Professional Challenges Research Articles

An explainable deep learning model for diabetic foot ulcer classification using swin transformer and efficient multi-scale attention-driven network

Diabetic Foot Ulcer (DFU) is a severe complication of diabetes mellitus, resulting in significant health and socio-economic challenges for the diagnosed individual. Severe cases of DFU can lead to lower limb amputation in diabetic patients, making their diagnosis a complex and costly process that poses challenges for medical professionals. Manual identification of DFU is particularly difficult due to their diverse visual characteristics, leading to multiple cases going undiagnosed. To address this challenge, Deep Learning (DL) methods offer an efficient and automated approach to facilitate timely treatment and improve patient outcomes. This research proposes a novel feature fusion-based model that incorporates two parallel tracks for efficient feature extraction. The first track utilizes the Swin transformer, which captures long-range dependencies by employing shifted windows and self-attention mechanisms. The second track involves the Efficient Multi-Scale Attention-Driven Network (EMADN), which leverages Light-weight Multi-scale Deformable Shuffle (LMDS) and Global Dilated Attention (GDA) blocks to extract local features efficiently. These blocks dynamically adjust kernel sizes and leverage attention modules, enabling effective feature extraction. To the best of our knowledge, this is the first work reporting the findings of a dual track architecture for DFU classification, leveraging Swin transformer and EMADN networks. The obtained feature maps from both the networks are concatenated and subjected to shuffle attention for feature refinement at a reduced computational cost. The proposed work also incorporates Grad-CAM-based Explainable Artificial Intelligence (XAI) to visualize and interpret the decision making of the network. The proposed model demonstrated better performance on the DFUC-2021 dataset, surpassing existing works and pre-trained CNN architectures with an accuracy of 78.79% and a macro F1-score of 80%.

The ultimate paradox: navigating the personal and professional contradictions of assisted dying.

The potential of the Terminally Ill Adults (End of Life) Bill to pass into law has raised critical questions for nurses, who are now confronting the possibility of involvement in assisted death. While the provisional bill contains protections against coercion or punishment of healthcare professionals who do not wish to participate in the assisted dying process, many are left wondering about the challenges they may face, even if they are in support of medically assisted death. Francesca Ramadan provides insight into nurses' complex and often contradictory experiences of assisted dying and the research, education and guidance necessary for navigating personal and professional challenges.

Perceptions of Artificial Intelligence Among IT Professionals: Exploring Job Opportunities, Threats, and the Moderating Role of Technology Literacy

Artificial Intelligence (AI) is transforming industries worldwide, creating both opportunities and challenges for IT professionals. This study examines the perceptions of AI among IT professionals in Kathmandu, focusing on job opportunities, threats, and the moderating role of Technology Literacy (TL). The research adopts a descriptive and causal-comparative design within the positivist paradigm, emphasizing measurable and objective data. A structured questionnaire with a 5-point Likert scale was distributed via Google Forms to 128 IT professionals in Kathmandu. Descriptive statistics indicated that IT professionals generally have a moderate level of Technology Literacy (mean scores ranging from 2.39 to 2.78). AI was perceived favorably, with mean scores between 3.02 and 3.39. However, perceived threats from AI were moderate (mean scores from 2.33 to 2.60), suggesting concerns about job security. Perceived opportunities were also moderate (mean scores between 2.38 and 2.81), indicating a balanced view of AI’s potential benefits and risks. Correlation and regression analyses revealed that Technology Literacy significantly moderates the relationship between AI and job opportunities, as well as AI and threats, suggesting that higher TL mitigates fears and enhances positive perceptions of AI. The study highlights the dual impact of AI on IT professionals, with both opportunities and threats being perceived at moderate levels. Technology Literacy plays a crucial role in shaping these perceptions, underscoring the need for continuous learning and adaptation in the IT sector.

Strengthening the Discipline Integration and Professional Development of Calligraphy Teachers

This study explored the professional development issues, challenges, and opportunities faced by calligraphy teachers in the context of disciplinary integration. Descriptive survey was used in the study to explore the professional development of Calligraphy teachers’ discipline integration. Through questionnaire surveys and comprehensive analysis, it was found that calligraphy teachers generally believe that subject integration has a positive effect on improving teaching effectiveness and promoting comprehensive development of students. However, in actual teaching, they face the challenge of increased workload and difficulty in integration brought about by literacy in interdisciplinary teaching. In response to these challenges, calligraphy teachers have expressed an urgent need for professional development, especially in organizing classroom teaching and creating various book styles. This study suggests that schools should develop specific training and support plans to meet the professional development needs of calligraphy teachers; and apply the research results to educational practice, providing theoretical support and practical guidance for the innovation and development of calligraphy education.

Why Are There So Many Ways to Measure Pain? Epistemological and Professional Challenges in Medical Standardization

Why Are There So Many Ways to Measure Pain? Epistemological and Professional Challenges in Medical Standardization

Detection of Cocaine Body Packers: The Role of X-ray Imaging

The concealment of illicit drugs within the human body, commonly referred to as "body packing," has been a growing challenge for law enforcement and healthcare professionals. In particular, cocaine body packers pose a significant medical risk due to the potential rupture of drug-filled pellets, leading to severe intoxication or death. Given the increasing role of transit countries in drug trafficking, the use of medical imaging as a detection tool has become critical (1,2). We wish to report a case that highlights the essential role of abdominal X-ray imaging and CT scans in identifying cocaine body packers. A 51-year-old male passenger was detained at Libreville International Airport, Gabon, under suspicion of intracorporeal drug transport. His travel pattern, lack of luggage, possession of a laxative (Xprep), and refusal of in-flight meals raised concerns among customs officers. Following legal authorization, he was referred to our radiology department for further examinati... Abdominal X-ray imaging revealed multiple radiopaque, oval-shaped opacities distributed along the colonic frame. Subsequent non-contrast CT scans confirmed the presence of dense, well-circumscribed foreign bodies consistent with cocaine pellets (3,4). Under medical and law enforcement supervision, the pellets were expelled within 48 hours, confirming the diagnosis. This case underscores the critical role of medical imaging in detecting body packers. While X-ray imaging serves as a rapid screening tool, CT scans remain the gold standard due to their superior sensitivity and ability to provide detailed localization and characterization of foreign bodies (5). In resource-limited settings where advanced screening technologies may be unavailable at airports, hospital-based radiological evaluation remains an indispensable strategy in the fight against drug trafficking. The increasing role of Central African nations as transit hubs for drug trafficking highlights the need for greater awareness and improved detection capabilities. We advocate for enhanced collaboration between healthcare professionals and law enforcement agencies to optimize early identification and management of body packers, ultimately preventing life-threatening complications (6).

2768 Needs of people with dementia in the perioperative environment from the perspective of healthcare professionals

Abstract Introduction The incidence of dementia among patients in perioperative settings is on the rise, presenting significant challenges for healthcare professionals in delivering adequate and appropriate care to this patient population. In order to gain a deeper understanding of the perioperative care needs of patients with dementia, thirty healthcare professionals were interviewed. The focus was on their experiences and perspectives regarding the fulfilment of these needs. Key factors influencing perioperative care were identified and categorised into three main themes: patient-related factors, healthcare professional-related factors, and healthcare environment-related factors. Methods Thirty interviews were conducted with a diverse group of healthcare professionals, including anaesthetists, surgeons, nurses, and other perioperative staff. Thematic analysis was employed to process and interpret the data, identifying recurring themes and sub-themes that reflect the complexities of perioperative care for patients with dementia. Results The analysis revealed three primary themes: 1) Factors related to the patient with dementia: Cognitive impairment and comorbidities uniquely challenge perioperative care. The unfamiliar hospital environment often exacerbates cognitive symptoms, and adherence to postoperative protocols can be problematic. Family involvement is crucial in supporting these patients. 2) Healthcare Professional Factors: Perceptions of dementia, communication issues, pain assessment, and the need for personalised care were highlighted. Training and education deficits among healthcare professionals were evident, impacting the quality of care. 3) Institutional Factors: Organisational policies and resource allocation significantly affect the provision of dementia care. Support for healthcare professionals through ongoing education and the development of dementia-specific guidelines were identified as essential needs. Conclusion Effective perioperative care for patients with dementia requires addressing multifaceted challenges. Improving communication, enhancing education and training for healthcare professionals, involving family members, and ensuring institutional support are critical steps. A comprehensive, empathetic approach can lead to better outcomes and experiences for patients with dementia in the perioperative setting.

Time to act: Institutional mental health support for Ukrainian academic staff during wartime

The study examines the impact of institutional mental health support on the career stability of academic staff at Ukrainian universities during the full-scale war, focusing on accessibility, cultural alignment, and tailored mental health initiatives provided by universities. The relevance of this topic arises from the unprecedented stressors affecting academic members in higher education institutions, who face both personal and professional challenges. A cross-sectional analytical design was employed, using an online survey distributed among 429 academic staff members. The findings reveal that nearly half of the respondents frequently contemplate changing careers, highlighting substantial job instability. Accessible mental health support is associated with a 6% decrease in career change intentions, while a supportive institutional culture further reduces these intentions by 8-9%. Notably, self-help practices emerged as the most effective support mechanism, associated with a 12% reduction in career change intentions. These findings suggest that institutions can improve retention by prioritizing and promoting accessible self-help initiatives. The study underscores the importance of structured mental health support in fostering resilience within the academic community, with implications for policy and practice in war-affected educational environments. AcknowledgmentThe research teams acknowledge the Armed Forces of Ukraine for providing safety during their research and credit their perseverance and courage for making this possible. Natalia Tsybuliak is grateful to the Ukraine Research Network@ZOiS, funded by the German Federal Ministry of Education and Research, for support in implementing the research.This work was supported by the Ministry of Education and Science of Ukraine as part of the state-funded research project 0123U105351, “Ukrainian universities in new realities: the impact of war and mechanisms for preserving the scientific and human resource potential for training specialists in high-tech fields.”

Are Wolves the Real Problem? Challenges Faced by Livestock Farmers Living Alongside Wolves in Northwestern Greece

Mitigating human–wolf conflict is crucial, yet conventional approaches often overlook the broader socioeconomic challenges faced by farming communities. Wolves frequently become scapegoats for deeper rooted issues such as economic disadvantages, policy deficiencies, and rural depopulation. We conducted semi-structured interviews with 118 livestock farmers to examine (a) farmer profiles and wolf-related interactions, (b) professional challenges and proposed solutions, (c) reasons for perceiving wolves as a major problem, and (d) the impact of wolf presence on job dissatisfaction. Farmers reported low specialized education and job satisfaction, particularly regarding income. Many struggled to afford or find shepherds, especially sheep/goat farmers. Guardian dog poisoning incidents and dissatisfaction with the damage compensation system were prevalent. Key challenges included economic marginalization, wolf presence, climatic factors, inadequate grazing policies, infrastructure deficits, distrust in policy, rural depopulation, and a lack of services. Farmers who perceived wolves as a major problem implemented weaker preventive measures and moved herds seasonally over longer distances. Job dissatisfaction was linked to wolf presence, livestock type, and economic marginalization. Our findings emphasize that while wolves impact farmers, economic and policy-related factors play a greater role. Educational initiatives, supportive policies, effective depredation mitigation, and fair compensation systems are essential for sustainable livestock farming and coexistence with wolves. By tackling socioeconomic challenges, enhancing policies, and supporting farmers to adapt to evolving circumstances, the livestock farming sector can thrive while minimizing conflicts associated with wolves.

Understanding the Support Needs of People with Autosomal Dominant Polycystic Kidney Disease: A Qualitative Phenomenological Descriptive Study.

Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent hereditary kidney disease and the fourth most common cause of kidney failure. Patients may be aware of their condition from an early age or discover it unexpectedly, with varying levels of familial knowledge about the disease. This chronic condition presents significant challenges for healthcare professionals. The study aimed to investigate how people with ADPKD experience their participation in a dedicated ADPKD clinic and to investigate their support needs in managing their disease in everyday life. A qualitative phenomenological descriptive study was conducted, involving semi-structured telephone interviews with patients who attended a newly established dedicated ADPKD clinic between March and April 2023. The data were analyzed using Malterud's principles of systematic text condensation. In total, 18 out of 22 patients agreed to participate in the interviews. Six themes emerged from the interviews. Participants expressed feelings of uncertainty about their future and highlighted the necessity for personalized care tailored to their individual circumstances. They reported challenges in coping with emotions associated with the disease and sought assistance in making difficult decisions. Maintaining control over their health and illness was a significant theme, alongside a desire for increased knowledge about their condition. Our study supports existing knowledge in this area. In this study, the participants experienced satisfaction with the dedicated ADPKD clinic, feeling well informed, listened to, and more at ease after the check-up. Investing in a dedicated ADPKD clinic could help alleviate the uncertainty that many people with ADPKD experience.

The Meanings That Keep Us Going in a Challenging Profession

This study explores the sources of meaning in the work of Jesuit high school teachers, examining how these sources vary across professional status, geographical setting, and teaching period. Through a comparative case study and 105 in-depth interviews with Jesuit and lay teachers in the United States and Latin America, the research identifies four key sources of meaning: relationships with students and society, self-perception, the work context, and spiritual life. Findings reveal that while the “other-regard” dimensions—focusing on students and societal impact—are consistently central, self-regard, work context, and spirituality play varying roles influenced by cultural and historical contexts. This study highlights how Jesuit educational values and mission shape teacher identity and meaning, providing insights for sustaining commitment within changing educational landscapes.

Trends in research on novel antidepressant treatments

Mood disorders, such as major depressive disorder and bipolar disorder, are among the most common mental illnesses and a leading cause of disability worldwide. Key symptoms of these conditions include a depressed mood or anhedonia, sleep and psychomotor disturbances, changes in appetite or weight, and fatigue or loss of energy. Prolonged cognitive disturbances further impair the ability to think or concentrate and are often accompanied by persistent feelings of worthlessness or excessive guilt. Collectively, these symptoms underscore depression as a serious, long-term global health issue. In addition, clinical studies indicate a growing number of patients experiencing difficulties in responding to treatment, even in the long term. This phenomenon poses significant challenges for healthcare professionals, families, and patients alike. As a result, there is an urgent need for therapies that are both rapid-acting and safe. This review aims to summarize the prevailing trends in research on novel antidepressants, emphasizing their diversity and multi-directional mechanisms of action. The development of rapid-acting drugs is increasingly focused on achieving high efficacy, particularly for treatment-resistant depression. Such advances offer the potential for rapid therapeutic effects without the prolonged and often tedious administration of older generation antidepressants. Findings from studies using animal models of depression continue to play a crucial role in predicting and designing new therapeutic strategies. These models remain indispensable for understanding the physiological effects of newly developed compounds, thereby guiding the creation of innovative treatments.

An Analysis of Teacher Resilience at Waladun Shalih Ratulangi Kindergarten in Palopo City

This study examines teacher resilience at Waladun Shalih Ratulangi Kindergarten in Palopo City, focusing on the challenges faced by early childhood educators. Using a descriptive qualitative approach, the research employs data collection techniques such as observation, interviews, and documentation. Data analysis follows the steps of reduction, presentation, and conclusion drawing. The findings reveal that (1) Teacher resilience aligned with the CO2RE dimensions: Control, Origin, Reach, and Endurance.; (2) Factors influencing resilience include intrinsic motivation and teacher creativity, which drive problem-solving and adaptability; and (3) Efforts to enhance resilience encompass transforming failures into opportunities, accepting constructive criticism, fostering courage and persistence, and expanding social networks. The study contributes insights into strategies for sustaining teacher resilience in early childhood education, highlighting its significance in overcoming professional and personal challenges. The results provide actionable recommendations for educators, administrators, and policymakers to support resilience development in educational settings.

Patient-centred care and technical challenges during polytrauma imaging - Experiences from radiography students.

Patient-centred care (PCC) is essential in radiography for polytrauma patients emphasising empathy, clear communication, and patient well-being. Polytrauma patients require tailored imaging approaches, often involving multiple modalities. Managing and handling these patients during imaging are key components of radiography training to develop the necessary competencies. This study aimed to explore the experiences of third- and fourth-year radiography students in applying PCC during the imaging of polytrauma patients. A qualitative interpretive phenomenological design was employed to capture the in-depth experiences of third and fourth-year radiography students at the University of Namibia. The study utilised purposive sampling to select participants. Data were collected through face-to-face semi-structured interviews, recorded and transcribed for interpretive phenomenological analysis. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability measures. Twenty-one students (3 males, 18 females; 10 third-year, 11 final-year) participated. Three interpretive themes shaped the findings: Compassionate Patient Care, reflecting students' commitment to balancing technical accuracy with empathy while managing personal fears; Professional Challenges in Polytrauma Imaging, highlighting emotional trauma, technical challenges, and communication barriers as central obstacles; and Professional Transformation Through Collaboration, illustrating how teamwork and reflective practice fostered growth, confidence, and resilience. The findings highlight the human and transformative nature of students' experiences in imaging polytrauma patients. This study highlights radiography students' experiences imaging polytrauma patients, emphasizing compassionate care, professional challenges, and collaborative growth. The interplay between technical skills, emotional resilience, and relational competence underscores the need for curricula that address patient-centred care, adaptive problem-solving, and emotional resilience to prepare students for clinical challenges. Radiography curricula should incorporate emotional resilience training, patient-centred care principles, and adaptive problem-solving to enhance students' preparedness for real-world clinical challenges.

التحديات المهنية والأخلاقية للصحافة الاستقصائية وعلاقتها بالممارسة الصحافية

The study aimed to identify the professional and ethical challenges of investigative journalism and its relationship to journalistic practice, relying on the media survey approach, by conducting a field survey on an available sample of (240) male and female journalists practicing journalism in press and media institutions in Jordan, by relying on the gatekeeper theory, and the approach of pressures and professional practices. The results of the study showed that (63.7%) of Jordanian journalists did not practice investigative journalism in their journalistic work, while the most prominent reasons for not practicing investigative journalism were: lack of interest in investigative journalism (26.9%), lack of freedom in investigative journalism (19.6%), and low level of experience sufficient to practice investigative work. The results showed that the most prominent professional and ethical challenges of investigative journalism were challenges related to the use of digital technology with mean of (4.39), then challenges of professional ethics (4.36), then professional principles (4.34), then editorial policy (4.03), then methods of managing and organizing journalistic work (4.21), and the results concluded that there is a statistically significant positive correlation between the impact of the professional and ethical challenges of investigative journalism, and the professional principles that investigative journalists adhere to.

The relationship between compassion fatigue, engagement and decent work among nurses: a cross-sectional study

BackgroundNurses face significant professional challenges arising from global pandemics, inadequate welfare protection, and declining social status. In this context, the decent working conditions for nurses are not adequately safeguarded. This study examines decent work status among Chinese nurses and its links work engagement, and compassion fatigue.MethodsThis study is a cross-sectional research. Through the method of convenience sampling, five reputable hospitals in Hangzhou, China, were selected, and a total of 838 nurses were surveyed. Data collection was conducted from April to May 2023. We employed a comprehensive set of assessment tools, including an evaluation of demographic characteristics, the Decent Work Perception Scale (DWPS), the Chinese version of the Compassion Fatigue Short Scale (C-CFSS), and the Gallup Q12 survey scale. ResultsThe findings of this study demonstrated that compassion fatigue was significantly negatively correlated with both decent work (r = -0.482, p < 0.001) and engagement (r = -0.461, p < 0.001). Additionally, decent work was significantly positively correlated with engagement (r = 0.811, p < 0.001). Mediation analysis revealed that compassion fatigue had a direct negative effect on decent work (β = -0.05, p < 0.001), while engagement partially mediated the relationship between compassion fatigue and decent work (β = -0.14, p < 0.001).ConclusionThis study found that compassion fatigue and engagement significantly influence nurses’ perception of decent work, with engagement mediating this relationship. Future research should explore these mechanisms further and develop interventions to enhance engagement and reduce compassion fatigue, improving nurses’ perception of decent work.

The Paradox of The Internet in Journalism in Nigeria: Between Flexibility and Accuracy Challenges

This study critically examines the role of the internet in the development of journalism in Nigeria, highlighting its benefits, drawbacks, and broader implications for the field. Grounded in the Theory of Technological Determinism and employing a Discourse Analysis approach through secondary data analysis, the research explores how digital advancements reshape journalistic practices. The findings reveal that while the internet enhances editorial flexibility and accessibility, it also creates a tension between speed and accuracy, posing significant challenges for journalism professionals. Furthermore, the study underscores the dual nature of the internet as both a catalyst for progress and a potential disruptor within the industry. By offering a nuanced analysis of these dynamics, this research contributes to the ongoing discourse on digital journalism, providing fresh insights into the evolving media landscape in Nigeria. The study’s novelty lies in its critical assessment of the internet as a “double-edged sword,” offering a comprehensive understanding of its paradoxical impact and proposing new perspectives on sustainable digital journalism practices.

Vietnamese millennial teachers’ career identity during and after the transition to work

ABSTRACT This article, using identity-agency and positioning theory, studies millennial university teachers’ (MUTs) experiences during and after the graduate transition to work (GTW). The teachers reported their reflection on their pre-entrance into the labour market, the first few years as early career teachers, their current performance at work, and their future projection of their career development. The MUTs encountered professional and socialization challenges during the GTW due to their deliberate self-positioning, other positioning and forced self-positioning, but they enacted their identity-agency and continuously worked on their career identity through repositioning. The findings also highlight specific traits of Millennials, such as adaptability, embracement of work-life balance, self-development, and self-driven career.

Caries de la primera infancia. Visión de conjunto actualizada. Revisión narrativa de la literatura

Objective: The purpose of this literature review is to gather updated information on diagnostic and therapeutic guidelines for early childhood caries. Material and methods: PubMed, Embase, Ovid, Cochrane Central and Google Scholar were searched for appropriate articles up to 5 years old (up to January 2018 inclusive). 229 studies were identified, including 13 clinical trials that discussed different treatment modalities for teeth affected by this disease. Conclusion: Early childhood caries is an increasingly common disease and is a condition that presents a unique set of clinical challenges for dental health professionals. This updated information recommends starting treatment as early as possible to eliminate the risk of increased cavitations because of early childhood dental caries and its consequences in these patients.

Development, review, and activation of thoracic oncology investigator-initiated trials.

Investigator-initiated trials (IITs) may address important biological and clinical questions that may not be prioritized by pharmaceutical sponsors. However, little is known about the process by which IIT proposals are evaluated and activated. We performed a retrospective study of IIT concepts submitted through the Academic Thoracic Oncology Medical Investigators Consortium (ATOMIC), which comprises 13 institutions in the U.S. and Canada, from 2014 (consortium inception) to 2024. We compared approved and disapproved concepts using chi-squared tests, Fisher's exact tests, and Wilcoxon Rank-Sum tests. Among a total of 68 presented IIT concepts, 60 (88%) received consortium approval a median of 30 days (interquartile range [IQR] 31-59 days) after submission. Concepts submitted by junior faculty were more likely to be approved than those from full professors (P=0.003). Of the 60 concepts subsequently submitted to pharmaceutical sponsors, 15 (25%) were approved, 43 (72%) were disapproved, and 2 (3%) remain under review. The median time between concept submission to a sponsor and the sponsor's decision was 61 days (IQR 31-183 days). Concepts with shorter projected durations were more likely to be approved by the pharmaceutical sponsor (P=0.05). For sponsor-approved IIT concepts, median overall time from initial submission to trial activation was 18 months. Only a small proportion of proposed investigator-initiated cancer clinical trials are successfully activated following a prolonged development process. Given the importance of IITs in addressing real-world, practical questions and the growing professional challenges facing clinical research physician faculty, further attention to IIT development facilitators and barriers is warranted.