Multifaceted Issue Research Articles

Grief among parents of children with autism spectrum disorders: a systematic review

Objectives Bringing up a youngster with Autism Spectrum Disorders (ASD) is a multifaceted issue with major changes in family dynamics. Parents experience great distress and feel anxious or sad throughout the diagnostic process and the time after the diagnosis. There are very few studies on the aspect of grief in parents of children with ASD. Hence an attempt was made to do a systematic review of the available literature to assess the prevalence and pattern of grief among parents of children with autism spectrum disorder. Methods A systematic review of available literature was done up to November 2021. The data was extracted from the literature by two independent observers and any conflict was resolved by a third person. Results The two predominant disorders seen in these parents are grief and distress. The emotions usually described are the sense of loss leading to pain, parental expectations being put into peril, shock, turmoil, and a feeling of helplessness in family members after hearing the diagnosis. Conclusions A literature search has revealed a huge lacuna in studies related to the feelings of grief experienced by the caregivers of autistic children. Emotional stability and coping of the parents are highly essential not only for the rehabilitation of the child but also to make an improvement in the quality of life of the parents. The primary caregivers of children in the spectrum suffer very powerful and incessant emotions of sadness and grief. The feelings of mothers and fathers of children with autism from recent studies include an unexpected sense of losing a child along with shock, denial, fearfulness, guilt, rage, and/or sorrow. Two most common affective reactions of these parents were grief (“chronic sorrow” or “nonfinite grief”) and distress. The maternal experience of grief was found to be more especially in children with recent diagnoses of autism.

Anthropogenic debris as nest material in three swift species: New insights into the interactions of atmospheric pollution with wildlife

Plastic pollution has become a global concern, affecting many species around the world. While well-documented for marine ecosystems, the impact of plastic pollution on terrestrial ecosystems is comparatively limited. In fact, only recently have some studies begun to explore the occurrence, pathways, and impacts of plastic in the atmosphere and on terrestrial species. Here, we assess the presence of synthetic material in nests of three swift species breeding in the Western Palearctic: the common swift (Apus apus), the pallid swift (Apus pallidus), and the alpine swift (Tachymarptis melba). Using data from 487 nests spanning 25 colonies and seven European countries, we show that 36.5 % of the examined nests contained anthropogenic materials, mainly plastic debris. Notably, Pallid swifts' nests, with 85 % of the total nests examined with plastic, rank among birds with the highest plastic content in nests. We also demonstrate that the probability of finding plastic in the nest increased substantially with the human footprint of the landscape. Last, we recorded four cases of swifts entangled in their own nest, a low proportion compared to other species studied previously. Our study provides compelling evidence that plastic pollution may also be considered a concern for other terrestrial species, particularly for birds with highly aerial lifestyles, such as other swifts. The correlation with the human footprint suggests that areas with higher human activity contribute more significantly. Moreover, the entanglement cases, although low, indicate a threat to bird health and welfare. To our knowledge, our study is the first to report a direct interaction between floating plastic debris in the atmosphere and any species. Understanding this interaction is key, not only due to the lack of research on the topic, but also because it highlights that plastic pollution is a multifaceted environmental issue affecting various ecosystem categories, and the broader implications of atmospheric plastic circulation on wildlife and ecosystems health.

Flowing Prosperity: Empowering Riverbank Communities in Rajshahi City

This study investigates strategies to enhance the quality of life for riverbank communities in Rajshahi City, Bangladesh, situated along the Padma River. A comprehensive analysis of socioeconomic, environmental governance, and community aspects, the study identifies key challenges and opportunities. By paying attention to the natural resources and cultural heritage of the riverbanks, the endeavor seeks to foster socio-economic growth, environmental sustainability, and cultural preservation. Findings reveal pervasive socio-economic disparities, exacerbated by environmental degradation and governance shortcomings. The study also indicates that only 78% of inhabitants take the polio vaccine and the Body Mass Index shows 72% of people are under-weight. Despite these challenges, the study highlights community resilience, and the potential of grassroots initiatives to effect positive change. The study emphasizes the importance of integrated and participatory approaches to address the multifaceted issues facing riverbank communities. By prioritizing socio-economic equity, environmental sustainability, and community empowerment, it is possible to create inclusive and resilient communities along the riverbanks of Rajshahi City in Bangladesh. Through collaborative efforts including local stakeholders, governmental bodies, and non-profit organizations, the study creates opportunities for inclusive participation, enhances livelihoods, and promotes resilience against socio-economic challenges. The authors identify why these (River-bank people) cannot manage the sustainability of river ecosystems, health problems, and sustainable development, which advocates for a harmonious balance between social, economic, and environmental dimensions. Finally, a well-thought-out recommendation has been drafted by the authors.

Synergistic evaluation of energy security and environmental sustainability in BRICS geo-political entities: An integrated index framework

Research background: The increasing demand for energy, driven by economic growth and population expansion, is a critical driver of societal progress. However, the predominant reliance on fossil fuels to meet this demand presents significant challenges, particularly in the rapidly developing BRICS nations (Brazil, Russia, India, China, and South Africa). These countries are faced with a complex interplay of energy security and environmental sustainability issues, stemming from their substantial fossil fuel reserves and the associated environmental consequences. The challenges manifest as inequalities in access to clean energy, environmental degradation, and heightened vulnerability to the impacts of climate change. Addressing these multifaceted issues requires a comprehensive approach. Metrics-based strategies, which employ aggregated indices derived from a diverse set of energy and environmental indicators, have the potential to provide valuable insights into these complexities. However, the development of a universally applicable energy sustainability index is complicated by the heterogeneity of metrics, disparities between countries, and methodological challenges, emphasizing the need for an innovative and holistic analytical framework. Purpose of the article: This study aims to develop a tailored Energy Security and Environmental Sustainability Index for BRICS economies to evaluate the robustness of their energy systems and the viability of their ecological practices. The index serves as an instrument to assess the progress of these nations in the Energy and Environment domain and identify areas that require targeted interventions and improvements. Methods: The construction of the composite ESESI involves the selection of relevant parameters and the application of a Multi-Criteria Decision Analysis (MCDA) framework in conjunction with the Weighted Product Method (WPM). To ensure objectivity in the determination of optimal and least favorable weights for each indicator, the study employs the Multiplicative Data Envelopment Analysis (MDEA) model. Findings & value added: The ESESI analysis reveals disparities in the progress made by BRICS nations in enhancing energy security, promoting renewable energy deployment, and mitigating environmental impacts. While some countries demonstrate substantial advancements, others face challenges in improving energy efficiency and reducing carbon emissions. The study underscores the necessity for tailored policies and targeted infrastructural enhancements that align with the unique challenges and strengths of each nation. Harnessing the abundant renewable energy potential through advanced energy trade mechanisms and fostering cross-border investments are identified as crucial strategies for ensuring environmental sustainability and long-term energy in the BRICS region. The ESESI provides a valuable tool for policymakers and researchers to evaluate the progress of BRICS nations in achieving sustainable energy goals and to inform evidence-based decision-making processes. By offering a comprehensive and scientifically rigorous assessment framework, this study contributes to the ongoing discourse on sustainable energy transitions and environmental stewardship in the context of rapidly developing economies.

Food security challenges: A comparative review of USA and African Policies

This review provides a comprehensive overview of the food security challenges faced by the United States (USA) and African nations, examining the distinct policy approaches implemented to address these critical issues. The analysis focuses on key factors influencing food security, such as agricultural practices, economic structures, and political considerations. The United States and African nations grapple with diverse challenges in ensuring food security for their populations. This study undertakes a comparative review of the policies adopted by these regions to tackle the multifaceted issues related to food production, distribution, and accessibility. In the USA, the emphasis lies on advanced agricultural technologies and industrial farming practices. The country's policies are geared towards maximizing efficiency, ensuring a stable food supply, and promoting exports. However, challenges arise from the environmental impact of intensive farming, unequal distribution of resources, and the vulnerability of large-scale monocultures. Contrastingly, African countries face unique hurdles stemming from a combination of socio-economic factors, including limited access to modern farming technologies, land tenure issues, and inadequate infrastructure. Additionally, political instability and climate change exacerbate the challenges, impacting food production and distribution systems. The comparative analysis sheds light on the importance of tailoring food security policies to the specific needs and contexts of each region. It explores the potential for knowledge exchange and collaboration between the USA and African nations to address global food crises collaboratively. Emphasizing sustainable agricultural practices, equitable resource distribution, and adaptive governance strategies emerge as key recommendations to fortify both regions against future food security challenges. This study contributes valuable insights to policymakers, researchers, and practitioners aiming to develop effective strategies for enhancing global food security in a rapidly changing world.

Plant diversity conservation issues and challenges: A review

Significant conceptual changes have occurred over the past years in plant conservation, with major methodological advances incorporating modern techniques, technology, and disciplines. The global, national, and regional loss of biodiversity is a multifaceted issue affecting social, economic, organizational, political, scientific, and communicational scenarios. The identification of root causes is key to preventing biodiversity loss. India's diverse ecosystem supports various needs, including food, medicine, clothing, and shelter. Spatial biodiversity assessment is important for prioritizing and monitoring mechanisms and efforts in the context of land use, land cover change, unprecedented overexploitation, uncontrolled pollution, and alien species invasion. Odisha, an eastern Indian state, is rich in natural resources, with tropical moist, and dry deciduous forests covering remote areas of many districts, north-south-western hills, plateaus, and isolated pockets. Conservation efforts have expanded with protected areas, Red Lists, ex-situ facilities, wild plant accessions, and some developed species recovery programs. The conservation community is concerned about how to respond to the continuously depleting bioresources. Conservation prioritization focuses on protecting socioeconomically, medicinally, and environmentally significant species and living communities, regions of high species richness and endemism, and active functional ecosystems. The present review explores how to address sustainable biodiversity conservation practices and natural ecosystems aligning with UN Sustainable Development Goals No. 13 and 15.

Gender-based violence and femicide interventions-perspectives from community members and activists in South Africa.

Globally, Gender-Based Violence and Femicide (GBVF) remains a multifaceted social issue in the 21st century. Despite the ratification of international treaties and national laws, South Africa continues to have alarmingly high levels of GBVF, which were worsened during the Covid-19 national lockdown. The 2020 crime statistics reported that one in five South African women were victims of GBVF and South African Police Services (SAPS) data from 2015 to 2020 showed that seven women are killed daily nationwide. Despite copious studies on GBVF, the voices of local community members and activists as key collaborators in such research have been excluded. Therefore, this study used a mixed methods approach to determine the known interventions to decrease or eliminate GBVF and their effectiveness in seven communities across South Africa. The study included 191 participants in a survey for the quantitative aspect as well as a qualitative aspect of the study. Community members participated in gender-specific focus group discussions, while activists had a focus group of their own to obtain data on interventions. Our findings showed that three main forms of interventions existed in South Africa, viz. government-led campaigns that normally occurred during the 16 days of activism against violence towards women and children, community-led campaigns in response to GBVF cases reported in the media as well as NGO-led initiatives to support GBV survivors. However, these interventions were stifled by the social and cultural stigma against reporting GBVF, a lack of sustainability, decreased visibility, poor organisation and management as well as a lack of funding. Therefore, our findings show that while the South African government has made strides in its efforts to eliminate GBVF, there are no sustainable community level programming and interventions aimed at changing social norms and toxic masculinity that perpetuate GBVF. In conclusion, we recommend that efforts be made to implement intervention initiatives that go beyond creating awareness on GBVF, but partner with local NGO-led organizations to engage in programming and intervention that is aimed at changing social norms.

The Socio-Economic Characteristics and Challenges of Homeless Youths in Maiduguri and Lagos: A Comparative Study

Homelessness is a pervasive and multifaceted global issue affecting societies across various economic landscapes. This study provides a critical and extensive examination of youth homelessness in Maiduguri and Lagos, Nigeria. By analysing socio-economic characteristics, pathways into homelessness, living conditions, health challenges and experiences of social discrimination, the study underscores the importance of tailored interventions considering regional variations and the diverse needs of homeless youth populations. The findings highlight both commonalities and disparities, reflecting the complex interplay of socio-economic factors and regional dynamics, and provide valuable insights for developing effective policies and interventions.

Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic.

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced. In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations. The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic. Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans. Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference. Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.

Centering Communities in Global Health: Using Human-Centered Design to Facilitate Collaboration and Intervention Development.

Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development. The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi. A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights. In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi. Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities. Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.

Discharge against medical advice in rural and remote emergency departments: views of healthcare providers.

The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence. This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol. Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled. DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.

Refugee Housing Accessibility with a Strategic Digital City Project

Adequate housing is pivotal for the refugee’s well-being, demanding strategic urban management to facilitate their integration. The research objective is to analyze housing access for adult refugees within the context of a strategic digital city, focusing on adult refugees and city strategies as a subproject of the strategic digital city project. The research methodology adopted is a case study in Curitiba, the research employs both qualitative and quantitative techniques, guided by a research protocol. Results suggest that addressing housing access challenges entails more than mere provision; it involves safeguarding rights, stability, integration, and participation in public policies and municipal strategies within the strategic digital city framework and the right to the city. These findings underscore the necessity for support services and robust collaboration among diverse stakeholders and public policies to tackle the multifaceted refugee issue, thereby fostering their integration and well-being in the host society. The conclusion emphasizes prioritizing concepts such as privacy and dignity in housing, highlighting the urgent need for effective policies catering to refugees' diverse needs.

The evolution of plant phenomics: global insights, trends, and collaborations (2000-2021).

Phenomics, an interdisciplinary field that investigates the relationships between genomics and environmental factors, has significantly advanced plant breeding by offering comprehensive insights into plant traits from molecular to physiological levels. This study examines the global evolution, geographic distribution, collaborative efforts, and primary research hubs in plant phenomics from 2000 to 2021, using data derived from patents and scientific publications. The study utilized data from the EspaceNet and Lens databases for patents, and Web of Science (WoS) and Scopus for scientific publications. The final datasets included 651 relevant patents and 7173 peer-reviewed articles. Data were geocoded to assign country-level geographical coordinates and underwent multiple processing and cleaning steps using Python, Excel, R, and ArcGIS. Social network analysis (SNA) was conducted to assess collaboration patterns using Pajek and UCINET. Research activities in plant phenomics have increased significantly, with China emerging as a major player, filing nearly 70% of patents from 2010 to 2021. The U.S. and EU remain significant contributors, accounting for over half of the research output. The study identified around 50 global research hubs, mainly in the U.S. (36%), Western Europe (34%), and China (16%). Collaboration networks have become more complex and interdisciplinary, reflecting a strategic approach to solving research challenges. The findings underscore the importance of global collaboration and technological advancement in plant phenomics. China's rise in patent filings highlights its growing influence, while the ongoing contributions from the U.S. and EU demonstrate their continued leadership. The development of complex collaborative networks emphasizes the scientific community's adaptive strategies to address multifaceted research issues. These insights are crucial for researchers, policymakers, and industry stakeholders aiming to innovate in agricultural practices and improve crop varieties.

Obesity in Adults: Causes, Health Consequences, and Treatment Methods

Introduction Obesity is defined as an excessive accumulation of body fat that can negatively affect a person's physical as well as mental health. It results not only from excessive caloric intake relative to energy expenditure, but also from a myriad of genetic, metabolic, environmental and behavioral factors. Obesity poses the risk of a number of chronic diseases that impair quality of life and increase the risk of death. Understanding the causes of obesity, the consequences it brings, and learning about treatments can help improve health and public awareness. Aim of the Study This study aims to analyze the causes, health consequences, and available treatment methods for obesity in adults, providing a comprehensive overview of the current knowledge on the subject. Materials and Methods This review utilized data from recent literature published over the last 15 years, sourced primarily from PubMed. The focus was on identifying and synthesizing information related to the epidemiology, risk factors, health consequences, and treatment strategies for adult obesity. Keywords such as "obesity," "adult," "treatment," "epidemiology," and "health consequences" were used to search relevant studies. Conclusions Obesity in adults is a multifaceted issue requiring a comprehensive approach to treatment. Addressing this epidemic necessitates a combination of dietary changes, increased physical activity, behavioral therapies, pharmacological interventions, and surgical options when necessary. Ongoing support and monitoring are essential for achieving long-term success in weight management and improving overall health outcomes.

Investigating the Impact of Nutrition, Physical Activity, and Mental Health Interventions on Childhood Obesity

Childhood obesity is a multifaceted public health issue influenced by various factors, including nutrition, physical activity, and mental health. This study employs a qualitative approach to investigate the impact of interventions targeting these factors on childhood obesity. Through in-depth interviews, focus group discussions, and document analysis, the study examines the effectiveness of nutrition education programs, physical activity promotion initiatives, and mental health support services in addressing childhood obesity. The research explores how these interventions are implemented in diverse settings, such as schools, communities, and healthcare facilities, and assesses their outcomes in terms of changes in dietary behaviors, physical activity levels, and psychological well-being among children. Additionally, the study investigates the barriers and facilitators encountered during the implementation of these interventions, including socio-cultural factors, policy environments, and resource availability. The findings highlight the complex interplay between nutrition, physical activity, and mental health in shaping childhood obesity outcomes. Effective interventions often involve a comprehensive, multi-sectoral approach that addresses the underlying determinants of unhealthy behaviors and promotes holistic well-being. Key themes identified include the importance of community engagement, the need for culturally sensitive programming, and the integration of mental health support into obesity prevention efforts. By elucidating the impact of nutrition, physical activity, and mental health interventions on childhood obesity, this study contributes to the evidence base for designing and implementing effective strategies to combat this growing public health challenge.

Mapping the global research landscape on depression for patients with chronic kidney disease: a bibliometric and visualized analysis from 2006 to 2022.

Chronic Kidney Disease (CKD), a complex and multifaceted health issue, significantly contributes to global mortality rates. Accompanying chronic conditions, depression notably exacerbates health outcomes, increasing both mortality risk and the burden on affected individuals. This study employs bibliometric and visual analytics to evaluate the evolution, current trends, and future research directions in the field of CKD and depression. We conducted a thorough investigation using the Web of Science Core Collection, focusing on literature published from 2006 to 2022 that examines the interplay between CKD and depression. The analysis was enriched with bibliometric and visualization tools such as bibliometrix, CiteSpace, and VOSviewer to distill the essence of the research corpus. Our analysis incorporated 2,409 CKD-related publications, with significant contributions from the United States, China, and England. BMC Nephrology emerged as the leading publication outlet, while the American Journal of Kidney Diseases featured the most cited articles. Key terms such as "depression," "quality-of-life," "mortality," "prevalence," and "hemodialysis" dominated the keyword landscape, indicating the research focus areas. This bibliometric analysis offers an in-depth view of the research trajectory in CKD and depression. It provides valuable insights for researchers seeking relevant literature, potential collaborators, and an understanding of the field's current hotspots and emerging frontiers. The findings of this study are instrumental in guiding and enriching future research endeavors in this domain.

Communicate, support and integrate: strategies to improve engagement with cardiac rehabilitation

Abstract Background Factors beyond Cardiac Rehabilitation (CR) service continue to negatively impact CR attendance and programme completion. Intrapersonal, socioeconomic, health perception/co-morbidity and logistical factors can have a significant impact on CR uptake. During the COVID-19 pandemic many services reconsidered their approach and utilised novel but more flexible delivery solutions (1). As clinical services remodel post-COVID we sought to incorporate the patient perspective. Purpose To identify and co-design strategies to improve engagement with CR. Methods Experience Based Co-Design (EBCD) is a Codesign methodology that incorporates the experiences of patients, caregivers and service providers (2). The project involved staff, patients and caregivers linked to CR across the region. In an iterative process, a literature review followed by focus groups and co-design workshops were conducted by the research team during 2019-2021. Results The co-design workshops identified numerous multifaceted issues in relation to engagement with CR. These can be described in three distinct themes. Communicate Misunderstandings about CR content and efficacy persist amongst patients and the public. Health Care Professionals must streamline, and focus information provided to patients in order to highlight the multifaceted benefits of CR, a patient-led information video for patients and public was produced and shared through CR networks. Support Patients require additional emotional and social support following a cardiac event. Significant concerns described by patients relate to family, work, socialising and future health. A supportive, facilitated discussion was warranted and a brief cardiac intervention (CABIN) was developed and will be tested in a feasibility trial. Integrate Following COVID-19 patients are more receptive to hybrid approaches to delivering CR. Diverse options for delivery of CR should be integrated into standard practice. Patient suggestions included online learning modules, social exercise, video libraries, online support meetings, text chat facilities, and regionally specific webpages. The study resulted in three key outputs; a short regional information video, a regional webpage and the brief supportive intervention, CABIN. Conclusion Co-designing with staff and patients provides relevant and important information about highlighting the importance of and accessing and delivering a service which can be incorporated into future service changes.

Nepal-India Political Relations: A Comprehensive Analysis of Historical Dynamics, Contemporary Challenges, and Future Prospects

This research provides a comprehensive analysis of the historical dynamics, contemporary challenges, and future prospects in Nepal-India political relations. The diplomatic ties between the two nations, rooted in shared history, cultural affinities, and geographical proximity, have witnessed both cooperation and discord over the centuries. While historical documents highlight periods of mutual respect, the study delves into the complexities of the Treaty of Peace and Friendship in 1950, solidifying diplomatic bonds. However, recent years have seen a shift in this narrative, marked by territorial disputes, economic imbalances, and evolving geopolitical dynamics. Contemporary challenges include territorial disputes leading to diplomatic intricacies and economic imbalances raising questions about the equitable nature of the bilateral relationship. The research adopts a mixed-methods approach, combining historical analysis, policy examination, and stakeholder perspectives to offer timely and relevant insights. Key informant interviews with political leaders, diplomats, and professionals provide a diverse understanding of the multifaceted issues at hand. The study identifies territorial disputes and unequal diplomatic treaties as major challenges, contributing to tensions in Nepal-India relations. It emphasizes the need for a peaceful discourse to resolve border encroachments and calls for a revision of existing treaties in light of changing regional and international circumstances. Additionally, socio cultural affinities between the two nations are explored, with strategies proposed for bridging gaps and fostering a sense of shared identity. The research concludes with strategies for future cooperation, advocating for a balanced diplomatic relationship that considers the changing global landscape. The equidistance principle is discussed, urging both nations to adapt their mindsets and refrain from micromanaging each other's domestic politics. The study underscores the importance of recognizing the historical ties between Nepal and India, emphasizing the potential for multifaceted alliances in the future.

Green Behavior in Africa countries: A Bibliographic Review

Sustainable behavior in Africa has garnered increasing attention due to the continent's significant environmental and socio-economic challenges. This study critically analyzes existing literature on sustainable behavior in African countries, focusing on environmental conservation, resource management, and community development. By employing bibliometric analysis, the research identifies key trends, influential authors, and emerging topics in the field. The findings reveal the multifaceted issues faced by African nations, including inadequate infrastructure, deforestation, soil degradation, socio-economic disparities, and political instability. This comprehensive overview provides valuable insights for future research and policy development, highlighting the need for targeted support and education to promote sustainable practices in Africa.

Comprehensive computerized gait analysis: Barriers to access for children and adolescents

BackgroundComprehensive computerized gait analysis (CGA) alters orthopedic surgical plans and improves outcomes. Despite these documented benefits, CGA is not widely available to all patients who could be helped by it.Research Question: Do social determinants of health impact access to CGA? MethodsRetrospective review of patients seen for CGA from 2021 to 2022. Dates of referral, insurance approval and completion of CGA, demographics and insurance type were extracted from patient records. Zip codes were used to determine the neighborhood socioeconomic status (SES). Data were analyzed using non-parametric statistics. ResultsInsurance type affected time to authorization (private insurance/self-pay: median 9 days; HMO insurance: median 51.5 days; public insurance: median 27 days; p=0.0004). Once authorized, insurance type did not affect time to schedule and complete CGA (p=0.76). Lower neighborhood SES was associated with longer time to authorization but shorter time to complete CGA once authorized. Rescheduling was associated with longer time to complete CGA once authorized (median 29.5 vs. 16 days, p<0.0001). White, non-Hispanic families tended to reschedule more often than non-white or Hispanic families (35 % vs. 18 %, p=0.07). SignificanceKnowledge of barriers to CGA is necessary in order to design and implement effective strategies to widen its availability to all whom it could benefit. Social determinants of health and insurance type are associated with delays in authorization for CGA. Families with public insurance and HMO coverage experience delays in obtaining insurance authorization compared to PPO/self-pay patients, whose tests did not require prior authorization. However, there can also be delays in scheduling and completing CGA once authorized. This is a multi-faceted issue that requires further research.