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Abstract Background Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of evidence-based AMI care in high-income settings, but interventions to improve quality of AMI care have not been studied in sub-Saharan Africa. Methods Purposive sampling was used to recruit participants from key stakeholder groups (patients, providers, and healthcare administrators) in northern Tanzania. Semi-structured in-depth interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded to identify barriers to AMI care, using the 39 CFIR constructs. Barriers relevant to emergency department (ED) AMI care were retained, and the Expert Recommendations for Implementing Change (ERIC) tool was used to match barriers with Level 1 recommendations for targeted implementation strategies. Results Thirty key stakeholders, including 10 patients, 10 providers, and 10 healthcare administrators were enrolled. Thematic analysis identified 11 barriers to ED-based AMI care: complexity of AMI care, cost of high-quality AMI care, local hospital culture, insufficient diagnostic and therapeutic resources, inadequate provider training, limited patient knowledge of AMI, need for formal implementation leaders, need for dedicated champions, failure to provide high-quality care, poor provider-patient communication, and inefficient ED systems. Seven of these barriers had 5 strong ERIC recommendations: access new funding, identify and prepare champions, conduct educational meetings, develop educational materials, and distribute educational materials. Conclusions Multiple barriers across several domains limit the uptake of evidence-based AMI care in northern Tanzania. The CFIR-ERIC mapping approach identified several targeted implementation strategies for addressing these barriers. A multi-component intervention is planned to improve uptake of evidence-based AMI care in Tanzania.

Increasingly, government agencies and non-profit organisations are called on to address challenges that go well beyond any individual organisation's boundaries and direct control. Strategic management for single organisations cannot respond effectively to these crossboundary, cross-level, and often cross-sector challenges. Instead, a new approach called strategy management-at-scale is required. This article compares strategic management with strategy managementat-scale. It responds to the question, what does strategy managementat-scale look like, and what seems to contribute to its success? The new approach helps foster - but hardly guarantees - direction, alignment and commitment among the multiple organisations and groups needed to make headway against the challenge. [ABSTRACT FROM AUTHOR]

Material circularity offers a novel perspective for industrial ecosystems, emphasising the reintegration of materials and products into the supply chain as valuable resources. This approach leads to a reduction in primary resource consumption and waste generation. Nevertheless, the incorporation of material circularity within the construction sector is hindered by barriers, necessitating careful analysis and practical solutions. Therefore, a clear roadmap with practical strategies that promote material circularity is needed. This study aims to identify the drivers, barriers, and strategies, concurrently formulating a framework to enhance material circularity in building construction projects. A sequential qualitative-quantitative mixed methods approach was employed to achieve this aim, which involved a literature review, 19 expert interviews, and two questionnaire surveys, which collectively yielded 230 responses. A literature review and expert interviews identified drivers, barriers, and strategies for implementing material circularity practices. Subsequently, using a five-point Likert scale, the first survey measured the importance of drivers and barriers. Then, the second survey was conducted to align strategies with corresponding barriers to enhance material circularity practices effectively. The results of the study indicated that cost savings primarily drive the adoption of material circularity. The most significant barrier was the underdeveloped marketplace for secondary products. The government plays a crucial role in addressing various barriers by implementing key strategies, including the introduction of regulations, policies, and economic incentives to promote material circularity. Finally, an evidence-based framework is proposed to assist practitioners and policymakers in creating a roadmap for implementing circular economy practices. [Display omitted] • Material circularity diffusion is influenced by 11 identified drivers and 19 barriers. • Cost savings drive, yet lack of secondary product market deters material circularity. • 14 strategies were identified to enhance the adoption of material circularity. • The government emerges as a key player in addressing most of the barriers. • A framework for enhancing material circularity in building construction is proposed. [ABSTRACT FROM AUTHOR]

This anticipated consumer demand has put unprecedented pressure on natural resources. Being the highest contributor in the energy transition, Oil & gas (O&G) industry needs to lessen the negative impact of climate change and natural disasters. To combat the impact of emissions and a move towards circularity, O&G industry has undertaken numerous initiatives including energy efficiency, process fuel improvements, and technological transformation etc. But due to certain barriers O&G industry is unable to embrace Circular Economy (CE) implementation in the firms. Therefore, this study has proposed a model to examine the existing critical barriers and suggest strategies to overcome the barriers. The current study has employed an extensive analysis using a hybrid methodology of Fuzzy-DEMATEL (F-DEMATEL) and Best Worst Method (BWM) for assessing the barriers and ranking the strategies. The results showed that 'knowledge barriers' are the most critical in the O&G industry that hampers the implementation of CE currently. Further, the strategies 'Developing collaborative model' and 'Internal research and development, innovation' are the two most significant strategies that may help to reduce the barriers to a minimum. The findings, social and environmental implications are beneficial for the stakeholders and policy-makers to support the transition to CE. [ABSTRACT FROM AUTHOR]