Top Challenges Research Articles

Functions of the particle üldse ‘at all’ in questions in Estonian everyday conversations

Abstract The goal of the paper is to examine the use of the particle üldse ‘at all; ever; generally; absolutely (not)’ in questions in Estonian everyday face-to-face and telephone conversations. The analysis is based on the methodological framework of interactional linguistics. The particle üldse is found to serve three central functions in questions: (a) marking topic shifts and topic changes, (b) intensifying doubt or challenges, (c) emphasizing someone’s norm-violating behavior. Questions containing the particle üldse can be divided into two groups: neutral information-seeking questions and multifunctional questions that perform several social actions simultaneously. The particle üldse is commonly backward looking and serves both interpersonal and textual functions. Its use is often associated with non-preference, disagreement, or contradiction.

Libraries’ environmentally sustainable practices and services in California, Florida, and Georgia

This article reports findings from an exploratory survey study of library workers in California, Florida, and Georgia on their observations of libraries’ environmentally sustainable practices and services, and their perceptions of libraries’ roles and challenges in promoting environmental sustainability in the community. Findings from this study show that the most common environmentally sustainable practice in these libraries is to reduce, reuse, and recycle (3Rs). The respondents view libraries as primarily the information providers and educators on environmental sustainability. Lack of money, time, and community buy-in as well as the risk of being perceived as politicizing the topic are the top challenges faced by libraries when promoting environmental sustainability in the community, followed by the competing priorities faced by the libraries as well as the lack of expertise. Findings from this study contribute to the continuous effort to systematically study this topic and to identify the support libraries need to promote environmental sustainability in the community effectively.

Libraries’ Environmentally Sustainable Practices and Services in Three States

This article reports findings from an exploratory survey study of libraries in California, Florida, and Georgia on their day-to-day environmentally sustainable practices and related services, along with the respondents’ perception of library’s role and challenges in promoting environmental sustainability. Findings from this study show that the most common environmentally sustainable practices in these libraries are Reduce, Reuse and Recycle, and energy saving practices. Many libraries have taken individual actions, such as the 3Rs, or held programs on environmental issues. However, not many libraries were considered to have established policies or systematically address environmental issues. The respondents view library’s role as primarily the information providers and educators. Lack of money, staff time and subject expertise are the top challenges faced by libraries when promoting environmental sustainability in their community followed by competing priorities on library’s plate as well as a concern that promoting environmental sustainability in their community might be viewed as a political charge. Findings from this study contribute to the understanding of library’s roles and environmental sustainability, and inform the design of future studies on this topic and provide ideas on how to better support libraries.

Challenges of blockchain adoption for manufacturing supply chain to achieve sustainability: A case of rubber industry

Global market competitiveness and standards are pushing the manufacturing supply chain to adopt sustainable approaches to enhance quality, reduce waste, improve environmental practices, and optimize product costs. Blockchain technology has emerged as a promising tool for improving supply chain transparency and manufacturing sustainability. However, various challenges to the mainstream use of blockchain must be identified and addressed. In this regard, the study aims to identify and comprehend the challenges of adopting blockchain technology in the manufacturing sector to improve sustainable standards. To bridge this gap, the study used a three-step procedure. First, through a comprehensive literature review, 19 potential challenges were identified. Then, with the experts' discussion, a total of 18 challenges were finalized. In the second phase, data was collected from 15 professionals with industrial backgrounds. Lastly, the collected data was analyzed using Combined Compromise Solution methodologies and the Fuzzy-Decision-Making Trial and Evaluation Laboratory (fuzzy DEMATEL). This hybrid methodology prioritizes the challenges in blockchain adoption and categorizes them into causal groups. This improves the decision-making process by evaluating how the mutual impact of challenges in blockchain adoption affects achieving sustainability in the manufacturing supply chain. The outcomes of the presented work are validated through a sensitivity analysis of the outranked dimensions of blockchain adoption challenges. Results show that 'High Initial Investment Cost' and 'Lack of Digital Skills’ are the top challenges in its adoption. The findings of this work provide a roadmap to make the manufacturing supply chain sustainable and accomplish sustainability.

Emerging Topics, Challenges, and Strategies for Information Science Research

ABSTRACTThis panel will discuss emerging topics, challenges, and strategies for information scholars and information organizations to advance information science (IS) research in current complex information environments. Five panelists will provide their observations and thoughts based on their extensive research and/or professional practice experience, followed by active interaction with the audience. The panel discussion will be centered around 4 questions: 1. What emerging information topics or areas will have great significance to science and/or society? 2. What are the top challenges for IS researchers to perform cutting edge research? 3. How can information science researchers work together to address our research challenges? And 4. What are the implications of emerging topics, challenges, and strategies for information schools and information organizations? The engagement of the panelists and the audience will help information science research and practitioner communities gain insights into the directions of information science research.

Making the Move from "Med Math" to Medication Administration and Safety

The World Health Organization (WHO) recognized medication errors as a global health problem in 2017 highlighting them as a top patient safety challenge (World Health Organization, 2023). The American Association of Colleges of Nursing (AACN) highlights quality and safety one of the essentials of nursing (2021). In response to declining medication math scores and the emphasis on patient safety, one Midwest United States nursing program updated their curriculum to address medication administration and safety on exams instead of just “med math” as dosage calculation. Addressing the varying skills and knowledge of foundational mathematical concepts for nursing students entering and progressing throughout the program remains an area of further study.

Milestones in Medical Research from the Past to Cutting-edge

Abstract Coal and steel powered industrial revolution. The Industrial Revolution created tools and an enabling body of knowledge, which in turn facilitated research in tackling diseases by way of understanding the underlying causes. Empirical research, which also led to the birth of statistical rigor supported by research in human physiology and its building blocks created novel treatment methods. Wars accelerated their search incurring diseases and injuries-most notable being World War II. The explosion and democratization of computational power with communications has emboldened humanity to target deep into hitherto unthinkable challenges like longevity, manufacturing of organs, and designer medicines. Tools of artificial intelligence have started to crash time to discover molecules for the next major drug and have enabled higher accuracy of diagnosis. This study seeks to explore how these cutting-edge challenges have been met after the Industrial Revolution. The convergence of different streams of knowledge continues as industrial techniques like three-dimensional printing are being explored for customized prosthetics and also to produce organs on demand. Advanced mathematics and big data analytics are permitting the creation of complete genetic mapping at a fraction of the cost in a fraction of time than what was possible barely two decades ago. This has revolutionized the creation of vaccines and identifying strains of fast-mutating viruses—the current top global public health challenge. This study seeks to capture the excitement of discovery and explore the bleeding edge of medical research, which will occupy researchers for the next few decades while bringing forth the premise that medical research is not just confined to a few streams of knowledge and has not plateaued yet.

A systematic search and review of early contractor involvement in construction project development

PurposeThis study aims to review the current trends in early contractor involvement (ECI) in construction project development. The review consist of the following objectives: (1) identifying the benefits of ECI on construction project development; (2) identifying the challenges of ECI in construction project development; and (3) identifying the strategies of ECI in construction project development.Design/methodology/approachThis study systematically reviews the literature on the application of ECI in construction project development. A total of 133 related articles were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method.FindingsThis review identified “improved team work/collaboration working relationship” as the top benefits of ECI in construction project development. “Cultural barrier” was identified as the top challenge of ECI in construction project development, while “contributing value engineering” and “buildability evaluation input”, were the top two strategies of ECI in construction project development.Originality/valueTo the best of the authors’ knowledge, this study is the first to systematically review prior literature on ECI. As a result, the study provides a comprehensive understanding of the current state of the art and fills the literature gap. Researchers and industry professionals can use the study findings to increase the rate and benefits of implementing ECI in construction projects.

Improving growth in infants with CF.

Cystic fibrosis (CF) results in chronic pulmonary infections, inflammation, pancreatic insufficiency, and multiple gastrointestinal manifestations. Malnutrition and poor growth are hallmarks of CF, and strongly associated with poor outcomes. Through newborn screening, many infants can be diagnosed within a few days of life, which allows for early initiation of nutritional counseling and close clinical follow-up. Obstacles to growth for infants with CF start in utero, as newborns with CF can have a lower birth weight than the general population. Improving infant growth has been linked to improved clinical outcomes and survival. It remains a top priority and challenge for caregivers and healthcare teams. An interdisciplinary approach, including registered dietitian and social work support, is essential to optimize health for infants with CF. Remaining barriers to normalcy include deficits in linear growth, lack of accurate nutrition biomarkers, persistence of inequities related to social determinant of health, particularly in the global CF community.

Coping with today's top challenges.

Coping with today's top challenges.

Selected Topics of Technical Challenges of the ITER Central Solenoid

Selected Topics of Technical Challenges of the ITER Central Solenoid

Work Challenges Among Hotel and Restaurant Management Staff

Understanding and addressing these challenges is essential for the employees and the industry. The study was conducted to determine the work challenges among hotel and restaurant management staff in Butuan City. The researchers employed a descriptive comparative approach for this study. Based on the findings, there is a moderate extent of work challenges among hotel and restaurant management staff in Butuan City. This means that the extent of challenges sometimes coincides with the respondents’ experience. In addition, there is no significant difference in the work challenges faced by the hotel and management staff in Butuan City. Moreover, the challenges faced by hotel and restaurant management staff in Butuan City. The data reveals that lack of recognition as the top challenge; poor communication and work schedules are also significant challenges. Furthermore, Herzberg's Two-Factor Theory supports the study's findings by highlighting the importance of addressing both hygiene factors and motivators. Since the findings show that the hotel and restaurants lack recognition, to address the challenge of lack of recognition, hotel and restaurant management should implement a structured employee recognition program. This program can include monthly or quarterly awards, shout-outs during meetings, or employee of the month acknowledgments.

Interviewing students with special needs: Developing ethical considerations and interviewing protocols

AbstractInterviewing students with special needs (SSNs) comes with a unique set of ethical and practical challenges that require highly specialised skills and interviewing protocols. Our objectives were to identify the most appropriate tools for collecting data from SSNs, key differences in interviewing students with and without special needs, and ethical and practical challenges during it. The ultimate goal was to develop ethical considerations and interviewing protocols for SSNs (ECIP4SSN). It was done through a two‐step Delphi method, collecting data from 11 special education experts from 11 different countries. The experts believed the tools should be selected based on the study's nature; however, many of them preferred the interviews. They believed that interviewing special students is challenging due to their special needs. Challenges pertaining to consent, hyperactivity, emotional distress, and wrong and irrelevant answers were among the top challenges mentioned by them. Final ECIP4SSN consisted of the key ethical considerations and interviewing protocols i.e. obtaining the background information and support, training and preparations, consent, data collection, building rapport, emotional support, confidentiality, and anonymity, using supporting tools, language, methods of asking questions and validating responses. The ECIP4SSN will guide the university teachers, students and researchers in interviewing special students.

Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management.

Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Exploratory, convergent mixed methods. Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients' lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings.

Nanoengineering of Cathode Catalysts for Li-O2 Batteries.

Lithium-oxygen (Li-O2) batteries have obtained widespread attention as next-generation energy storage systems due to their extremely high energy density. However, the high charge overpotential, attributed to the insulating property of Li2O2, significantly limits the energy efficiency and triggers solvent degradation. The high electrochemical activities of oxygen reduction reactions (ORR) and oxygen evolution reactions (OER) on the cathode are crucial for alleviating the high charging polarizations and enhancing the lifetime of Li-O2 batteries, which are also top challenges of state-of-art research. In this review, the scientific challenges and the proposed solutions in the development of cathode catalysts have been summarized. The recent research advancements on the nanoengineering of cathode catalysts for Li-O2 batteries have been comprehensively discussed, and the perspectives on the structure optimization are presented. Meanwhile, we have elucidated the structure-performance relationship between the electronic state and performance of the cathode catalysts at the nanoscale level. This review intends to provide guidelines for the design and construction of cathode catalysts in advanced Li-O2 batteries.

Activating HR+/HER2- and triple-negative breast cancer care teams and their patients in shared decision-making.

1547 Background: In the rapidly evolving treatment landscape of metastatic breast cancer (MBC), shared decision-making (SDM) is critical to individualize care and improve patient outcomes. To help facilitate improved SDM, we developed an educational toolkit for health care providers (HCPs) to use with HR+/HER2- and triple negative breast cancer (TNBC) patients (pts) and evaluated the implementation of this toolkit at 5 community oncology clinics. Methods: In May-June 2022, pts (N=94) and HCPs (N=18) completed surveys assessing attitudes, confidence, goals, and barriers to SDM in MBC care. HCPs then led collaborative learning sessions with their pts using the SDM toolkit to provide education regarding treatment options and side effects, and to better align on shared goals and treatment plans. Results: In surveys, only 50% of pts reported that they decide on a treatment plan together with their HCPs , 38% reported being asked about treatment preferences, and 34% reported discussing supportive care, such as mental health care or pain relief. Additionally, very few pts reported high knowledge of BC treatments and side effects. HCPs and pts were misaligned on patient goals and barriers to SDM. For example, 56% of HCPs thought pts were too overwhelmed/anxious/fatigued to make treatment decisions, but only 21% of pts agreed that was a top challenge. While pts and HCPs were aligned on top treatment decision factors of effectiveness and quality-of-life, HCPs underestimated the importance of concerns about side effects (HCPs 11% vs pts 32%), and the cost and duration of treatment (17% vs 30%, and 22% vs 30%, respectively). HCPs correctly identified survival (56%) as a top goal for pts but were less likely to identify progression/recurrence as important to pts (39%). Additionally, 28% of pts reported their top challenge was worrying about being unable to work or meet responsibilities at home; however, only 19% of HCPs recognized this as a top challenge. Following pt-HCPs collaborative education sessions, in which HCPs used the SDM toolkit to facilitate pt education and SDM, HCPs and pts reported improved confidence in pt-HCP communication. Additionally, 46% of pts reported discussing treatment goals with their HCPs and 46% reported taking a more active role in their care following the learning session. Conclusions: These findings reveal misalignments between HCPs and patients with BC regarding treatment decision-making. The gaps identified are critical to address as they are pre-requisites for SDM. The downloadable shared decision-making toolkit developed as part of this implementation science initiative can be adopted by breast cancer clinical teams to help facilitate patient education and SDM, empowering patients to be active participants in their care.

Multidisciplinary care for patients with gastroesophageal cancers (GEC): A quality improvement initiative in community cancer clinics.

e16096 Background: Evidence-based guidelines for GEC management recommend multimodal care, which involves close coordination between medical, surgical, and radiation oncologists, together with specialists to manage symptoms and treatment-related adverse events (AEs). Optimizing the high level of multidisciplinary care required for effective GEC management poses substantial challenges for community oncology care teams. Methods: In August-October 2023, 57 healthcare providers (HCPs) from 4 US community oncology clinics completed surveys on challenges, barriers, and improvements needed in the multimodal care of patients with GEC. Based on findings from the baseline data, 70 HCPs participated in audit/feedback (AF) sessions to review site-specific gaps and challenges and develop action plans to address identified gaps. Follow-up surveys will evaluate the impact of changes in practice following action plan implementation. Results: Providers identified their 3 top challenges to providing care for patients with GEC: interdisciplinary care coordination, providing patient-centered supportive care, and managing AEs. They reported that care coordination was hampered by low frequency and poor-quality communication between medical oncology and surgical teams, by misalignment on methods of communication, and by a lack of relationship between the specialties. About one-third of HCPs reported recognizing and managing AEs as the most challenging aspect of caring for patients with GEC, including AEs that were immune-related (26%), dermatologic (19%), gastrointestinal (19%), neurologic (14%), immunosuppression-related (10%), and respiratory (5%). After the AF sessions, HCPs reported improving communication and coordination among care team members as an important means of improving and individualizing patient care plans and integrating new therapies into clinical workflows. Action plans included streamlining communication with surgical teams, increased use of patient navigation, and ensuring that every patient is reviewed through the multidisciplinary tumor board. With regard to AE management, action plans included improving patient education on AE identification, and better communication within the team on nutritional support. HCPs who participated showed improved confidence, knowledge, and competence in appropriately sequencing systemic therapy and surgical interventions. Conclusions: GEC care teams from community cancer clinics reported dissatisfaction with multidisciplinary care coordination, including poor communication between specialists involved in multimodal care of patients with GEC. Integration of sustainable changes in clinical workflows driven by this initiative improved oversight of multimodal care, improved workflows, and improved AE management.

Targeted interventions to address local challenges in HR+/HER2- and HER2+ breast cancer treatment in community-based settings.

e23213 Background: Advancements in novel targeted agents and antibody-drug conjugates (ADCs) have dramatically improved patient outcomes and survival for breast cancer patients, yet the successful utilization of these agents remains a key challenge for clinicians, particularly in the community. To improve the care of HR+/HER2- and HER2+ patients, a quality improvement (QI) initiative was conducted across 6 community-based oncology practices. Methods: Between 7/2023 and 10/2023, multidisciplinary oncology team members (N = 98) across 6 US-based community oncology practices were surveyed to identify gaps in the treatment and management of patients with HR+/HER2- and HER2+ breast cancer. Providers then participated in audit/feedback (AF) sessions where they (a) assessed site-specific practice gaps identified via the provider surveys; (b) received targeted education based on their specific gaps; and (c) developed action plans for improvement. Follow-up surveys administered 90 days after AF sessions will evaluate the impact of practice changes driven by the QI initiative. Results: Top challenges reported by providers in caring for patients with HR+/HER2- and HER2+ breast cancer were providing patient-centered supportive care measures (37%), individualizing treatment plans (18%), and managing treatment-related adverse events (14%). Reported challenges in treatment sequencing included rapidly evolving guideline recommendations (44%) and knowing which treatment to select when patients are eligible for multiple lines of therapy (34%). Additionally, oncology team members reported having the most difficulty managing treatment-related neurological effects (32%), neutropenia (16%), and GI toxicities (14%). Providers believed improved collaboration across interprofessional teams (28%) and increased patient education/referrals for supportive care (26%) would most improve care for breast cancer patients. To address the identified gaps at each location, teams participated in targeted AF sessions focused on addressing their specific gaps and developed action plans, such as developing new workflows for improving care coordination, implementing institutional protocols for identifying and managing adverse events, and improving patient supportive care, quality-of-life assessments, and distress screenings. Full findings from baseline surveys will be presented, along with follow-up surveys measuring real-world impact of the system-level practice changes. Conclusions: Through this QI initiative, teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into HR+/HER2- and HER2+ breast cancer care to optimize patient outcomes.

Beyond the binary: A transformative implementation science initiative to improve LGBTQ+ cancer care.

11010 Background: Patient, provider, and system-level barriers contribute to significant disparities in care of LGBTQ+ persons, including delays in screening and diagnosis, and poorer outcomes. This implementation science initiative was designed to identify and address root causes of disparities in care for LGBTQ+ patients (pts) and drive sustainable change to improve health equity in LGBTQ+ cancer care. Methods: In 2023, a steering committee of 3 expert oncologists and 5 LGBTQ+ cancer pts convened to develop survey instruments and a point-of-care LGBTQ+ Cancer Care Toolkit. Next, LGBTQ+ pts with cancer (N = 817) and oncology providers (OPs) from 2 academic and 5 community-based practices (N = 115) completed surveys to reveal alignments and discordances in beliefs, perceptions, and practices regarding cancer care. OPs participated in audit-feedback (AF) sessions to critically assess system-specific practice gaps, prioritize areas for improvement, and develop action plans for improving LGBTQ+ cancer care. Results: Provider-reported top challenges in care included: unsure how sexual orientation/gender identity (SOGI) affect treatment considerations (35%), unsure how to discuss SOGI (30%),and systemic barriers that limit inclusion (29%). While most providers (84%) were at least moderately comfortable treating LGBTQ+ pts, these data suggest they overestimated the level of comfort of their pts. For example, only 24% of pts reported feeling safe disclosing their LGBTQ+ identity, while 65% of providers thought pts felt safe. Additionally, while most providers (73%) thought it was important to know a pt’s gender identity, only 46% thought it was important to know sexual orientation, and only 3% of providers reported routinely discussing SOGI with new pts. Patients and providers were not concordant in several other key areas, including the experience of pts’ partners, measures of inclusivity, and supportive care services offered, such as fertility preservation. Survey data also revealed systemic barriers to equitable care, such as EMR documentation of SOGI. In AF sessions, teams reviewed survey outcomes, and developed action plans for improvement, including integrating the toolkit, updating EMR documentation, developing LGBTQ+ education, and adopting measures of inclusivity. Notably, following the intervention, there were considerable gains in provider confidence and knowledge, and ~70% of providers committed to discussing SOGI with their pts at first introduction. Conclusions: Through this QI initiative, teams identified patient-, provider-, and systemic-level barriers that affect LGBTQ+ cancer care in their own practices and implemented action plans to address key challenges. The sustainable changes implemented in this QI initiative represent key opportunities for improvement that can be implemented in clinics across the country to improve equitable LGBTQ+ cancer care.

Competitive Dynamic Pricing Under Capacity Constraints: An Experimental Study

Keeping up with competitors’ prices is one of the top operational challenges in pricing. However, competitive interactions in revenue management have not received much research attention in the past due to their complexity. We conduct a series of laboratory experiments to investigate the dynamic pricing behavior of two capacity-constrained firms under competition. Our experiments initially control for strategic interactions between the sellers and then allow for them. To gain a broader understanding, we also manipulate demand uncertainty and the expected market size. Our results confirm the dependency of dynamic pricing decisions on the competitor's behavior. We find that the theory is much more forgiving—in the sense that it predicts a lower level of competition among the sellers—than what we actually observe in the laboratory. The modeling literature indicates that the seller with the lower capacity has a competitive advantage, but our results reveal the opposite. Further, there is potential for high-capacity sellers to benefit from competition. Sellers tend to underprice (resp., overprice) their units at the beginning (resp., end) of a selling season. Also, competition lasts longer than the theory predicts, and customers benefit from the biases of the competing sellers. The higher-capacity seller following the best-response policy is not harmed due to the biases of the competitor. However, the lower-capacity seller's performance is greatly influenced by the competitor's degree of rationality.