Uphill Battle Research Articles

Experiences of autistic people in supported employment in France: a participatory research project

Purpose The employment rate of autistic people is low, and they are often employed in low-paying jobs or in jobs involving tasks that fall short of their skills and competence. To address this situation, the individual placement and support method (IPS) offers promising perspectives for personalized and long-term support measures. This evidence-based method has produced positive results in several countries. IPS has been used in France only since 2016. This paper aims to examine the experience of autistic people in France who have benefitted from supported employment measures. Design/methodology/approach Nineteen autistic adults in France took part in semistructured interviews. Interview questions focused on work and measures to support employment. The authors analysed the interviews using reflexive thematic analysis, within the paradigm of critical realism. The authors adopted a participatory approach; the project was led by an autistic researcher and autistic individuals were included at all stages. Findings This study identified six primary themes and three subthemes across the data: (1) The uphill battle to obtain adjustments in the workplace; (2) insufficient knowledge of autism; (2.1) explaining again and again: the educative burden; (3) the challenge of making oneself heard; (3.1) when the entourage steps in; (4) support measures as material assistance and reassurance; (4.1) between benevolence and condescension; (5) organizational factors that affect the quality of support; and (6) personal and professional life are closely intertwined. Originality/value This research provides a better understanding of how autistic people experience supported employment in France and highlights ways to improve it. Job coaches play a crucial role in offering practical help and reassurance, and their efforts to nurture an active personal life are perceived positively. However, supported employment also carries the risk of limiting autistic individuals' capacity for action and causing several difficulties if job coaches are not well-informed about autism, do not reflect on their own attitudes, do not assist in obtaining necessary accommodations and if there are organizational problems leading to a lack of resources.

The uphill battle for reinventing post-industrial regions: The case of Greater Manchester's ‘clean growth’ mission

In this paper we enrich the concept of place-based leadership. Building on social movement theory, our analysis of the clean growth mission development in Greater Manchester (UK) reveals the role of place-based leadership in mobilising and coordinating framing processes that linked the global climate change problem with local challenges, articulated local benefits of its resolution, and provided justification for local change efforts. We draw on theories of the policy process (i.e. Multiple Streams Framework) to shed light on how place-based leaders frame problems and solutions strategically to engender policy change. While framing processes had an impact on local policy agendas, we do not find evidence of accelerated implementation, pointing to the important distinctions between problem ownership and solution ownership in the context of wicked problems. Our findings contribute to the ongoing debate on the role of multi-level governance and localised agency in problem-based policymaking for sustainable regional development.

“Fighting an Uphill Battle”: The Pursuit of Equity Through the Every Student Succeeds Act in North Carolina

Purpose: The Every Student Succeeds Act (ESSA) reduced the role of the federal government in K-12 education, giving states more flexibility while maintaining protections for marginalized groups. Despite the potential to leverage flexibility, little is known about how states are addressing equity. Research Methods: Using a critical policy analysis (CPA) approach, this qualitative case study uses semi-structured interviews and document analysis to examine the design and implementation of equity efforts by the state education agency (SEA) in North Carolina. Findings: SEA officials describe writing the state ESSA plan as an exercise in compliance and believe the plan could have gone further in pushing equitable solutions. Competing priorities within the SEA, including the struggle to fulfill its dual roles as service provider and regulatory agency, complicated ESSA implementation, as did state-level political maneuvers. A significant, unexpected finding is that participants were much more comfortable discussing the needs of economically disadvantaged students than students of color, and often avoided mentioning race specifically. Additionally, although the pandemic caused major disruptions to schooling, SEA officials identified “keeps” that were begun as a pandemic response and may continue as the SEA pushes equitable solutions for traditionally underserved students. Implications for Research and Practice: This study suggests that competing initiatives, staff turnover, and political ideology may limit the SEA's capacity to address power and resource imbalances and hinder efforts to promote greater equity in the educational system. Moreover, the SEA's focus shifted to ESSER funding during the COVID-19 pandemic.

Drug response-based precision therapeutic selection for tamoxifen-resistant triple-positive breast cancer

Breast cancer adaptability to the drug environment reduces the chemotherapeutic response and facilitates acquired drug resistance. Cancer-specific therapeutics can be more effective against advanced-stage cancer than standard chemotherapeutics. To extend the paradigm of cancer-specific therapeutics, clinically relevant acquired tamoxifen-resistant MCF-7 proteome was deconstructed to identify possible druggable targets (N = 150). Twenty-eight drug inhibitors were used against identified druggable targets to suppress non-resistant (NC) and resistant cells (RC). First, selected drugs were screened using growth-inhibitory response against NC and RC. Seven drugs were shortlisted for their time-dependent (10–12 days) cytotoxic effect and further narrowed to three effective drugs (e.g., cisplatin, doxorubicin, and hydroxychloroquine). The growth-suppressive effectiveness of selected drugs was validated in the complex spheroid model (progressive and regressive). In the progressive model, doxorubicin (RC: 83.64 %, NC: 54.81 %), followed by cisplatin (RC: 76.66 %, NC: 68.94 %) and hydroxychloroquine (RC: 68.70 %, NC: 61.78 %) showed a significant growth-suppressive effect. However, in fully grown regressive spheroid, after 4th drug treatment, cisplatin significantly suppressed RC (84.79 %) and NC (40.21 %), while doxorubicin and hydroxychloroquine significantly suppressed only RC (76.09 and 76.34 %). Our in-depth investigation effectively integrated the expression data with the cancer-specific therapeutic investigation. Furthermore, our three-step sequential drug-screening approach unbiasedly identified cisplatin, doxorubicin, and hydroxychloroquine as an efficacious drug to target heterogeneous cancer cell populations. Significance statementHormonal-positive BC grows slowly, and hormonal-inhibitors effectively suppress the oncogenesis. However, development of drug-resistance not only reduces the drug-response but also increases the chance of BC aggressiveness. Further, alternative chemotherapeutics are widely used to control advanced-stage BC. In contrast, we hypothesized that, compared to standard chemotherapeutics, cancer-specific drugs can be more effective against resistant-cancer. Although cancer-specific treatment identification is an uphill battle, our work shows proteome data can be used for drug selection. We identified multiple druggable targets and, using ex-vivo methods narrowed multiple drugs to disease-condition-specific therapeutics. We consider that our investigation successfully interconnected the expression data with the functional disease-specific therapeutic investigation and selected drugs can be used for effective resistant treatment with higher therapeutic response.

An Uphill Battle: A systematic literature review on the challenges of addressing Child Sexual Abuse (CSA) in the developing countries

Despite worldwide concern over child sexual abuse (CSA), studies on barriers of combating it are still limited. Most studies focusing on the contributing factors particularly from the societal perspectives. Hence this article presents a systematic literature review on challenges in addressing CSA in the context of developing countries in Asia. Using PRISMA protocol, 17 articles from 2017 till present were selected. Several themes emerged leading to the conceptualization of the challenges in dealing with CSA which include taboo and social stigma, poverty and economic vulnerability, witnesses of the legal system, lack of knowledge and institutional and structural challenges.

Changing diasporic identity and increasing global backlash: the Xi government’s tactics and challenges of engaging new generation overseas Chinese

ABSTRACT The transnational engagement between the Chinese communist government and first-generation overseas Chinese has been analysed extensively, but the academic analysis of interactions between the Chinese communist government under Xi Jinping and new generation overseas Chinese is scarce. Questions arise regarding how the rise of new generation overseas Chinese has changed the diasporic identity of the overseas Chinese community; what the Xi government’s tactics of engaging new generation overseas Chinese are; and how new generation overseas Chinese respond to the Xi government’s targeted campaign. By answering these questions, this article provides an important case study for the emerging scholarship on the relations between authoritarian states and new generation diasporas. Building on government archives, ethnographic interviews, media reports, and online and offline diaspora events, this article analyses the Xi government’s tactics and challenges of diaspora engagement targeting new generation overseas Chinese, and forecasts an uphill battle for the Xi government.

Academic Uphill Battle to Personalize Treatment for Patients With Stage II/III Triple-Negative Breast Cancer.

Academic Uphill Battle to Personalize Treatment for Patients With Stage II/III Triple-Negative Breast Cancer.

Heterodox conspiracy theories and evidence-based theories of error

ABSTRACT Heterodox ideas face an uphill battle. This is not least the case for heterodox conspiracy theories. As an empirical observation, this is hardly controversial. What is controversial is whether and to what extent this should be the case. Some authors have gone so far as to argue that heterodox conspiracy theories should be generally dismissed, and that it is precisely their heterodox status that justifies such dismissal. Most particularists are likely to object strongly to such an assessment, arguing that conspiracy theories – whether heterodox or orthodox – should not be dismissed before careful examination of the relevant evidence. But even particularists will probably concede that proponents of heterodox conspiracy theories have to bear a special epistemic burden. The main aim of this paper is to take a closer look at this particular epistemic burden. Drawing on the literature about peer disagreement, genealogical debunking arguments, and related philosophical debates, I focus in particular on the question of whether and under what conditions it can be rational to defend heterodox conspiracy theories, and argue that what I will call theories of error play a crucial role in this context.

The Polarities of Care for Bipolar Patient

This study explored the experiences of caregivers handling bipolar patients. It utilized the descriptive-phenomenological method of research with 10 participants from the SOCCSKSARGEN region. The findings of the study reveal that the caregivers were 46.8 years old on average, the majority were women. Most participants were parents of the patients. Most have been a caregiver for 10 years or more. The data when thematically analyzed generated eleven (11) clustered themes which, furthermore, categorized into four (4) emergent themes: (1) Navigating the Complexities of Caregiving; (2) The Uphill Battles of Caregiving; (3) The Resilience and Support in Caregiving, and (4) Joys of Caregiving. The responsibilities of the caregivers revolve around providing compassionate care to the patient, ensuring adherence to therapeutic management, recognizing early signs and symptoms to prevent relapse, assuming caregiving roles, and fostering the patient’s independence whenever possible. The challenges experienced by caregivers that affected their lives in some way include the presence of constant stress, financial constraints, and lack of socialization with other people. Furthermore, they did not receive any help from the government. As a coping mechanism, caregivers nurture themselves by pursuing what they love to do like cooking or visiting family members. Moreover, having faith in God, especially praying also helped them to cope with stress. Caregivers also experienced joys in caregiving.

Special considerations for the use of AI tools by PEERs as a learning and communication aid.

There is no doubt that navigating academia is a formidable challenge, particularly for those from underrepresented backgrounds who face additional barriers at every turn. In such an environment, efforts to create learning and training environments that are diverse, equitable, and inclusive can feel like an uphill battle. We believe that harnessing the power of artificial intelligence (AI) tools can help in leveling the playing field. While AI cannot supplant the need for supportive mentorship, it can serve as a vital supplement, offering guidance and assistance to those who may lack access to adequate avenues of support. Embracing AI in this context should not be stigmatized, as it may represent a vital lifeline for underrepresented individuals who often face systemic biases while forging their own paths in pursuit of success and belonging in academia. AI tools should not be gatekept from these individuals, particularly by those in positions of power and privilege within the scientific community. Instead, we argue, institutions should make a strong commitment to educating their community members on how to ethically harness these tools.

Peacebuilding Efforts in Civil War-Affected Countries in Afghanistan

Purpose: The aim of the study was to analyze peacebuilding efforts in civil war-affected countries in Afghanistan. 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: Peacebuilding in war-torn Afghanistan faces hurdles due to ongoing conflict, ethnic divides, and Taliban resurgence. Governance reforms and reconciliation efforts struggle amidst poverty and corruption. Despite some progress, achieving lasting peace is an uphill battle. Unique Contribution to Theory, Practice and Policy: Liberal peacebuilding theory, critical peacebuilding theory & relational peacebuilding theory may be used to anchor future studies on the peacebuilding efforts in civil war-affected countries in Afghanistan. Peacebuilding efforts should prioritize local ownership, inclusivity, and participatory approaches that empower affected communities to take an active role in shaping their own futures. Peacebuilding efforts should be integrated into broader development, security, and governance frameworks to ensure coherence, coordination, and sustainability.

Abstract MP03: Social Adversities and Mortality in HIV and Heart Failure Patients: A Multi-Center Retrospective Cohort Study From Public Hospitals in New York City

Introduction: Individuals living with HIV often face heightened social challenges, particularly in the context of heart failure, turning their chronic disease management into uphill battle. Yet, current literature provides limited insight into how social adversities impact the outcome of HIV heart failure population. This study aims to investigate the relationship between overall mortality and lifetime social adversities in patients diagnosed with HIV and heart failure. Methods: This study utilized data from the New York City Health + Hospitals HIV Heart Failure (NYC 4H) retrospective cohort, encompassing records from eleven major New York City Health + Hospitals. Patients were recruited from both inpatient and clinic hospital visits between 7/2017 and 6/2022. Those under the age of 18 and with baseline cancer were excluded from the study. Social adversities were meticulously assessed through licensed social workers' psychosocial assessment notes. The cohort was categorized into groups based on their number of exposures to social adversities (0, 1-2, >2). We evaluated the association between social adversities and overall mortality using hazard ratios (HR) employing Cox proportional hazards models. The analysis was adjusted for age, sex, race, co-morbidity, CD4 counts, HIV viral load, and activities of daily living (ADL). Result: The analysis included a total of 668 patients, comprising 400 males and 268 females. Over an average 4-year follow-up period, 112 deaths were identified. We found that 244 patients (36.5%) encountered at least one social adversity, and 125 patients (18.7%) faced more than one social adversity. After adjusting for covariates, exposure to any adversity was significantly associated with an 89% increase in risk for overall mortality compared to those without (HR 1.89, 95% Confidence Interval [CI] [1.23,2.90], p=0.004) during follow-up period. Patients exposed to one to two adversities had 1.57 times risk (HR 1.57, 95%CI [1.05,2.43], p=0.027) comparing to those without any social adversities. Patients who have more than two social adversities had 2.83 times overall mortality risk (HR 2.83, 95%CI [1.69,4.74], p<0.001) compared to those without. Particularly, significant associations were observed among individuals facing food deprivation (HR 3.58, p<0.001), lacking family support (HR 2.80, p<0.001), engaging in polysubstance abuse (HR 1.72, p<0.01), and suffering from mental illness (HR 1.64, p<0.05). Conclusion: Our study demonstrates a significant correlation between social adversities and higher mortality rates among HIV-related heart failure patients. Notably, factors such as food deprivation, lack of family support, polysubstance abuse, and mental illness emerged as pivotal contributors to this association, underscoring the need for comprehensive social evaluation and support within this vulnerable population.

An Uphill Battle: A systematic literature review on the challenges of addressing Child Sexual Abuse (CSA) in the developing countries

An Uphill Battle: A systematic literature review on the challenges of addressing Child Sexual Abuse (CSA) in the developing countries

NFT Based Secure Platform for Copyright Images

Artists are digitally disenfranchised, rampant online sharing and ease of copying make protecting their work from unauthorized use an uphill battle. Digital art is effortlessly duplicated, shared, and manipulated without credit or compensation, even leading to individuals profiting off stolen work. This widespread issue, particularly plaguing social media, demands a solution. We propose a blockchain-based platform utilizing Non-Fungible Tokens (NFTs) to empower artists. By creating NFTs for their art, they claim irrefutable ownership, authenticity, and copyright, enabling secure sales via cryptocurrencies and combating unauthorized use. This innovative approach empowers artists to thrive in the digital age

Analysis of the 2024 Taiwan Presidential Election

In the 2024 Taiwan presidential election, Lai Ching-te, the ruling Democratic Progressive Party (DPP) candidate calling for the continuation of the Tsai Ing-wen administration’s line, won the election, while the DPP lost its majority in the legislative elections held at the same time. The opposition Kuomintang (KMT) became the leading party in the Legislative Yuan, and the third largest party, the Taiwan People’s Party (TPP), although a small party, held the casting vote. The election campaign revolved around the pros and cons of “change in government,” and the DPP, already in power for eight years, had an uphill battle. In the end, however, neither of the opposition parties was able to raise expectations higher than those of the DPP. For the next four years, Taiwan’s political landscape is now under a “divided government,” with the Executive Yuan led by the ruling party but the Legislative Yuan dominated by the opposition parties. This situation shows a fine balancing act, but it could also lead to a paralysis of Taiwanese politics. The election results carry a degree of uncertainty.

Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study.

Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.

An uncertain uphill battle – experiences and consequences of living with lipedema

ABSTRACT Purpose To describe and analyse experiences of living with lipedema. Methods: Individual, semi-structured interviews with a purposive sample of 12 women diagnosed with lipedema and analysed by qualitative content analysis utilizing an inductive approach. Results The overarching theme, “An uncertain uphill battle against a divergent body and societal ignorance”, covers the experiences of living with lipedema and is based on five categories; “Captivated by a disintegrating body”, “Face the impairments of a chronic condition”, “Experience social exclusion”, “Need emotional support to go on” and “Mull over an insecure future”. The women felt entrapped within their bodies and experienced social exclusion due to the chronic symptoms and the progressive body shape alteration caused by their illness. Having experienced deficient information on the illness, varying support from other people, and a deteriorating economic situation, the women face an uncertain future. Conclusions Symptoms and restrictions caused by lipedema affect women’s livelihood and future, as there are no indications for disease improvement. Preventive work aimed at reducing health deterioration should be a priority. More research is needed to raise healthcare awareness regarding difficulties experienced by patients with lipedema.

Apple Revolution in the Tribal District of Kinnaur: From Tradition to Technology, Horticulture Redefined with Quality Assurance and Sustainability

Nestled amidst the breathtaking landscapes of Himachal Pradesh, Kinnaur has garnered renowned niche as a veritable paradise for apple orchards. Its distinction arises from the harmonious convergence of climatic conditions, featuring a unique blend of dryness, temperance, and cold that fosters the perfect environment for apple cultivation. Within this rich tapestry of crops, apples stand as the undisputed sovereign, commanding a remarkable 90% share of the total cultivated fruit area and making an astounding 99% contribution to the overall fruit production in the region. The significance of apples transcends mere Horticulture and agriculture statistics; it has become an emblem of Kinnaur's Horticulture expertise and a substantial pillar supporting its Gross Domestic Product (GDP). The orchards of Kinnaur are not just fruitful in terms of their produce but are also laden with the economic promise that this quintessential cash crop brings to the region. The growth trajectory of apple cultivation in Kinnaur reads like a tale of prosperity and ambition. Over the years, the cultivation of apples has witnessed a breathtaking expansion, evolving from a modest 670 hectares of apple orchards in the early 1970s to an expansive 10,925.5 hectares by the year 2022-23. This exponential surge in apple cultivation has yielded astounding results, with a record-breaking apple production of 83,324 metric tons per hectare, achieving a remarkable productivity rate of 7.63 metric tons during the year 2022-23.In this idyllic setting, the apple orchards of Kinnaur flourish, standing as a testament to the region's Horticulture and agricultural prowess, economic vitality, and its unceasing commitment to the cultivation of the 'fruit of kings.' Royal Delicious, celebrated for its exquisite taste and crisp texture, rightfully commands the spotlight in Kinnaur's apple orchards, where it dominates the landscape, constituting a staggering 90% of the apple varieties grown. The year 2022-23 witnessed Kinnaur's apple production soaring to new heights, with the district proudly yielding a bounteous harvest of 84,192.93 metric tons of temperate fruits, sprawled across an expansive expanse of 12,142.6 hectares. However, even within this remarkable success story, the apple industry in Kinnaur faces a set of formidable challenges that demand attention and innovative solutions. One pressing issue lies in the prevalence of traditional apple cultivars, which, while deeply rooted in Kinnaur's heritage, often hinder the production of high- quality fruits. The rigid adherence to these time-honored strains limits the potential for innovation and improvement. Compounding this challenge is the daunting topography of Kinnaur's terrain, marked by steep and treacherous slopes. This rugged landscape presents an additional obstacle to the introduction of new apple cultivars, making the transition to improved strains an uphill battle, both literally and figuratively. Furthermore, the dearth of access to these new and improved apple cultivars, coupled with a knowledge deficit regarding their cultivation, adds complexity to the task of enhancing fruit quality. Another issue contributing to the challenge is the conventional orchard layout prevalent in most of Kinnaur's apple orchards. These orchards are arranged in a square method with low-density plantings of old standard apple trees. While this traditional approach may be deeply ingrained in our culture and has a unique manifestation of purity and nutrition. However, these modern systems feature high-density plantings of vibrant, good-colour strain apple trees, promising superior fruit quality. The shift to such high-density systems aligns with the changing preferences of consumers and the need to meet international export standards, making it essential for Kinnaur's apple industry to embrace innovation, adapt to modern practices, and invest in knowledge dissemination to maximize its full potential in apple cultivation.

Disability Justice and Access on the College Campus: An Uphill Battle Toward Organizational Change

Feeling the exhaustion of multiple disability-related violations occurring in the classroom, staff from the Office of Disability Access at Heneton College have begun to feel isolated and hopeless. When the opportunity for collaborative, college-wide disability-centered training becomes available, it is met with mixed reviews and lots of opinions from across the institution. Some are supportive, many are feeling the pressure of multiple professional development and training obligations, and some question why the institution even needs this kind of training. Leaders in this case are faced with questions around shared governance, organizational change, and equity and inclusion.

Tunnels as Temples of 'New Green India': Dominant Narratives of Himalayan Dam Building

The dramatic unfolding of the Joshimath crisis in Uttarakhand, India, has brought the world’s attention once again to the Himalaya. The contribution of a 520-megawatt hydropower dam to land subsidence is squarely in the spotlight. River valleys with bumper-to-bumper hydropower dam building, especially in the North Western Himalaya, in the past decade and a half or so, have witnessed frequent slope de-stabilisation, landslides and seepages. Unlike the visible dispossession of rural—often adivasi and dalit— populations in reservoir based dam affected areas, even establishing and ‘scientifically’ correlating cascading hazards with human impacts of the ‘invisible’ activity of run-of-the-river dams in the relatively sparsely populated regions of the Himalaya, has been an uphill battle for impacted mountain people. This article examines the conflict around hydropower development in Himachal Pradesh to understand the trajectory of State policy, dominant narratives and responses of affected communities. Tracing the history of such contestation in the 180 MW Bajoli Holi hydropower project in Chamba’s tribal belt Bharmour, we illustrate the complicity of project proponents, regulatory institutions, political actors, scientists and the judiciary in transferring the project’s risks to local inhabitants and the environment. The burden of building fresh evidence, staking claims and posing counter-narratives lies unfairly with the dispossessed as they struggle for safety and survival.