Multidimensional Challenges Research Articles

Diversity, equity and inclusiveness in healthcare: A primary care perspective.

Addressing Diversity, Equity and Inclusion in health care is a multidimensional challenge. From a US perspective, the third-party payment system has disempowered and depersonalized health-care delivery. The net result is wasteful and inefficient use of human and financial resources, burnout among providers, as well as care inequities. Financial integration at the point of patient care is essential to aligning the needs of patients with advances in medical technology. Complexity theory offers valuable insights into the roles of government, intermediaries and patients. The government must focus on equity as a rule compiler and referee of the system. Patient and providers who are actively engaged in shared decision-making will naturally address the diverse needs of multitudinous communities. Intermediaries address inclusion by connecting resources with the point of care. In a dynamic, emerging health-care system that serves diverse communities, patient and community-based financing, vouchers and defined contributions are necessary first steps in addressing cultural diversity, inclusion and equity.

An Institutional Approach to Equity and Improvement in Child Health Outcomes.

Pediatric health inequities are pervasive. Approaches by health care institutions to address inequities often, and increasingly, focus on social needs screening without linked, robust responses. Even when actions in pursuit of health equity do occur within health care institutions, efforts occur in isolation from each other, standing in the way of cross-learning and innovation. Learning network methods hold promise when institutions are confronted with complex, multidimensional challenges. Equity-oriented learning networks may therefore accelerate action to address complex factors that contribute to inequitable pediatric health outcomes, enabling rapid learning along the way. We established an institutional Health Equity Network (HEN) in pursuit of excellent and equitable health outcomes for children and adolescents in our region. The HEN supports action teams seeking to eliminate pediatric health inequities in their clinical settings. Teams deploy targeted interventions to meet patients’ and families’ needs, addressing both medical and social factors affecting health and wellbeing. The primary, shared HEN measure is the equity gap in hospitalization rates between Black patients and all other patients. The HEN currently has 10 action teams and promotes rapid learning and scaling of interventions via monthly “action period calls” and “solutions labs” focused on successes, challenges, and potential common solutions (eg, scaling of existing medical-legal partnership to subspecialty clinics). In this Advocacy Case Study, we detail the design, implementation, and early outcomes from the HEN, our equity-oriented learning network.

The Challenges of Iranian Female Nurses Caring for Male Patients: A Qualitative Study.

Caring is a multidimensional concept with many factors that can affect its quality such as caring for the opposite sex. This study aims to explore the experiences of Iranian female nurses caring for male patients. A descriptive qualitative study was conducted via conventional content analysis and purposeful sampling. Seventeen female nurses including staff and head nurses participated. Unstructured, face-to-face, in-depth interviews were conducted from June to December 2019 in Iran. The interviews were recorded by an MP4 player. When no new codes were extracted from the interview the data saturation was achieved. All interviews were immediately transcribed verbatim and were analyzed via Graneheim and Lundman's conventional content analysis guidelines. Four themes emerged from the data: 1) women nurses' concerns about caring for men, 2) women nurses' unpleasant feelings while caring for men, 3) Ignoring women nurses' dignity, and 4) efforts to avoid unpleasant situations. Female nurses in Iran are faced with multidimensional challenges when providing care to men. Not only can these challenges decrease the quality of nursing care for male patients, but also make the hospital a stressful environment for female nurses and may lead to them leaving the work.

Exploring the Multifaceted Influences on Childhood Nutritional Status: A Study Conducted in South Punjab, Pakistan.

Introduction The double burden of malnutrition (DBM) in Pakistan is a rising concern affecting school-going children, marked by coexisting under- and over-nutrition within the same population. Key influences include shifts in dietary habits, socioeconomic status, and lifestyle changes due to rapid urbanization. With a focus on Multan, Pakistan, the study seeks to assess the proportion of underweight and overweight students while identifying the risk factors and sociodemographic characteristics associated with this incidence. The aim is to guide future health interventions addressing this multidimensional health challenge. Materials and methods This study, adopting a descriptive cross-sectional research design, collected data from female teenage students through interviews and anthropometric measurements. A total of 300 participants were randomly selected from a comprehensive school list representing diverse urban and rural settings. Participants' weight and height were measured to calculate their body mass index (BMI), categorizing them into underweight, normal weight, and overweight groups. The relevant risk factors were collected through an interview questionnaire. Collected data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with the results stratified according to socioeconomic, dietary, and psychosocial factors and compared across different weight categories. Results The study collected data from 300 students, revealing a correlation between socioeconomic status, dietary habits, and BMI. Parental occupation significantly affected nutritional status, with children of laborers primarily falling within normal and underweight categories. Dietary habits like frequency of fast food and milk or dairy consumption showed notable associations with nutritional status. Psychosocial factors such as peer or teacher comments about weight and outdoor sports participation also influenced the students' nutritional status. However, factors like family income, video game hours, and the presence of pets at home did not show significant associations with nutritional status. Conclusions The study illustrates a multi-faceted association between socioeconomic status, dietary habits, and BMI among schoolchildren in Multan, Pakistan, emphasizing the need for comprehensive interventions.

Challenges for Conducting Research during Pandemics. A Narrative Review

Background: Research during pandemics presents unique challenges and opportunities that are crucial for advancing scientific knowledge and improving public health responses. This study's topic is significant due to the unprecedented disruptions caused by pandemics like COVID-19, which have impacted all stages of the research process. This study aims to identify and analyze research challenges during pandemics and propose strategies to overcome these obstacles.Methods: A narrative literature review was conducted, focusing on the challenges of conducting research during pandemics. A comprehensive search strategy was implemented, using databases such as PubMed, Google Scholar, and Web of Science, with keywords including "pandemic," "research challenges," "COVID-19 research," "SARS research," "clinical trials during pandemics," "best practices," and "research strategies." The review covered studies published from 2004 to 2023, including previous pandemics like SARS, H1N1, and COVID-19. Relevant articles were identified through database searches and manual reference list reviews.Discussion: The review revealed multidimensional challenges affecting various stages of the research process. Political, economic, administrative, regulatory, logistical, ethical, and social challenges were identified. Logistical difficulties were prevalent, such as limited access to laboratories and supply chain disruptions. Ethical challenges, including informed consent and data privacy, were magnified during health crises. The mental health impacts on researchers and participants were also significant, with increased anxiety and depression affecting engagement and well-being.Conclusion: The study concludes that while pandemics introduce considerable challenges for conducting research, there are also valuable lessons and best practices that can be applied in future crises. Effective strategies include investing in digital infrastructure, developing flexible ethical frameworks, implementing adaptive clinical trial designs, and supporting mental health for researchers and participants. By learning from the COVID-19 pandemic, the research community can better prepare for and navigate future pandemics, ensuring the continuity and effectiveness of scientific investigations.

Introduction to Special Issue on Multidimensional challenges for national and international security in the context of hybrid warfare

Introduction to Special Issue on Multidimensional challenges for national and international security in the context of hybrid warfare

The Experiences and Perceptions of Older Adults with Multimorbidity Toward E-Health Care: A Qualitative Evidence Synthesis.

Background: Given the growing population of older adults globally, e-Health plays an indispensable role in the chronic disease management of multimorbidity. However, qualitative evidence that synthesizes the experiences of older adults with multimorbidity using e-Health service is currently lacking. The objective was to explore the experiences and perceptions of e-Health care in community-based settings among the older adults with multimorbidity. Methods: Seven electronic databases including PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature were searched, and the search was limited to studies from inception to September 1, 2023. Screening, data extraction, and quality appraisal were conducted independently by two reviewers. Thomas and Harden's thematic synthesis methodology was applied to synthesize the original themes. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the confidence of synthesized themes was evaluated by the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results: Ten studies with moderate methodological quality met eligibility criteria and were included finally. Studies were conducted in four countries with 235 participants who were living with multiple chronic conditions. Among the 10 included studies, 37 credible findings were extracted and interpreted into 3 synthesized themes and 12 subthemes: (1) advantages and benefits perceived during e-Health service, (2) multidimensional challenges and negative experience posed by e-Health service, and (3) preferences, suggestions, and expectations for future e-Health improvement. The confidence in the majority of the three final synthesized themes was rated between "low" and "moderate" scales. Conclusions: The findings of this study provide new insights into implementing tailored e-Health care for older adults with multimorbidity. Further research should emphasize on realizing the potential value of e-Health service based on users' needs and perspectives to promote age-friendliness in geriatric practice.

Measuring and Assessing the Level of Living Conditions and Quality of Life in Smart Sustainable Cities in Poland—Framework for Evaluation Based on MCDM Methods

The increasing degree of urbanization of the world community is creating several multidimensional challenges for modern cities in terms of the need to provide adequate living and working conditions for their residents. An opportunity to ensure optimal conditions and quality of life are smart sustainable cities, which integrate various resources for their sustainable development using modern and smart technological solutions. This paper addresses these issues by presenting the results of a study of the level and quality of living conditions in the 29 largest cities in Poland, an EU member state. This study used 35 indicators characterizing the six main areas of activity of the cities to assess the living conditions and quality of life in these cities. To achieve this purpose, an original research methodology was developed, in which the EDAS and WASPAS methods and the Laplace criterion were applied. The application of a multi-criteria approach to the issue under study made it possible to determine the levels of quality of life and living conditions in the studied cities for each dimension, as well as the final index of this assessment (Smart Sustainable Cities Assessment Scores). On this basis, a ranking of these cities was made. In addition, relationships between living conditions and quality of life and the levels of wealth and population of the cities were also assessed. The results showed a wide variation in the levels of living conditions and quality of life in the cities studied, as well as their independence from geographic location. Cities with higher GDP levels that were investing in innovation and knowledge-based development fared much better.

Indigenous Elder perspectives on climate change challenges and solutions: learning reflection from Blackfoot First Nation perspectives, Canada

In this article, we explore the importance of incorporating Indigenous Elders’ perspectives in developing solutions to climate change. Following relational land-based theoretical frameworks, we learn from Indigenous Elders how they foster a strong sense of community and collective responsibility. Indigenous Elders prioritize inclusivity, social cohesion, and the interconnectedness of humans with nature. In our study, we focus on two main perspectives: how traditional land-based knowledge and practices held by Indigenous Elders contribute to the development of solutions for climate change mitigation and adaptation. What lessons can be learned from Indigenous Elder perspectives that may guide global efforts in addressing climate change and creating a sustainable future for all? Our study suggests that recognizing and incorporating Indigenous Elder perspectives into climate change solutions is essential for addressing the complex and multidimensional challenges of the current climate crisis.

Parametric Optimization of Proton Exchange Membrane Fuel Cell Using Chaotic Swarm Intelligence Technique

AbstractThe proton exchange membrane fuel cell (PEMFC) converts chemical energy into electricity without pollution or noise. PEMFC has a stable electrolyte, reliable, fast start‐up, and lightweight portability. Optimal PEMFC parameter prediction is difficult. Due to inaccurate estimation, many meta‐heuristic models are inaccurate. Particle swarm, Ant colony, and grey wolf algorithms are tested for fuel cell parameter estimation. These traditional algorithms benefit from chaotic maps for exploitation and exploration. Analyzing V–I and P–I polarization curves, hybrid approaches estimate unknown parameters. Results are compared with others to support the identifying strategy. This project examined SR‐12 and NedSstack PS‐6 PEMFC stacks. The objective function was shown by the sum of square errors between the experiments, and once an appropriate map is identified, the single chaotic map inclusion method can perform better than the multiple chaotic map scheme, and the “Iterative” approach in chaotic swarm is the most promising for multidimensional challenges.

Exploring the multidimensional challenges in integrating Design for Safety (DfS) in the Ghanaian construction industry

Purpose The uptake of Design for Safety (DfS) practices in developing countries like Ghana has been limited. This study aims to provide an in-depth understanding of the barriers across regulatory, organizational, cultural and educational dimensions that restrict DfS assimilation in the Ghanaian construction sector. Identifying the key impediments can inform policy initiatives and industry efforts to facilitate safer construction. Design/methodology/approach A postpositive philosophy underpinned the quantitative research. Multi-stage research was used. A comprehensive questionnaire survey was designed and given to six industry experts to assess clarity, relevance and effectiveness after a thorough literature review. In all, 164 professionals were reached to take part in the study using purposive sampling and consequently snowballing. “Variables” were ranked using mean score ranking and normalization techniques; exploratory factor analysis was then used to group variables into clusters. Findings Emergent findings revealed four distinct clusters of challenges; Design Process and Communication Challenges; Regulatory and Expertise Limitations; Planning and Education Constraints; and Attitudinal and Perception Barriers. These findings help identify targeted solutions to overcome barriers including developing robust regulatory frameworks, promoting collaboration among stakeholders and cultivating a positive safety culture. Originality/value This study provides new insights into the integration of DfS in the context of the developing construction industry in Ghana. This study expands the knowledge base to drive further research in enhancing construction safety in developing countries. Practical recommendations for overcoming these challenges are proposed.

Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol.

While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?" We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context. This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).

Brief Analysis of the Location and Determination of Maximum Capacity of Distributed Generation in Electrical Systems Considering Demand Scenarios in Ecuador

This research focuses on evaluating the importance of the use of renewable sources through distributed generation and its implication in the operation of electrical systems given that its incorporation has a direct impact on the expansion of the capacity of the networks, the minimization losses, and the impact on end users, all supported by the growth of demand. Under this context, the study focuses on incorporating distributed generation (DG), taking scenarios of base, medium, and peak demand and the modeling of the network, and subsequently evaluating the service quality indices and operating costs in addition to the electrical variables of the system. For this purpose, the present work proposes an optimization model to be solved using the Matlab (2021b) computational program together with GAMS (37.1.0 Major release (11 November 2021)) and mixed-integer nonlinear programming, determining the optimal insertion and determination of the maximum capacity of distributed generators while complying with the technical restrictions of the system and applying optimal AC power flows. Localizing and determining maximum capacity for distributed generation (DG) in electrical systems are critical aspects of modern grid planning and operation. With the increasing penetration of renewable energy sources and the growing complexity of energy demand patterns, efficient integration of DG has become paramount for ensuring grid reliability and sustainability. In this context, the analysis of DG localization and capacity determination considering demand scenarios emerges as a critical area of research in electrical engineering. By employing advanced optimization techniques such as mixed-integer nonlinear programming (MINP), this research addresses the multidimensional challenges associated with DG deployment, including technical constraints, economic considerations, and environmental impacts. Understanding the contribution of this optimization approach to electrical engineering is fundamental for optimizing grid performance, enhancing renewable energy integration, and supporting the transition towards more resilient and sustainable energy systems. Consequently, investigating this optimization model represents a crucial step towards advancing the state-of-the-art in grid planning and facilitating the transition to a cleaner and more efficient energy future.

Climate Literacy in the Age of Global Climate Change: A Critical Inquiry into Shaping Climate –Literate Society for a Sustainable Future

Climate Change is a multidimensional challenge in the twenty-first century. The challenges venting out of the consequences of climate change are mainly due to a lack of information and knowledge to combat it. It is important to build a climate-literate society to address and combat the consequences of ecological catastrophe. There is a need for cutting-edge knowledge on understanding the nuances of critical components of climate science, which is the need of the hour. Henceforth, climate literacy is an understanding of anthropogenic impact driven by human activities that have led to planetary crisis; cultivating ecological skills and thought processes, with a pragmatic vision of providing a tool to build a sustainable world in the era of climate change world. The role of educators and academic institutions in nurturing environmental stewardship becomes a vital for taking a step forward to a sustainable future in the cocoon of sustainable development goals. This paper will explore and address the vision of cultivating climate literacy as a framework for sustainable development and addressing climate resilience in the age of global climate change. The aim of the study is to identify the efficacy of Climate Change Education (CCE) initiatives and to trace few of the best practices and methods for developing a climate-literate society. As we introspect into the future outcome of the present study, it will envision climate literate society and decision-making processes at individual, institutional, and governmental levels for promoting sustainability and millennium development goals. Thus, it calls for action, emphasising the urgency of humanising climate literacy to empower current and future generations to contribute meaningfully to the global environmental sustainability and resilience effort.

A ‘greenhouse affect’? Exploring young Australians’ emotional responses to climate change

Recent studies reveal that young people are experiencing a range of emotions relating to climate change, including anxiety, anger and a sense of powerlessness. Young people have also voiced distrust in governments for failing to adequately address climate change, which they see as a critical threat to their future. However, there is limited research considering the interplay between young people’s emotions about climate change and the broader social context in which they live; social-ecological theory can assist in identifying important systemic factors influencing emotional responses to climate change. In this qualitative research project, I drew upon a social-ecological theoretical framework to explore the affective dimensions of climate change as experienced by young Australians aged 18–24 (N = 14). A primary, overarching finding was of climate change as a multidimensional emotional challenge for young people, with four sub-themes that describe key experiences through which it manifests: a fragmented climate education; disillusionment with politics, but hope for change; reckoning with uncertain futures; and grappling with agency. The findings contribute to the growing literature on climate-related emotions, highlighting experiences of interrelated emotions that resist being reduced to one label (e.g., ‘eco-anxiety’). Accordingly, I discuss a ‘greenhouse affect’ to convey the affective quandary provoked by climate change, expanding upon established anxiety-centred concepts. I also discuss implications for educating young Australians about climate change, and how this might improve their sense of agency to meaningfully contribute to climate solutions.

Research on Innovative Vocational Education for Disabled College Students Empowered by Smart Technologies in the Perspective of New Productive Forces

The rapid development of smart technologies in the field of education presents a transformative opportunity for vocational education for disabled college students. This group faces multidimensional challenges such as personalized learning needs, information access and effective communication, psychological health and self-esteem maintenance, social integration and identity recognition, as well as teacher training and professional development. This study, based on a sample of 100 disabled students from Zhejiang Special Education Vocational College, employs literature review, case analysis, and empirical research. Through personalized learning and support, barrier-free communication and interaction, emotional care and psychological counseling, social practice and inclusive education, as well as optimization of teaching staff and sharing of resources strategies, a smart solution is designed to improve the learning ecosystem, optimize the learning environment, and broaden career pathways.

Critical Factors to Consider When Designing an Innovation Management System

Overview: Organizations can implement an innovation management system in order to address the multidimensional challenges they often have in their practical innovation work. Until the ISO 56002 standard was released in 2019, there was no international standard for the design of innovation management systems. The standard provides support as a framework and highlights important systems elements. We studied two early adopters that have used this international standard to design their innovation management systems. Based on the study findings, we devised a practical approach for framing the design of an innovation management system. The approach includes a set of steps and critical considerations that include understanding a company’s innovation ambitions and direction, analyzing the systemic dimensions of the system (the elements and how they interconnect), and introducing a balanced set of control mechanisms.

Unveiling the Surge: A Comprehensive Analysis of the Stimulating Impact of the Covid-19 Pandemic on Telemedicine and Its Academic Landscape.

The Covid-19 pandemic spurred an unprecedented shift towards digitalization, prompting a surge in telehealth practices. This paper explores the impact of the pandemic on telemedicine through a comprehensive analysis of scientific publications. Utilizing a bibliometric approach, the study examines trends in telemedicine research before and after the onset of Covid-19. The systematic search in PubMed yielded 8,454 pre-Covid-19 publications (2016-2019) and 16,633 post-Covid-19 publications (2020-2023). A total of 21,989 distinct keywords were extracted. Co-occurrence maps reveal evolving thematic clusters, with "mhealth" and "ehealth" dominating pre-Covid-19, while "Covid-19" emerges as a top keyword post-pandemic. The Top-10 keywords shift post-Covid-19, reflecting dynamic research priorities. The bibliometric approach illuminates a heightened exploration of telehealth solutions post-pandemic, emphasizing the enduring impact of the crisis on academic discourse. Changes in key terms and shifts in key term ranking indicate dynamic research priorities and a broader consideration of multidimensional healthcare challenges. Acknowledging study limitations, the analysis offers a high-level perspective, focusing on authors' keywords. Despite challenges, the study provides a systematic overview, revealing the emergence of new telemedicine application domains and the need for further in-depth analyses. Future research directions may explore the ecological impact of telemedicine applications and other intriguing aspects, contributing to a comprehensive understanding of telemedicine's scholarly trajectory.

Lived Experiences of Indians with Acne: Navigating Social Support and Mental Well-being

This qualitative inquiry delved into the complex lived experiences of individuals in India navigating acne and its impact on social support dynamics and psychological well-being. Through subjective narratives, the study revealed profound emotional repercussions, challenges to self-perception, and sociocultural influences. Participants reported feelings of embarrassment, anxiety, and insecurity, exacerbated by societal beauty standards and external scrutiny. Familial support provided crucial emotional solace, while societal pressures, especially through social media, heightened psychological distress. Supportive peer relationships mitigated adverse effects on self-esteem. Coping strategies ranged from therapy-seeking to skincare regimens. Cultural factors and gender disparities, including male emotional invalidation, were identified. This research contributes to understanding the multidimensional challenges faced by individuals with acne in India, highlighting the need for tailored interventions promoting resilience and holistic well-being.

Ski-orienteering: a scientific perspective on a multi-dimensional challenge

Ski-orienteering, which combines cross-country skiing with orienteering, dates back to the late 1800s, with the first World Championships in 1975. While researchers have explored the physiological and biomechanical determinants of success in cross-country skiing and orienteering separately in detail, scientific knowledge concerning ski-orienteering remains limited. Based on the information that is presently available together with interviews with elite ski-orienteers, we explore here for the first time the historical development, physiological, biomechanical, and psychological demands, certain training strategies, and future prospects and challenges associated with this sport, including its potential to become an Olympic event. A demanding endurance sport (with racing times of 12–120 min), ski-orienteering requires both considerable aerobic and anaerobic capacity, as well as well-trained upper and lower body muscles. In addition, ski-orienteering demands advanced skiing technique on various types of terrain, with frequent changes between sub-techniques, on both wide and narrow tracks and with numerous turns on downhill terrain. Moreover, success in this sport requires accurate and rapid orienteering—the ability to navigate a complex network of ski tracks with numerous intersections/crossings in a manner designed to pass the multiple control points in the order indicated on the map as rapidly as possible, i.e., advanced spatial cognition and highly developed navigational skills. Thus, ski-orienteering requires training designed to improve both relevant physiological characteristics and orienteering skills, which should become the focus of future interdisciplinary research on this complex sport.