Policy Development Research Articles

Anti-racist beauty micro-enterprises: Black women’s subversive entrepreneurship in Cali, Colombia*

ABSTRACT This paper explores how Black women entrepreneurs in Cali, Colombia confront racism and sexism, as they engage in the expanding neoliberal beauty market. We argue that anti-racist entrepreneurial experiences in Cali are shaped by four interconnected processes: First, changes in gender and development policies, aligned with inclusive neoliberal development projects. Second, the limitations of state neoliberal multicultural policies, which has made activists aware of the need to address racism and sexism. Third, activist’s appropriation of the intersectional turn, allowing them to recognize articulations between racism, classism and sexism. Fourth, the adoption of anti-neoliberal discourses supporting distributive and solidarity practices. Our analysis suggests that while entrepreneurial anti-racist actions do not generate radical or permanent changes in the beauty industry, they do have material and symbolic effects in Black women’s experiences of racial justice.

The impact of the urban traffic on the CO2 intensity: a navigation study using GNSS application in Jakarta city

ABSTRACT Massive traffic congestion is one of the many challenges faced by Jakarta as the capital city of Indonesia with the largest metropolitan area. The overarching goal of the study is to explore a combination of global navigation satellite system (GNSS) with vehicle-based measuring devices to precisely map the impact of the urban traffic on the CO2 emissions in Jakarta city. The research objectives include to examine and understand the CO2 intensity in major cities using state-of-the-art research strategies to correctly map the impact of the urban traffic patterns on urban areas and overall well-being of people in these locations. Urban traffic was studied in selected major urban transportation routes that were selected using PPK GNSS and the HT 2000 environmental sensor. This study reports that there is indeed a correlation between urban traffic and air pollution. The study noted that the macro and micro parameters of urban development and traffic policies are influencing the slowing down of traffic in city centers. The research outcomes could serve as a framework for designing the conceptual smart measure and tool of transportation carbon pricing in achieving the more sustainable transportation sector of Indonesia.

Current status, challenges, and future career pathways of diploma-prepared nurses from the stakeholders’ perspective: a qualitative study

BackgroundThe global shortage of nurses is a pressing issue affecting healthcare quality and patient outcomes. Nurse turnover is driven by work-related stress, and job dissatisfaction is persistent. In Saudi Arabia, many diploma-prepared nurses need more bridging programs to convert their diplomas into bachelor’s degrees. Educational and organizational issues can limit the provision of quality nursing care. Differences in educational preparation influence nurses’ interpretations of patient safety and their roles within healthcare systems. Addressing the need for more policies and regulations regarding nurse turnover and the retention of diploma-prepared nurses is crucial. Thus, a comprehensive exploration of barriers and incentives for diploma-prepared nurses to complete their Bachelor of Science in Nursing (BSN) can lead to transformative institutional strategies, such as tuition compensation and clinical-academic collaborations. This study aims to fill this gap by understanding the current challenges, future trends, and solutions from stakeholders’ perspectives and developing tailored career pathways for diploma-prepared Nurses from the stakeholders’ perspective. Thus, it contributes to policy development and improved healthcare delivery and fosters a promising future for healthcare.MethodsThis qualitative study employed a thematic analysis and grounded theory methodology as we delved into stakeholders’ perspectives to generate a substantive framework for overcoming obstacles and cultivating tailored career pathways for diploma-prepared nurses. A purposive sampling technique was used to choose participants, ensuring their rich, relevant, and diverse information based on their expertise, experience, and ability to provide valuable insights. Data were collected using one-on-one semi-structured questions for in-depth interviews.ResultsOur findings revealed key concepts that were evident in the data. These concepts formed three main themes and several subthemes essential to understanding the current status of, challenges faced by, and career pathways for diploma-prepared nurses. The three main themes have emerged, and core categories have emerged under each theme accordingly. The results generated a practical framework, offering tangible solutions to overcome challenges and develop career pathways for diploma-prepared nurses.ConclusionsThe findings significantly affect policy development and healthcare delivery improvement. This suggests the need for policies that support diploma-prepared nurses in completing their BSN and the development of tailored career pathways that align with their educational background and career goals and the Kingdom’s 2030 Vision.

Fifty years of research on psychosocial working conditions and health: From promise to practice.

This paper presents an overview of 50 years of research on psychosocial working conditions and health with regards to conceptualization, interventions and policy. We reflect on the promise of past and current research on psychosocial working conditions and, in addition, discuss current progress in translating this research into workplace practice and improvements in people's working lives. We conducted a narrative review of meta-reviews and key publications on psychosocial working conditions and health. The review covers a historical overview of theories of the past 50 years, measurement of psychosocial working conditions, health effects, intervention research, and policy development on psychosocial working conditions. Psychosocial working conditions are conceptualized in different ways, with increasing complexity in the understanding developing over time. Exposures related to psychosocial working conditions are associated with a wide range of health outcomes, in particular cardiovascular disease and mental health conditions. In response to growing evidence on associations between psychosocial working conditions and health outcomes, intervention research has expanded rapidly, but for various reasons the evidence base is stronger and more extensive for individual- than organizational-level interventions. This individual/organizational imbalance is reflected in practice, and may partly explain why policy interventions have yet to show reductions in exposures to psychosocial work factors and associated adverse outcomes. Pressing needs for advancing the field include improvements in capturing exposure dynamics, developing objective measures of exposure, methodologic advancements to optimize causal inference in etiologic studies, and alternatives to randomized controlled trials for intervention evaluation.

Optimisation of recovery policies in the era of supply chain disruptions: a system dynamics and reinforcement learning approach

Incidents like the COVID-19 pandemic or military conflicts disrupted global supply chains, causing long-lasting shortages in multiple sectors. This so-called ripple effect denotes the propagation of disruptions to further elements of the supply chain. Due to the severity of the impact that the ripple effect has on revenues, service levels, and reputation among supply chain entities, it is essential to understand the related implications. Given the unpredictable nature of disrupting events, this study emphasises the value of a reactive development of effective recovery policies on an operational level. In this article, a system dynamics model for a supply chain is used as framework to investigate the ripple effect. Based on this model, recovery policies are generated using reinforcement learning (RL), which represents a novel approach in this context. As main findings, the experimental results demonstrate the applicability of the proposed approach in mitigating the ripple effect based on secondary data from a major aerospace and defence supply chain and furthermore, the results indicate a broad applicability of the approach without the need for complete information about the disruption characteristics and supply chain entities. With further refinement and real-world implementation, the presented approach provides the potential to enhance supply chain resilience in practice.

Adaptation planning of container ports in the context of typhoon risks: The case of Ningbo-Zhoushan port in China

This study conducts a comprehensive survey of the risk of typhoon to container ports by assessing the risk level of typhoons in China's major container ports, predicting their economic losses, and evaluating corresponding adaptation measures. It analyzes adaptation measures in response to typhoon impacts, with a case study of Ningbo-Zhoushan port, one of China's most representative regional ports. It identifies the inadequate supply of institutions and the absence and misbehavior of the main port stakeholders as the main cause of varying institutional imperfections in the port adaptation system. This study contributes to the development of efficient port typhoon prevention policies, reduction of economic losses and casualties, and improvement of port operational efficiency. It also fills an important research gap on climate risk and adaptation in China's container ports, with an emphasis in enhancing port resilience.

A study on substance abuse awareness and usage trends within the construction sector

Purpose To address safety risks, worker well-being concerns and productivity losses in construction due to substance misuse, this study aims to explore awareness and usage levels of various substances among Nigerian construction professionals. The findings aim to inform targeted interventions and policy development to tackle these industry-specific challenges. Design/methodology/approach A comprehensive literature review identified several substances and intoxicants commonly used in construction, which informed the development of a well-structured questionnaire. This questionnaire was distributed to both construction professionals and nonprofessionals. The Shapiro-Wilk test assessed the normality of awareness and utilization scores for each substance, while the Kruskal-Wallis H-test explored significant differences in awareness and usage scores among different respondent groups. Findings Despite reporting low awareness of substances commonly used in construction, a significant proportion (over 60%) of respondents admitted to using several of these substances in their construction activities. This highlights a concerning disconnect, with more than half (62.5%) exceeding a predefined threshold (3.5) for significant substance use. Ten out of the 16 substances surveyed fell into this category, indicating a widespread issue within the industry. Practical implications The findings of this study highlight the need for increased education and awareness programs about the dangers of substance misuse in the construction industry. Construction companies should implement regular training sessions and workshops to educate workers on the risks associated with substance use. Additionally, there should be stricter enforcement of substance use policies and routine substance testing to deter misuse. These measures can enhance safety, improve worker well-being and boost overall productivity in the construction industry. Originality/value The insights from this study can inform the development of international policies and best practices for substance use prevention and worker well-being in the construction industry. Sharing these findings with international organizations, policymakers and industry stakeholders can help create broader guidelines and frameworks adaptable for implementation in various countries.

Patients' Attitudes Toward the Use of Artificial Intelligence as a Diagnostic Tool in Radiology in Saudi Arabia: Cross-Sectional Study.

Artificial intelligence (AI) is widely used in various medical fields, including diagnostic radiology as a tool for greater efficiency, precision, and accuracy. The integration of AI as a radiological diagnostic tool has the potential to mitigate delays in diagnosis, which could, in turn, impact patients' prognosis and treatment outcomes. The literature shows conflicting results regarding patients' attitudes to AI as a diagnostic tool. To the best of our knowledge, no similar study has been conducted in Saudi Arabia. The objectives of this study are to examine patients' attitudes toward the use of AI as a tool in diagnostic radiology at King Khalid University Hospital, Saudi Arabia. Additionally, we sought to explore potential associations between patients' attitudes and various sociodemographic factors. This descriptive-analytical cross-sectional study was conducted in a tertiary care hospital. Data were collected from patients scheduled for radiological imaging through a validated self-administered questionnaire. The main outcome was to measure patients' attitudes to the use of AI in radiology by calculating mean scores of 5 factors, distrust and accountability (factor 1), procedural knowledge (factor 2), personal interaction and communication (factor 3), efficiency (factor 4), and methods of providing information to patients (factor 5). Data were analyzed using the student t test, one-way analysis of variance followed by post hoc and multivariable analysis. A total of 382 participants (n=273, 71.5% women and n=109, 28.5% men) completed the surveys and were included in the analysis. The mean age of the respondents was 39.51 (SD 13.26) years. Participants favored physicians over AI for procedural knowledge, personal interaction, and being informed. However, the participants demonstrated a neutral attitude for distrust and accountability and for efficiency. Marital status was found to be associated with distrust and accountability, procedural knowledge, and personal interaction. Associations were also found between self-reported health status and being informed and between the field of specialization and distrust and accountability. Patients were keen to understand the work of AI in radiology but favored personal interaction with a radiologist. Patients were impartial toward AI replacing radiologists and the efficiency of AI, which should be a consideration in future policy development and integration. Future research involving multicenter studies in different regions of Saudi Arabia is required.

The four dimensions of metropolitanization: a case study of Warsaw, Wrocław and Lublin

ABSTRACT Metropolitanization represents a pivotal process viewed from various perspectives. It is approached diversely, yet underpinned by a comprehensive understanding of the metropolis and its immediate surroundings’ development. This study introduces a conceptual framework for metropolitanization across four dimensions, distinguishing between qualitative-quantitative and vertical-horizontal delineations. The spectrum of metropolitanization encompasses demographic expansion as well as nuanced qualitative shifts, influenced, for instance, by extensive integration into the global economy and the consolidation of the nation's economic dominance. The proposed framework is applied to three Polish agglomerations, each exhibiting relatively comparable settlement system structures but markedly distinct socio-economic conditions. This approach also assesses the vigour of metropolitanization at varying levels, facilitating the identification of metropolises that, due to their unique challenges relative to other cities, hold strategic importance for developmental policies.

The political economy of gender mainstreaming in energy access in Senegal

Abstract In June 2017, the Economic Community of West African States (ECOWAS) adopted the Policy for Gender Mainstreaming in Energy Access to integrate gender equity in West Africa’s energy and climate policy making. The policy represents the first regional gender and energy policy in the world, establishing a framework to enhance understanding at the nexus of gender and energy, improve the inclusivity of policies, programs, and initiatives, and increase women’s participation in the field of energy in the public and private sectors. Each member state developed a National Action Plan to operationalize these goals and align implementation with national contexts and policy priorities. This study examines the experience of Senegal’s National Action Plan development, from 13 semi-structured interviews of key stakeholders and document review. We use the Actor, Objective, Context political economy framework to understand how Senegal’s economic and political structures, historical and social context, and influence of key stakeholders shaped their efforts to mainstream gender in the country’s energy sector. We then describe four main objectives of actors in government, civil society, and the development space involved in policy development, summarizing these as: electricity access, economic development, access to clean fuels and technologies for cooking, and gender equity. We find that the objectives of government and development actors are reflected in the emphasis on energy access in the National Action Plan and the government’s long-term development agenda, though a critical lack of engagement with the private sector has limited the policy’s effectiveness in mainstreaming women across energy sub-sectors beyond clean cooking. Women’s civil society organizations, historically less engaged with energy issues, have nonetheless achieved considerable success in advocating for increased women’s political participation. This advocacy has set a precedent for policies promoting “positive discrimination” for women and marginalized groups, evident in the policy’s activities aimed at electrifying women’s economic sectors.

The Sri Lanka Mother and Newborn Growth (S-MaNGro) Cohort: Protocol of a Nationwide Prospective Study

Perinatal cohort studies with a prospective longitudinal design are critical for determining the effects of early-life exposures on offspring’s health outcomes. The Sri Lanka Mother and Newborn Growth cohort study aims to investigate the impact of maternal nutritional and psychosocial factors on newborns’ birth weight in the Sri Lankan context. This paper presents the methodology of participant recruitment, follow-ups, an overview of measurements, and planned data analyses. This study included a nationally representative sample of Sri Lankan pregnant women recruited in their first trimester of pregnancy. Follow-up assessments were conducted once during the second and third trimesters of pregnancy and after the baby’s birth, prospectively tracking the women’s dietary intake, mental health, hemoglobin concentrations, and gestational weight gain data. Once the participants delivered their babies, the data on gestational age, sex of the newborn, birth weight, length and occipitofrontal circumference at birth, and mode of delivery were collected. Between August 2022 and August 2023, we recruited 2000 first-trimester pregnant women to the cohort and continued to follow up with them until the baby’s birth. The response rates were 90.4%, 81.4%, and 75.2% in the first, second, and third follow-ups. We plan to analyze the data in July 2024. We expect this study to provide valuable insights into various early-life exposures affecting neonatal birth weight. The study’s findings will serve as a valuable information resource for a broader scientific community, enabling the development of effective policies to prevent low-birth-weight deliveries in low-resource settings.

Influence of Cultural Festivals on Local Economic Development in Zimbabwe

Purpose: The aim of the study was to analyze the influence of cultural festivals on local economic development in Zimbabwe. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Cultural festivals in Zimbabwe boost local economic development by attracting tourists and increasing spending in businesses, hotels, and restaurants. They also create job opportunities in event management and hospitality. Additionally, these festivals promote cultural heritage and community pride, which can enhance regional attractiveness for investment. However, economic benefits are often concentrated in larger cities, leaving rural areas less impacted. To maximize benefits, it is essential for festival organizers and local governments to ensure equitable distribution of resources and support sustainable infrastructure development. Unique Contribution to Theory, Practice and Policy: Creative economy theory, event impact theory & place-based economic development theory may be used to anchor future studies on analyze influence of cultural festivals on local economic development in Zimbabwe. Local governments and festival organizers should develop targeted marketing strategies that not only attract more visitors but also extend the festival’s economic benefits beyond its duration. Develop and implement policies that provide financial and logistical support to cultural festivals. This could include grants, subsidies, or tax incentives for festivals and local businesses involved in the event.

A Comparison of the Characteristics of Informal Economy between Developing and Developed Countries and the Experience and Reference of China: A Case Study of Malaysia and Singapore

As China continues to urbanise, the size of the informal economy in the country is also increasing, creating numerous governance issues. This thesis explores the differences between developing and developed countries by comparing the characteristics of the informal economy in Malaysia and Singapore. A literature study was used to analyze the size and characteristics of the informal economy in the two countries. It is found that despite the commonalities, there are significant differences between the two countries' informal economies in terms of development stages and policy implications. This study provides valuable experience and lessons for the governance of the informal economy in China, emphasising the impact of government policies and socio-cultural factors on the informal economy, and it also provides important insights into the effective governance of the informal economy in developing countries.

Design and management considerations for the Kenya-Tanzania marine transboundary conservation area.

Although transboundary conservation areas (TCAs) are critical tools for protecting ecosystems and ecological processes that transcend national jurisdictions, they are challenging to create due to the differences in governance contexts and capacity and power dynamics among countries. Marine TCAs are also more difficult to enforce relative to terrestrial TCAs because most nations still treat oceans as open access. Current guidelines for TCA development and implementation also focus mostly on terrestrial TCAs, which are not practical for marine TCAs. Hence, we reviewed the challenges associated with the design and management of marine TCAs and devised analytical and practical approaches to support the application of spatial planning frameworks and adaptive governance mechanisms. We used the lessons from the review to examine the decisions made for the proposed marine TCA in the Kenya-Tanzania border region and created options and considerations to promote effective design and management processes. We found the obstacles to marine TCAs in general are related to issues of fit, particularly differences in environmental research capacity, socioeconomic contexts, and internal institutional arrangements. These included differences in knowledge and capacity for marine ecological research and conservation; ability to adjust and update data; differences in values, interests, and resource uses; conservation costs; jurisdictional differences; engagement of multiple levels of organization; and differences in legal bases and policy development processes. Understanding and reconciling these challenges during the TCA development process can help enhance meaningful discussions in the design of the TCA and cultivate the enabling conditions for collaborative governance across countries and within different levels of organization from national to local actors.

Predicting multidimensionality of mathematical creativity among students: Do mathematics self-efficacy, attitude to mathematics and motivation to mathematics matter?

Mathematical creativity is the focus of most curriculum in that students with this ability are prone to solving problems in society from a multidimensional perspective. However, studies of this nature, especially in Africa, are limited, and this poses a challenge to policy development. To cover this gap, the study sought to model the predictive effect of mathematics self-efficacy, motivation for mathematics, and attitude towards mathematics on mathematical creativity from a multidimensional perspective. The study adopted a cross-sectional survey using 654 mathematics students for the study. Two instruments–the mathematics self-efficacy, attitude towards mathematics, and mathematical motivation scales and the mathematical creativity test were used for data analysis after they had undergone a qualitative and quantitatively rigorous validation process. This was done using exploratory and confirmatory factor analysis with the average variance extracted and Fornell-Larcker criterion for convergent and divergent analysis, respectively, while Cronbach’s alpha was used to determine the stability of the scales. Analysis was performed using hierarchical regression and the result showed that mathematics self-efficacy and attitude towards mathematics, when taken individually, are the only strong predictors of mathematics creativity from the perspective of fluency, flexibility, and originality components. Collectively, the three predictors were significant in contributing to the variance in mathematics creatively from the three dimensions assessed. However, mathematics self-efficacy was the strongest predictor, followed by attitude towards mathematics. The implications of the study were discussed for policy and curriculum redesign in mathematics education.

Assessing the Intention to Use a First-Generation Vaccine against COVID-19 Using Quantile Regression: A Cross-Sectional Study in Spain

Understanding the factors that influence the intention to use vaccines is crucial for implementing effective public health policies. This study examined the impact of various cognitive, affective, normative, and sociodemographic variables on the intention to be vaccinated against COVID-19 with the first-generation AstraZeneca vaccine. A survey of 600 residents of Spain was used to assess the influence and hierarchy of the drivers of the intention to vaccinate via least-squares and quantile regressions. The most significant factors were the perceptions of efficacy and social influence, both of which had positive impacts (p < 0.0001). The positive influence of fear of COVID-19 and the negative influence of fear of the vaccine were also significant in shaping the central tendency toward vaccination. However, these fear-related variables, particularly the fear of COVID-19, lost importance in quantile adjustments outside the central tendency. Among the sociodemographic variables, only the negative impact of income was statistically significant. These results are valuable for the development of vaccination policies because they measure the sensitivity of attitudes toward vaccination to exogenous variables not only in the central values, as is common in similar studies, but also across the entire range of responses regarding the intention to vaccinate. This additional analysis, which is not commonly performed in studies on vaccine acceptance, allows us to distinguish between variables which are consistently related to the intention to vaccinate and those that influence only expected responses.

The Development of Reservation Policies Under Article 15 of the Indian Constitution and Social Justice in India

This article examines the evolution and impact of reservation policies under Article 15 of the Indian Constitution and their role in advancing social justice in India. The historical context of inequality in India, rooted in the varna and caste systems, has profoundly influenced contemporary constitutional provisions. Article 14 guarantees equality before the law, while Article 15 prohibits discrimination on grounds such as religion, race, caste, sex, or place of birth. Article 15(1) and 15(2) collectively aim to eliminate discriminatory practices in public life and access to public places. Article 15(3) allows for special provisions for women and children, and Article 15(4) provides a constitutional basis for affirmative action to benefit socially and educationally backward classes, Scheduled Castes (SCs), and Scheduled Tribes (STs). Recent amendments, including Article 15(5) and the 103rd Constitutional Amendment Act introducing Article 15(6), expand reservations to private educational institutions and reinforcing caste identities, socio-economic disparities within reserved categories, and the balance between affirmative action and meritocracy persist. The researcher has emphases the reservation policies aim to enhance social equity and opportunities for marginalized communities, their effectiveness is complex and influenced by ongoing socio-economic factors. The role of the judiciary, particularly the Supreme Court, remains pivotal in interpreting and implementing these provisions to ensure true equality and social justice.

The mechanism of legal relations in the context of modern legal policy P. P. Serkov. Legal relationship (theory and practice of modern legal policy): in 2 parts. Moscow: Norma, 2023. Part 1: legal doctrine and legal policy measures. – 872 pp.; Part 2: generalization of legal experiences of ascent to man, society And the state. – 672 pp.

The multidimensional nature of law, designed to act as the main social regulator and the importance of legal policy for the progressive development and functioning of the legal system, which is increasing in the context of modern challenges to national security, determines the theoretical and practical significance of research on the phenomenon of legal policy. The peer-reviewed monograph provides a scientific substantiation of the systemic relationship between the mechanism of legal relations and legal policy. The author of the monograph comprehensively and from original positions examines the essence of legal policy, the problems associated with its scientific knowledge and implementation, and identifies its patterns.

The impact of energy sector pollution on human development and inequality amidst climate change

Abstract The provision of energy is a primary contributor to climate change and environmental pollution, the latter including air pollution from aerosol emissions and a broad range of other human health effects and ecosystem damages. At the same time, aerosol emissions also reduce radiative forcing, leading to a masking of part of the warming due to rising CO$_2$ concentrations and temporarily reducing the adverse impacts of climate change. Using an energy-economy-climate model linked to atmospheric chemistry, health impact and life cycle assessment models, we show that the societal costs of the health impacts of environmental pollution substantially exceed the economic benefits from masked warming. We further highlight the unequal burden of these issues on developing countries and explore the implications for human development, global inequality and international climate policy.

Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records.

Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs). Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs. In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million. The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.