Multifaceted Issue Research Articles

Factors Contributing to Poor Academic Performance among Undergraduates at Gollis University

This study investigates the causes of poor academic performance among undergraduate students at Gollis University, Hargeisa, Somaliland. Utilizing a cross- sectional design, a quantitative survey was conducted with 93 respondents from a target population of 310 freshmen students. The research identifies multiple contributing factors categorized into student-related, teacher-related, and family-related factors. Key findings indicate that lack of home study, high absenteeism, peer influence, and negative student attitudes are significant student-related factors. Teacher-related factors include inadequate teaching skills, lack of subject knowledge, and poor teaching methodologies. Additionally, family-related factors such as parents' educational levels, financial problems, and lack of parental involvement significantly affect students' academic performance. The study underscores the need for comprehensive interventions addressing these multifaceted issues to enhance academic performance.

Clinician voices on ethics of LLM integration in healthcare: a thematic analysis of ethical concerns and implications

ObjectivesThis study aimed to explain and categorize key ethical concerns about integrating large language models (LLMs) in healthcare, drawing particularly from the perspectives of clinicians in online discussions.Materials and methodsWe analyzed 3049 posts and comments extracted from a self-identified clinician subreddit using unsupervised machine learning via Latent Dirichlet Allocation and a structured qualitative analysis methodology.ResultsAnalysis uncovered 14 salient themes of ethical implications, which we further consolidated into 4 overarching domains reflecting ethical issues around various clinical applications of LLM in healthcare, LLM coding, algorithm, and data governance, LLM’s role in health equity and the distribution of public health services, and the relationship between users (human) and LLM systems (machine).DiscussionMapping themes to ethical frameworks in literature illustrated multifaceted issues covering transparent LLM decisions, fairness, privacy, access disparities, user experiences, and reliability.ConclusionThis study emphasizes the need for ongoing ethical review from stakeholders to ensure responsible innovation and advocates for tailored governance to enhance LLM use in healthcare, aiming to improve clinical outcomes ethically and effectively.

Caring for Veterans With Depression and Cancer: An Overview for Civilian Nurse Clinicians.

Veterans put their lives on the line to serve our country, but their well-being is often threatened by multifaceted health issues related to military service, including elevated rates of lung cancer and depression. A significant percentage of Veterans have lost faith in mental health care or are unable to breach stigma-related barriers to seek and engage in this care. Veterans' lack of trust can be exacerbated by community mental health clinicians who have had little experience with Veterans and feel inadequately prepared to address their complex needs. The following databases were searched: PubMed, CINAHL Plus with Full Text, and Google Scholar; as well as the U.S. Department of Veterans Affairs website. Results indicated that 50% of Veterans use civilian health care and perceive that civilian nurses lack knowledge of military culture and related trauma. The current review offers civilian mental health professionals an overview of Veterans' unique issues and provides resources and practical suggestions for helping them overcome barriers to mental health care. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Gender differences in cost-related unmet healthcare needs: a national study in Turkiye

BackgroundUnmet healthcare needs are a complex and multifaceted issue, influenced by individual, socioeconomic, and healthcare system factors. This study aimed to investigate the determinants influencing cost-related unmet healthcare needs within the Turkish population, emphasizing a comprehensive analysis of gender disparities in accessing healthcare services.MethodsThis secondary analysis scrutinizes the 2019 Turkiye Health Survey data of 16,976 individuals aged 15 and older. The dependent variables included cost-related unmet medical, dental, and prescribed medication, and mental services. The independent variables were considered under a three-domain approach for the determination of health service utilization, developed by Andersen. Logistic regression models with predisposing, enabling, and need factors were run for any self-perceived cost-related unmet need for each sex and overall population. Another six regression models for both sexes were run for each subgroup of indivuals with unmet healthcare needs.ResultsThe study revealed that 15.4% of individuals cannot access healthcare due to financial constraints, with 16.8% for women and 13.5% for men. The highest level of unmet needs is associated with accessing dental care services for both sexes. According to multivariate analyses, the unmet need for both sexes decreases with older age and higher education level, and it is greater for those who have difficulties communicating in Turkish. By adding enabling and needs factors, the odds ratios of education decreased for men, while education became nonsignificant for women. Having chronic disease impacts unmet needs for both sexes. However, the inability to perform daily activities due to health problems was not a significant factor for men. Poorer household income increases overall unmet needs. Education is a determinant of both medical and mental care needs.ConclusionsThis pioneering study illuminates the multifaceted gender disparities in cost-related unmet healthcare needs across Turkiye, reflecting the intertwined issues of access influenced by a complex interplay of factors. Our findings underscore the significance of adopting an intersectional approach to address health inequalities.

Analyzing and Critically Evaluating the Problems of Antiviral Chemotherapy

Antiviral chemotherapy, an indispensable tool in combating viral infections, faces numerous challenges that often undermine its overall effectiveness and application. This review critically examines the multifaceted issues associated with antiviral chemotherapy, drawing on comprehensive data from NCBI, PubMed, and other reputable academic sources. The primary purpose of this research is to analyze and evaluate key problems such as the development of drug resistance, narrow therapeutic windows, limited spectrum of activity, toxicity, high costs, viral latency, and the complexities inherent in combination therapy. These challenges necessitate a delicate and strategic balance in the development, regulation, and application of antiviral drugs. The research methodology included an exhaustive review of peer-reviewed articles and clinical studies sourced from PubMed and NCBI databases, focusing on ten critical challenges in antiviral chemotherapy. The findings underscore the persistent issue of drug resistance, particularly in RNA viruses like HIV and hepatitis C, which demand ongoing innovation in antiviral drug design and implementation. Additionally, the analysis reveals the significant risks posed by the narrow therapeutic index of many antiviral drugs, which often increases the likelihood of adverse effects, thus limiting their safe and effective use. The study also highlights the formidable challenges posed by viral latency and the limited efficacy of current therapies against emerging and re-emerging viral threats. This research significantly contributes to the understanding of the inherent limitations in existing antiviral therapies and underscores the pressing need for more effective, accessible, and safe treatments. The practical significance lies in offering insights that could guide future research, clinical practice, and policy decisions, ultimately improving global health outcomes in the fight against viral diseases.

Examining the Intersection of Agricultural Production, Farm Revenue, Gender Dynamics and Adaptation Strategies in the Face of Climate Change

In recent times the context of climate change has become a complex and multifaceted issue as it affects agricultural production by altering weather patterns and by shifting the growing seasons of the crops, increasing pest and disease prevalence, thus reducing the yield, affecting the quality of the produce and threatening the food security in both the global and regional level. The farm revenues fluctuate significantly due to the unpredictable yields and the increased costs associated with the adaptation measures. Greater financial instability due to the changing climate scenario is faced by small and marginal farmers, as it affects market dynamics, potentially leading to price volatility. It also exacerbates the existing gender inequalities in agriculture by making them more vulnerable to the challenges of adopting climate-resilient practices, access to resources, education and decision-making opportunities which can hinder their ability to adapt to climate change. Thus the intersection of crop production, farm revenue and gender disparity under climate change highlights the need for integrated approaches to address the impacts of climate change.

Significance and Response to APOE Genetic Testing in the Anti-amyloid-β Therapy Era

Conventionally, APOE genetic testing has not been recommended as a component of the standard diagnostic and management practices for Alzheimer's disease. However, recent research highlights the importance of this test, particularly for assessment of the safety profile of anti-amyloid-β therapies. Therefore, the current United States guidelines for the administration of lecanemab explicitly advise APOE genetic testing. However, integration of this testing into clinical practice is associated with many clinical, ethical, legal, and economic challenges. It is important to initiate comprehensive discussions to address these multifaceted issues in Japan.

Проблематика информационного шума в контексте современного кинематографа

The article is devoted to the study of the ‘information noise’ phenomenon in the context of modern cinema. As a comprehensive art form, cinema in the current era confronts this multifaceted issue. This study critically analyses the concept of information noise scrutinizing its manifestations across diverse cultural and social contexts. The author highlights various dimensions of information noise and assesses its impact on the perception and interpretation of cinematic productions, encompassing aspects like historical authenticity, value stereotyping, the preservation or substitution of core ideas, censorship influence, narrative complexity, and verbal imperfections. The article also addresses the current state of scientific development of the topic under study. It underscores people’s limitations in processing information and how perception is influenced by their socio-cultural origins. The necessity for a standardized approach to identify characteristics of information noise in film production is also emphasized.

Foresight in EU policy‐making: Purpose, mindsets and methods

AbstractThis article examines the foundational principles and methodologies of foresight and their integration into EU policy‐making. It explores how foresight can improve policy analysis to create future‐ready, resilient decisions amid uncertainties. By synthesising empirical evidence and interpreting multifaceted issues through an interdisciplinary lens, foresight provides EU policymakers with tools to make informed decisions that remain adaptable in the face of unpredictability. The author argues that foresight, through comprehensive analysis of trends, uncertainties and potential challenges, can guide policymakers in forming future‐focused strategies. Key foresight methods emphasised include horizon scanning, systems analysis, stakeholder engagement and scenario planning. The article advocates a holistic policy approach, urging analysts to acknowledge biases and assumptions while integrating diverse perspectives. Concluding with a framework for responsible policy‐making, the article argues that foresight can shape evidence‐based, inclusive and transparent strategies, ensuring that the EU will be prepared for unpredictable futures.

Periodic update rule with Q-learning promotes evolution of cooperation in game transition with punishment mechanism

Cooperative behavior assumes a critical role in resolving conflicts arising between collective and individual interests, while punishment measures serve as a robust deterrent against opportunistic free-riding. Within this context, evolutionary game theory (EGT) emerges as an indispensable paradigm for addressing this multifaceted issue. When it comes to introspection behaviors, reinforcement learning (RL) methods exhibit remarkable capabilities to capture agents’ cognitive processes. Nonetheless, previous research has often focused on a static and time-invariant update rule, neglecting the dynamic nature of real-world scenarios where individuals can flexibly transit between strategies in periodic time-dependent patterns. Here, we propose periodic update rules with Q-learning algorithm and game transition model with a punishment mechanism that grants cooperative agents the autonomy to exercise discretion in deciding whether to initiate punishment actions. The agents display dynamic rules periodically through game model transitions, thus ensuring EGT’s inherent adaptability. By employing Monte Carlo (MC) simulations, we analyze the emergence of cooperation that underscores the substantial enhancement of cooperative behavior through the proposed periodic update rules with Q-learning algorithm and game transitions in the presence of punishment. Our study highlights the indispensable significance of appropriate periodic intervals for updating rules and determining optimal punishment costs in the game transition model as critical elements for fostering the evolution of cooperation in real-world scenarios.

A Systematic Review on Deep Fake Image Generation, Detection Techniques, Ethical Implications, and Overcoming Challenges

Deepfake technology, rooted in sophisticated machine learning techniques, utilizes deep neural networks to create highly realistic fake content such as videos, audio recordings, and images. This technology has rapidly evolved due to advancements in deep learning models, computational power, and data availability. The ethical implications, social impact, misuse, and legal frameworks surrounding Deepfake technology have been extensively studied. Detection techniques using deep learning approaches have been developed to combat the challenges posed by Deepfake content. Recommendations for future research include enhancing detection techniques, integrating explainable AI, and exploring real-time detection systems. Industry and policy implications emphasize the need for robust detection technologies, comprehensive legal frameworks, and collaborative efforts to address ethical concerns and regulate Deepfake content. This systematic review explores the landscape of deep fake image generation, detection techniques and challenges, in addition to ethical considerations. By synthesizing existing research, we aim to provide insights into deep-fake technology's advancements, limitations, and societal implications. This review underscores the urgent need for interdisciplinary collaboration and robust frameworks to address the multifaceted issues surrounding deep fakes in the digital age.

Nursing education leadership strengths in South Africa: An exploratory study

Introduction and backgroundNumerous multifaceted issues continue to pose a serious challenge to the success of nursing education and training worldwide. In South Africa, distinct situations, such as the transitioning of public nursing colleges to higher education to be part of a unified higher education system, amplify the problems faced by nursing education leaders. To unravel these complexities, an exploration of South Africa’s existing nursing education leadership strengths was undertaken. PurposeTo describe the leadership competencies deemed as an existing leadership strength in a challenged and transforming South African nursing education context. MethodAs part of a larger study, embedded in social constructionism, an exploration of the country’s existing nursing education leadership strengths was conducted with the purposefully selected nursing education leadership experts. Qualitative, descriptive, and contextual data yielded by the ten participants were analysed using thematic analysis. FindingsFour main themes emerged namely, leadership competencies; governance, leadership, legislation, and policy; staff development as well as community engagement. ConclusionThe authors propose that the described leadership competencies offered by the nursing education leadership experts as the existing nursing education leadership strengths in the country be considered as a foundational basis to navigate emergent challenges in wider contexts.

THE INVESTIGATION OF ANXIETY ON ENGLISH LANGUAGE LEARNING IN HIGH SCHOOL STUDENTS: A CASE STUDY IN GRADE ELEVENT

This research aims to investigate the impact of anxiety on English language learning achievements among high school students. It identifies anxiety as a significant emotional condition that can either hinder or motivate language acquisition. The study focuses on 11th-grade students at SMAN 106 Jakarta and examines various factors contributing to anxiety, including internal elements such as perception, personality, and intelligence, as well as external factors like motivation, classroom environment, and cognitive characteristics. The research highlights that anxiety can lead to feelings of restlessness, frustration, self-doubt, and tension. This emotional state often results in fear of negative evaluation, nervousness about making mistakes, and concerns about others' language abilities. Utilizing a descriptive qualitative research approach, the study employs questionnaires and in-depth interviews to collect data from students. Findings suggest that anxiety is a multifaceted issue, with students experiencing anxiety due to a range of factors including fear of criticism, judgment, and low grades. The research aims to provide valuable insights into the challenges faced by high school students and emphasize the need for tailored interventions and support mechanisms to help manage and alleviate anxiety. This understanding is intended to assist both teachers and students in addressing and overcoming the barriers posed by anxiety in language learning.

Cardiac implantable electronic device infection awareness – A European survey amongst implanting physicians

Background and aimsCardiac Implantable Electronic Device (CIED) infections pose significant mortality and morbidity despite optimal treatment. This survey aimed to understand whether and how the risk of CIED infection is assessed and mitigated in clinical practice in Europe, and to detect gaps with respect to EHRA recommendations. MethodsAn Expert Group of 8 European cardiologists with specific expertise across CIED therapy designed and distributed electronically a survey to a number of European Cardiologists. Results302 physicians from 18 European countries responded to the survey. 288/302 (95%) physicians agreed that CIED-related infections represent a burden on healthcare resources and are associated with significant morbidity and mortality. 285/302 respondents (94%) primarily assess the risk of CIED infections by only evaluating the patient's clinical profile (137/302, 46%) or with the support of a risk score (148/302, 49%). Intravenous antibiotic prophylaxis is used by 282/302 (93%), followed by the implantation of the lowest number of leads possible (182/302, 60%), and by the use of an antibacterial envelope (173/302, 57%). 230/302 respondents (76%) declared that there is need for clear and concise guidelines and more sensitive risk-scores for CIED infection, to maximize the chances of preventative strategies. ConclusionsThis survey demonstrates a high level of awareness about the multifaceted issue of CIED infection, however, it also highlights an incomplete penetration of scoring systems for risk stratification owing to their perceived limitations, and detects a strong commitment to increase the effectiveness of preventative strategies.

Causal discovery reveals complex patterns of drought-induced displacement

The increasing frequency and severity of droughts present a significant risk to vulnerable regions of the globe, potentially leading to substantial human displacement in extreme situations. Drought-induced displacement is a complex and multifaceted issue that can perpetuate cycles of poverty, exacerbate food and water scarcity, and reinforce socio-economic inequalities. However, our understanding of human mobility in drought scenarios is currently limited, inhibiting accurate predictions and effective policy responses. Drought-induced displacement is driven by numerous factors and identifying its key drivers, causal-effect lags, and consequential effects is often challenging, typically relying on mechanistic models and qualitative assumptions. This paper presents a novel, data-driven methodology, grounded in causal discovery, to retrieve the drivers of drought-induced displacement within Somalia from 2016 to 2023. Our model exposes the intertwined vulnerabilities and the leading times that connect drought impacts, water and food security systems along with episodes of violent conflict, emphasizing that causal mechanisms change across districts. These findings pave the way for the development of algorithms with the ability to learn from human mobility data, enhancing anticipatory action, policy formulation, and humanitarian aid.

LSPR-enhanced photoresponsive antibacterial efficiency of Bi/MoS2-loaded fibrin gel for management of diabetic wounds

Chronic diabetic wounds present formidable challenges, marked by uncontrolled bacterial infections, prolonged inflammation, and impaired angiogenesis. The evolving landscape of photo-responsive antibacterial therapy holds great promise in addressing these multifaceted issues, with a particular focus on leveraging the distinctive properties of 2D heterojunction materials. In this investigation, we engineered composite sprayed hydrogels, seamlessly integrating Bi/MoS2 nano-heterojunctions. Capitalizing on the synergistic interplay between photocatalytic antibacterial and photothermal antibacterial mechanisms, the Bi/MoS2 heterojunction, guided by its localized surface plasmon resonance, demonstrated outstanding antibacterial efficacy within a mere 10-minute exposure to 808 nm near-infrared light. This accelerated sterilization both in vitro and in vivo, consequently expediting wound healing. The sprayed composite gel not only furnishes protective shielding for skin tissues but also fosters endothelial cell proliferation, vascularization, and angiogenesis. This safe and ultrafast sterilizing hydrogel presents immense potential for application in antimicrobial dressings, thereby offering a promising avenue for diabetic wound healing.

Jurisdictional risk assessment and implementation of theory of change to sustainable palm oil in Pelalawan District, Riau Province

Abstract The jurisdictional approach has been widely used to address multifaceted issues associated with commodity-driven deforestation. Risk assessment at the jurisdictional level is required to implement jurisdictional programs. We developed a risk framework and indicator to assess the risks associated with achieving sustainable palm oil, using Pelalawan District as a case study. Pelalawan scored 0.48 out of 1, with the highest risks in the percentage of deforestation driven by oil palm plantation in mineral forest and pressure due to demand by global trade/export. Risks that are not mitigated will hamper the district’s effort to achieve sustainability. Following the assessment, we brought together multistakeholder in a workshop to develop a common vision using the theory of change framework. This study introduces new ways to approach sustainable palm oil initiatives in the palm oil sector using risk assessment and a theory of change framework.

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.