents and environmental sustainability, the existing literature has not investigated empirical research on the moderating effects of technological innovation, environmental innovation, and green energy technologies in the oil rents and environmental sustainability nexus. To do this, the study implements the model of dynamic AutoRegressive Distributed Lag (ARDL) simulations. The results indicate that rising oil rents, economic growth, trade, and urbanization in Saudi Arabia worsen environmental sustainability while increasing green energy technologies, technological innovation, and environmental innovation enhances environmental sustainability. Interestingly, the findings of the moderating effects of technological innovation, environmental innovation, and green energy technologies in the oil rents and environmental sustainability nexus show that the predicted coefficients of the multiplicative interaction terms are both positive and statistically significant. This demonstrates that these technologies play crucial roles in mitigating the negative effects of oil rents on environmental sustainability in Saudi Arabia. Based on the outcomes, promoting technological innovation, prioritizing investments in green sources and reducing dependence on natural resource extraction are key policy recommendations that can significantly bolster environmental sustainability in Saudi Arabia.

Photoreduction of carbon dioxide into methane and ethylene using TiO2 inverse opal-derived PCN-222(M)

Solar-driven photocatalytic CO2 reduction has significant potential to address the energy crisis and mitigate greenhouse gas emissions by producing valuable organic compounds. Narrow bandgap materials enhance photon absorption within the visible light spectrum, thereby improving exciton generation. Both the inverse opal (IOT) and the porphyrin-based MOF (PCN-222) exhibit biomimetic design concepts. The IOT has a highly ordered porous structure that increases the light-absorbing surface area, facilitating efficient light harvesting. Conversely, the PCN-222 structure, which is modelled on biological porphyrin molecules, has a highly ordered pore structure and abundant active centers. Under hydrothermal conditions, PCN-222 self-assembles on the IOT surface to form a P(Cu, Fe, Zn)/IOT heterostructure. The tight interface of this heterostructure promotes rapid electron-hole separation and transport. In addition, the slow-light effect is exploited to increase the light absorption efficiency, thus improving the overall photocatalytic reaction efficiency and stability. In this study, the morphology, structure and photoelectric properties of P(Cu, Fe, Zn)/IOT heterostructures are investigated, revealing enhanced photocatalytic efficiency. The P(Fe)/IOT composite demonstrated outstanding CO2 conversion rates under simulated sunlight, yielding carbon monoxide (62 %), methane (0.11 %), and ethylene (0.09 %). The Z-scheme charge transfer mechanism significantly enhances photocatalytic performance by improving the efficiency of carrier separation and transfer, thereby increasing the overall photocatalytic reaction efficiency. This advance offers significant benefits for environmental and renewable energy remediation. The study provides key insights and recommendations for enhancing the efficiency of Z-scheme photocatalytic systems in future research and development.

Global viewpoints: proposals for the development of endourology in resource-limited countries in Africa.

Endourology plays an important role in modern urological practice. Compared to open surgery, it offers many advantages. In Africa, endourology is not widely practiced or non-existent in some referral centres. Several factors have been linked to this challenge. This article explores and proposes strategies to improve endourology practice in the African context. Recognising the unique challenges and opportunities in the region, the document discusses key initiatives and recommendations to promote the growth and development of endourological practices, including the identification of local needs, training, technological adaptation, etc. It aims to provide valuable information on the advancement of endourology in Africa.

Widening Educational Disparities in Health and Longevity

Educational attainment level has long been a strong predictor of adult health and longevity in the United States. Interestingly, the association between education and these outcomes has strengthened in recent decades. Since the 1980s, higher-educated adults have experienced favorable trends in health and longevity, while lower-educated adults have experienced stagnation or unfavorable trends. Studies have provided important clues about why the association between education and health and longevity has strengthened over time. However, explanations remain incomplete and contested. This article discusses key findings and debates about why the association has become stronger and offers recommendations to advance robust explanations. Two key recommendations call for a fundamental shift in how researchers conceptualize and study the increasingly strong association. These include (a) reconsidering which education groups should be viewed as normative in analyses of the trends and (b) elevating attention on contexts, institutions, and actors that have had an outsized influence on the trends.

Versorgungsqualität und -sicherheit nach Implantation eines Linksherzunterstützungssystems: eine qualitative Studie zur Patient*innenperspektive auf relevante Versorgungsaspekte

IntroductionImplantation of a left ventricular assist device (LVAD) requires extensive aftercare. It is largely unclear how aftercare should be designed from the patients’ perspective. Implications can be developed based on an examination of the healthcare context. Its main components are mapped on five tiers in the Human Factors of Home Health Care Model by Henriksen, Joseph, and Zayas-Caban (2009). Using this model, the present study explores the patient perspective on the context of healthcare after an LVAD implantation. MethodsWe employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers. ResultsWe interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.g., self-management skills), 3 on caregiver characteristics (e.g., professionalism), 11 healthcare-related tasks and requirements (e.g., wound management), 8 on factors of the physical environment (e.g., controllability), medical devices and technologies (e.g., carrying systems for external components), and cultural, social and community environment (e.g., interaction with peers), as well as 3 on external environmental factors (e.g., healthcare infrastructure). DiscussionThe present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients’ own initiative and the personal care provided by the VAD outpatient clinics. ConclusionThree key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.

Recommendations for incorporating invasive species into U.S. climate change adaptation planning and policy

AbstractExecutive Order No. 14008 mandated that U.S. federal agencies and departments develop Climate Change Adaptation Plans to enhance the nation's resilience to climate change. Invasive species are documented to reduce the effectiveness of climate adaptation and mitigation actions. In spite of this, only eight of the 26 federal plans directly reference invasive species, and just four meaningfully consider the reciprocal impact of invasive species on climate adaptation efforts. To ensure that climate adaptation planning and processes are effective with associated benefits for biodiversity conservation, a gap analysis of the Climate Change Adaptation Plans was conducted. Five key recommendations were developed that would transform how invasive species are considered within them. Examples of how invasive species have been included in some of the plans are provided, with suggestions for agencies that did not include invasive species on how they might do so, to illustrate that dedicated efforts in prevention, detection, and management of invasive species can safeguard carbon sequestration, protect communities and infrastructure, and minimize economic and biodiversity losses. Although developed based on U.S. federal plans, these recommendations can be used by state and local, as well as international, jurisdictions tasked with implementing climate‐adaptive policies to build resilience across multiple sectors.

Introduction to the Contemporary Assessment and Recommendations to Enhance Surgical Education and Training: Reports of the Subcommittees of the Blue Ribbon Committee II.

The BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees, each of which was asked to prepare a manuscript on their findings and recommendations. The BRC II Subcommittees were: Blue Ribbon Committee 1 Review and Assessment; Surgical Workforce; Medical Student Education; Work Life Integration; Resident Education; Goals, Structure and Financing of Training; Education Support and Faculty Development; Research Training; Educational Technology and Assessment. BRC II used the Delphi approach with consensus defined as equal to or greater than 80% and identified and recommended 31 priorities for surgical education in 2024. The initial findings were presented to a general surgery and related specialty resident and fellow focus group for comments and written feedback, and they were asked to prepare a manuscript as well. The reports of the Subcommittees of the BRC II provide an assessment and key recommendations concerning surgical education and training in 2024.

The influence of unstable coalition governments in Gauteng metropolitan municipalities

Background: Coalition governments involve multiple political parties uniting to govern because of the absence of a majority party in the council following electoral outcomes. In South Africa, coalitions have become much more common since the 2016 and 2021 local government elections.Aim: This study investigates the implications of unstable coalition governments on municipal administration within the Gauteng metropolitan municipalities.Setting: The study focused on the City of Tshwane, Ekurhuleni, and the City of Johannesburg metropolitan municipalities in the Gauteng Province of South Africa.Methods: Employing a qualitative approach with a case study design, this research draws upon secondary sources and employs thematic analysis for a comprehensive examination of data.Results: The findings underscore that unstable coalition governments exert multifaceted effects on municipal administration in Gauteng. Firstly, they erode the foundational principles of democratic and accountable governance. Secondly, the instability adversely affects the provision of essential services. Thirdly, the process of budget formulation and approval is compromised. Fourthly, the precarious nature of political coalitions jeopardises creating a safe and healthy municipal environment and contributes to hung councils. Fifthly, municipal human resource practices are negatively influenced, alongside challenges in effectively managing municipal funds.Conclusion: There is a critical need for government and municipalities to institute effective legislation and policies addressing the challenges associated with unstable coalition governments in order to foster stability, promoting democratic values and ensuring efficient municipal administration within the Gauteng metropolitan context.Contribution: The study makes key recommendations for improving municipal administration under coalition councils in South Africa’s metros.

Recommendations for managing adults with chronic non-cancer pain in primary care: A systematic clinical guideline review.

Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence. To undertake a systematic review of CPGs that address the management of adults with CNCP, regardless of underlying condition type, in primary care. We systematically reviewed and synthesised current CPGs for managing adults with CNCP in primary care (2013-2023). We followed a stepwise systematic process to synthesise key CPG recommendations: extracted and analysed each recommendation, synthesised by compiling similar recommendations using a thematic analysis approach, and assessed the strength of CPG recommendations to create a final, unified set of recommendations. We focused on identifying CPGs containing recommendations on the following topics: (a) opioid pain management, (b) non-opioid pharmacological pain management, (c) non-pharmacological pain management, and (d) patient-centred communication around pain management, prevention, and organisation of care. We included 13 CPGs, 8 of which focused solely on use of opioids, emphasising the lack of long-term effectiveness and safety concerns, being mainly based on the expert consensus. As an exception, high-quality evidence recommended referring patients with suspected opioid use disorder to specialist addiction services for medication-assisted treatment. Recommendations for non-opioid pain management were often contradictory and based on the expert consensus. Patient-centred pain management combined with exercise-based interventions and psychological therapies are appropriate strategies for managing patients with CNCP. Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.