Search results for: political inclusion
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3925

Search results for: political inclusion

835 Madness in Susanna Kaysen’s Girl, Interrupted: A Focouldian Reading

Authors: Somaye Sabetnia

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This paper is accomplished to probe Susanna Kaysen’s memoir Girl, Interrupted in the light of Michel Foucault’s theory of madness comprehensively set forth in his History of Madness (1961). It is an endeavor to analysis this novel based on Foucault’s idea of madness. In his archeological study of madness, Foucault introduces a way to perceive madness and its association with dominant discourses. He argues that the concept of madness is constructed within the social context, and different institutions affect its definition. Furthermore, he takes into consideration how each era treats madness, and affirms that in modern times, people considered mad are exiled out of cities, confined in madhouses, and later in clinics where they are treated with drugs. Set after World War II, the novel under observation highlights women’s conditions in which they were becoming a housewife or following their own desires; in fact, choosing the second one results in labeling mad. The protagonist of novel is labeled 'mad,' and is hence impelled to go to asylums where so-called patients are under the vigilant surveillance of the authorities to go through the process of 'normalization.' To discern how she is considered 'mad,' this article probes the dominant discourse of the time when the stories take place to provide a better understanding of madness under the impact of social, cultural, and political conditions. It examines how a so-called mad considered 'Other' and treated after being confined by the disciplinary system of the asylum in a panoptic world. In addition to, it describes the aim of treatment is to punish and control a patient not to cure. This article aims to indicate that Susanna Kaysen tries to picture what is defined as women’s madness is the result of the patriarchal society of the post-war America as well as the mental illness has nothing to do with blood; it is rather the result of the social inequality of the age.

Keywords: clinical treatment, disciplining and punishment, dominant discourse, normalization, other, panoptic world, reason vs. unreason

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834 Translators as Agents: Jewish Translators and Zsolnay Publishing House’s Translational Culture in Pre-Anschluss Austria,1924-1938

Authors: Tatsiana Haiden

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The role of the translator in the publishing process has been underestimated for centuries. Any translation is produced in a certain socio-political context by agents with different background, interests, and opinions, i.e., no translation is neutral. Any translation goes beyond the text; it is not only an interlingual transfer of signs but a social phenomenon. The case study shows how Jewish social networks influence publishing translations and aims to explain the unexpected success of the Jewish publishing house in pre-Anschluss Austria. The research shows that translators play a central role (‘Translator’s visibility’ - Pym, ‘Activist turn’ - Wolf, ‘Translator studies’ - Chesterman) in choosing what has to be translated and establishing communication between the author and the publisher. The concept of Translationskultur of Prunc is being historized and applied to the publishing house for the first time by analyzing business correspondence between the main actors of translation (publisher-translator-author). The translation studies project has become interdisciplinary –it encompasses sociology (concepts of Bourdieu’s ‘Field theory’ are used) and history. The historical research method Histoire croiseé is being used to avoid subjectivity and to introduce a new ‘translator-oriented’ vision in translation studies instead of the author-oriented one. In the course of the archival research, it was established that Jewish background plays an essential role in the destiny of the translators and the publishing house, so the Jewish studies have been added to the project. The study goes beyond the Austrian translational culture; it can be used as an example of dealing with publishing houses policies, publishing translations, and translator studies.

Keywords: history of translation, Jewish studies, publishing translations, translation sociology, translator studies, translators as actors

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833 The Precarious Chinese Ecology of Financial Expertise: Discontent in the Mix

Authors: Giulia Dal Maso

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Within the contemporary financial capitalist configuration, the interplay of Chinese statecraft and financialization has shaped a new ‘ecology of financial expertise.’ This indicates the emergence of a new financial technocratic governance; that is increasingly changing the Chinese economy, reducing the state’s administrative and fiscal functions and increasing state assets in accordance with a new shareholder logic. In this shift, the creation of the stock market by the state was conceived not only as a new redistributor of wealth but as a ‘clearing house’ for social discontent resulting from work casualization, wage repression and a lack of social welfare. Since its inception in the wake of Deng Xiaoping’s reforms, the Chinese state has used the stock market as a means of securing social legitimation by providing a prearranged space where the disaggregated and vulnerable subjects left behind by the dismantlement of the collective work units of the Maoist period (danwei) can congregate. However, fieldwork which included both participant observation as well as interviews with investors in brokerage rooms in Shanghai (where one of only two mainland Chinese stock exchanges is situated) reveals that both new formal and informal financial experts—namely the haigui (Chinese returnees with a financial degree abroad) and sanhu (individual Chinese scattered players), are equally dissatisfied with their investing activities. They express discontent with the state, which they hold responsible for the summer 2015 financial crisis and for the financial turmoil that jeopardizes China’s financial and political project. What the investors want is a state that will guarantee the continuation of the current gupiaore ‘stock fever’. This paper holds that, by embracing financialization, the state is undermining the contract at the base of its legitimacy.

Keywords: Chinese state, Deng Xiaoping, financial capitalism, individual investors

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832 A Psychosocial Approach to Community Development, Lessons from the Transition Town Movement in Italy

Authors: Anna Zoli

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In recent years, we have been witnessing a surge of locally-sustained communities committed to promoting new ethical economies while fostering the full participation of socially excluded groups and individuals into the labor market. This article explores the practices of a particular community development model, Transition Towns, as implemented in Monteveglio, Italy. Data were gathered throughout two years long ethnography, using multiple qualitative techniques, namely participant observation, document analysis, and semi-structured interviews. Data were analyzed triangulating from multiple sources of evidence and using hybrid thematic analysis. Major findings show that Transition Town movement works on two main axes, vertical and horizontal. Vertical transition involves interactions with an overreaching political, economic, and social structure which is not transitioning, and therefore poses structural resistances to the transformative social change fostered by the TT. Conversely, horizontal transition involves intragroup dynamics within the communal relational and geographical spaces and therefore poses process resistances between 'self and others' to the interpersonal communication between TT members. The study concludes that a psychosocial approach to community development is essential in order to conflate macro-social dynamics and psychological processes that may obstacle grassroots social movements to thrive. Skills from psychosocial disciplines are a unique set that could facilitate communication and relational processes for community development, and ultimately enabling social change.

Keywords: community development, grassroots social movements, psychosocial approaches, Transition Towns

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831 Data Science in Military Decision-Making: A Semi-Systematic Literature Review

Authors: H. W. Meerveld, R. H. A. Lindelauf

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In contemporary warfare, data science is crucial for the military in achieving information superiority. Yet, to the authors’ knowledge, no extensive literature survey on data science in military decision-making has been conducted so far. In this study, 156 peer-reviewed articles were analysed through an integrative, semi-systematic literature review to gain an overview of the topic. The study examined to what extent literature is focussed on the opportunities or risks of data science in military decision-making, differentiated per level of war (i.e. strategic, operational, and tactical level). A relatively large focus on the risks of data science was observed in social science literature, implying that political and military policymakers are disproportionally influenced by a pessimistic view on the application of data science in the military domain. The perceived risks of data science are, however, hardly addressed in formal science literature. This means that the concerns on the military application of data science are not addressed to the audience that can actually develop and enhance data science models and algorithms. Cross-disciplinary research on both the opportunities and risks of military data science can address the observed research gaps. Considering the levels of war, relatively low attention for the operational level compared to the other two levels was observed, suggesting a research gap with reference to military operational data science. Opportunities for military data science mostly arise at the tactical level. On the contrary, studies examining strategic issues mostly emphasise the risks of military data science. Consequently, domain-specific requirements for military strategic data science applications are hardly expressed. Lacking such applications may ultimately lead to a suboptimal strategic decision in today’s warfare.

Keywords: data science, decision-making, information superiority, literature review, military

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830 Oil Exploitation, Environmental Injustice and Decolonial Nonrecognition: Exploring the Historical Accounts of Host Communities in South-Eastern Nigeria

Authors: Ejikeme Johnson Kanu

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This research explores the environmental justice of host communities in south-eastern Nigeria whose source of livelihood has been destroyed due to oil exploitation. Environmental justice scholarship in the area often adopts Western liberal ideology from a more macro level synthesis (Niger Delta). This study therefore explored the sufficiency or otherwise of the adoption of Western liberal ideology in the framing of environmental justice (EJ) in the area which neglects the impact of colonialism and cultural domination. Mixed archival research supplemented by secondary analysis guided this study. Drawing from data analysis, the paper first argues that micro-level studies are required to either validate or invalidate the studies done at the macro-level (Niger Delta) which has often been used to generalise around environmental injustice done within the host communities even though the communities (South-eastern) differ significantly from (South-south) in terms of language, culture, socio-political and economic formation which indicate that the drivers of EJ may differ among them. Secondly, the paper argues that EJ framing from the Western worldview adopted in the study area is insufficient to understand environmental injustice suffered in the study area and there is the need for environmental justice framing that will consider the impact of colonialism and nonrecognition of the cultural identities of the host communities which breed environmental justice. The study, therefore, concludes by drawing from decolonial theory to consider how the framing of EJ would move beyond the western liberal EJ to Indigenous environmental justice.

Keywords: environmental justice, culture, decolonial, nonrecognition, indigenous environmental justice

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829 Indian Emigration to Gulf Countries: Opportunities and Challenges

Authors: Sudhaveni Naresh

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International migration is an important subject and gaining more significance andinterest among scholars in recent years. It is defined as crossing of the boundaries of political or administrative units for a certain minimum period for reasons such as education, employment, etc.International migration is not new for India because it has a long history with the Gulf region since ancient period. India is also one of the largest migrant-sending countries after China in the world. Migration towards the Gulf region became more prominent during early 1970s due to oil boom which led to rapid increase in the demand for foreign labour. Of 25 million Indian emigrants are living across the world, about six million Indian emigrants working in the Gulf. Most of these migrants were either unskilled or semi-skilled. Both the pull and push factors behind labour emigrate to Gulf countries. India is world’s leading receiver of remittances and the flow of remittances to India has been increasing steadily since the 1970s. In 2011-12, it was about 4 percent of GDP.Emigrants play a significant role in the economic development and growth of the country via the remittances and knowledge and skill transfer. Scholars see remittances as vital tool in the development for origin country. This paper examines the recent trend and pattern of migration from India to Gulf countries and explores impact of remittances on emigrants’ families at home country. It also highlights opportunities, challenges and the need for strengthening multilateral cooperation to transform migration into an efficient, orderly and humane process.The study propose to undertake a primary survey for this purpose. Both quantitative and qualitative research methods will be used to study the above issues.

Keywords: development, international migration, remittances, unskilled labour

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828 Behavioral Analysis of Anomalies in Intertemporal Choices Through the Concept of Impatience and Customized Strategies for Four Behavioral Investor Profiles With an Application of the Analytic Hierarchy Process: A Case Study

Authors: Roberta Martino, Viviana Ventre

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The Discounted Utility Model is the essential reference for calculating the utility of intertemporal prospects. According to this model, the value assigned to an outcome is the smaller the greater the distance between the moment in which the choice is made and the instant in which the outcome is perceived. This diminution determines the intertemporal preferences of the individual, the psychological significance of which is encapsulated in the discount rate. The classic model provides a discount rate of linear or exponential nature, necessary for temporally consistent preferences. Empirical evidence, however, has proven that individuals apply discount rates with a hyperbolic nature generating the phenomenon of intemporal inconsistency. What this means is that individuals have difficulty managing their money and future. Behavioral finance, which analyzes the investor's attitude through cognitive psychology, has made it possible to understand that beyond individual financial competence, there are factors that condition choices because they alter the decision-making process: behavioral bias. Since such cognitive biases are inevitable, to improve the quality of choices, research has focused on a personalized approach to strategies that combines behavioral finance with personality theory. From the considerations, it emerges the need to find a procedure to construct the personalized strategies that consider the personal characteristics of the client, such as age or gender, and his personality. The work is developed in three parts. The first part discusses and investigates the weight of the degree of impatience and impatience decrease in the anomalies of the discounted utility model. Specifically, the degree of decrease in impatience quantifies the impact that emotional factors generated by haste and financial market agitation have on decision making. The second part considers the relationship between decision making and personality theory. Specifically, four behavioral categories associated with four categories of behavioral investors are considered. This association allows us to interpret intertemporal choice as a combination of bias and temperament. The third part of the paper presents a method for constructing personalized strategies using Analytic Hierarchy Process. Briefly: the first level of the analytic hierarchy process considers the goal of the strategic plan; the second level considers the four temperaments; the third level compares the temperaments with the anomalies of the discounted utility model; and the fourth level contains the different possible alternatives to be selected. The weights of the hierarchy between level 2 and level 3 are constructed considering the degrees of decrease in impatience derived for each temperament with an experimental phase. The results obtained confirm the relationship between temperaments and anomalies through the degree of decrease in impatience and highlight that the actual impact of emotions in decision making. Moreover, it proposes an original and useful way to improve financial advice. Inclusion of additional levels in the Analytic Hierarchy Process can further improve strategic personalization.

Keywords: analytic hierarchy process, behavioral finance anomalies, intertemporal choice, personalized strategies

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827 Local Development and Community Participation in Owo Local Government Area of Ondo State, Nigeria

Authors: Tolu Lawal

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The genuine development of the grassroots particularly in the developing societies depends largely on the participation of the rural populace in policy conception and implementation, especially in the area of development policies, fundamentally, the rural people play a vital and significance role in economic and political development of the nation. This is because the bulk of the economic produce as well as votes come from these areas. However, the much needed development has continued to elude the rural communities inspire of the various development policies carried out by successive governments in the state. The exclusion of rural communities from planning and implementation of facilities meant to benefit them, and the international debate on sustainable rural development led Ondo State government to re-think its rural development policy with a view to establishing more effective strategies for rural development. The 31s initiatives introduced in 2009 emphasizes the important role of communities in their own development. The paper therefore critically assessed the 31s initiative of the present government in Ondo State with a view to knowing its impact on rural people. The study adopted both primary and secondary data to source its information. Interviews were conducted with the key informants, and field survey (visit) was also part of method of collecting data. Documents, reports and records on 31s initiatives in the selected villages and from outside were also consulted. The paper submitted that 31s initiative has not impacted positively on the lives of rural dwellers in Ondo-State, most especially in the areas of infrastructure and integrated development. The findings also suggested that 31s initiatives is not hopeless, but needs a different kind of investment, for example introducing measures of accountability, addressing the politicization of the initiative and exploiting key principles of development and service delivery.

Keywords: development, infrastructure, rural development, participation

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826 An Exploration of the Place of Buddhism in the Tham Luang Cave Rescue and Its Aftermath

Authors: Hamish de Nett

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On 23rd June 2018, twelve young footballers from the Wild Boar Academy and their coach went to explore the Tham Luang cave in the Doi Nang Non mountain range in Chiang Rai Province, Northern Thailand. Whilst they were inside the cave, monsoon rains hit, and the complex became partially flooded. In the following days, Thai Navy SEALs and an international team of expert divers assembled at the cave complex in order to rescue the boys. Although it was only marginally reported in the Western press, Buddhism and ritual activities played a major role in the rescue and its aftermath. This paper utilises numerous news articles and books written by reporters who covered the cave rescue to uncover what the place of Buddhism was in the Tham Luang cave rescue. This paper initially sets out the development of Thai Buddhism and the Thai nation state, paying particular note to the tension in Thai Buddhism between Buddhism as it is popularly practised and normative, state-favoured Buddhism. Secondly, this paper demonstrates that, during the Tham Luang cave rescue, Buddhism helped people cope with the disaster, provided an explanation for its occurrence, and allowed bystanders some efficacy in the process. Thirdly, this paper discusses how Buddhism helped people to give thanks after the rescue, achieve reconciliation, and gain closure. Finally, this paper analyses how the government and the political sphere utilised Buddhism during the rescue. The conclusion reached is that the Buddhism practiced during the Tham Luang cave rescue and its aftermath is representative of the wider tension between popular Buddhism and normative state-favoured Buddhism that is currently present within Thai Buddhism and has been for centuries.

Keywords: cave rescue, contemporary Buddhism, lived religion, Thai Buddhism, Tham Luang cave rescue

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825 Measuring Enterprise Growth: Pitfalls and Implications

Authors: N. Šarlija, S. Pfeifer, M. Jeger, A. Bilandžić

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Enterprise growth is generally considered as a key driver of competitiveness, employment, economic development and social inclusion. As such, it is perceived to be a highly desirable outcome of entrepreneurship for scholars and decision makers. The huge academic debate resulted in the multitude of theoretical frameworks focused on explaining growth stages, determinants and future prospects. It has been widely accepted that enterprise growth is most likely nonlinear, temporal and related to the variety of factors which reflect the individual, firm, organizational, industry or environmental determinants of growth. However, factors that affect growth are not easily captured, instruments to measure those factors are often arbitrary, causality between variables and growth is elusive, indicating that growth is not easily modeled. Furthermore, in line with heterogeneous nature of the growth phenomenon, there is a vast number of measurement constructs assessing growth which are used interchangeably. Differences among various growth measures, at conceptual as well as at operationalization level, can hinder theory development which emphasizes the need for more empirically robust studies. In line with these highlights, the main purpose of this paper is twofold. Firstly, to compare structure and performance of three growth prediction models based on the main growth measures: Revenues, employment and assets growth. Secondly, to explore the prospects of financial indicators, set as exact, visible, standardized and accessible variables, to serve as determinants of enterprise growth. Finally, to contribute to the understanding of the implications on research results and recommendations for growth caused by different growth measures. The models include a range of financial indicators as lag determinants of the enterprises’ performances during the 2008-2013, extracted from the national register of the financial statements of SMEs in Croatia. The design and testing stage of the modeling used the logistic regression procedures. Findings confirm that growth prediction models based on different measures of growth have different set of predictors. Moreover, the relationship between particular predictors and growth measure is inconsistent, namely the same predictor positively related to one growth measure may exert negative effect on a different growth measure. Overall, financial indicators alone can serve as good proxy of growth and yield adequate predictive power of the models. The paper sheds light on both methodology and conceptual framework of enterprise growth by using a range of variables which serve as a proxy for the multitude of internal and external determinants, but are unlike them, accessible, available, exact and free of perceptual nuances in building up the model. Selection of the growth measure seems to have significant impact on the implications and recommendations related to growth. Furthermore, the paper points out to potential pitfalls of measuring and predicting growth. Overall, the results and the implications of the study are relevant for advancing academic debates on growth-related methodology, and can contribute to evidence-based decisions of policy makers.

Keywords: growth measurement constructs, logistic regression, prediction of growth potential, small and medium-sized enterprises

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824 Virtual Reality as a Method in Transformative Learning: A Strategy to Reduce Implicit Bias

Authors: Cory A. Logston

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It is imperative researchers continue to explore every transformative strategy to increase empathy and awareness of racial bias. Racism is a social and political concept that uses stereotypical ideology to highlight racial inequities. Everyone has biases they may not be aware of toward disparate out-groups. There is some form of racism in every profession; doctors, lawyers, and teachers are not immune. There have been numerous successful and unsuccessful strategies to motivate and transform an individual’s unconscious biased attitudes. One method designed to induce a transformative experience and identify implicit bias is virtual reality (VR). VR is a technology designed to transport the user to a three-dimensional environment. In a virtual reality simulation, the viewer is immersed in a realistic interactive video taking on the perspective of a Black man. The viewer as the character experiences discrimination in various life circumstances growing up as a child into adulthood. For instance, the prejudice felt in school, as an adolescent encountering the police and false accusations in the workplace. Current research suggests that an immersive VR simulation can enhance self-awareness and become a transformative learning experience. This study uses virtual reality immersion and transformative learning theory to create empathy and identify any unintentional racial bias. Participants, White teachers, will experience a VR immersion to create awareness and identify implicit biases regarding Black students. The desired outcome provides a springboard to reconceptualize their own implicit bias. Virtual reality is gaining traction in the research world and promises to be an effective tool in the transformative learning process.

Keywords: empathy, implicit bias, transformative learning, virtual reality

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823 How Envisioning Process Is Constructed: An Exploratory Research Comparing Three International Public Televisions

Authors: Alexandre Bedard, Johane Brunet, Wendellyn Reid

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Public Television is constantly trying to maintain and develop its audience. And to achieve those goals, it needs a strong and clear vision. Vision or envision is a multidimensional process; it is simultaneously a conduit that orients and fixes the future, an idea that comes before the strategy and a mean by which action is accomplished, from a business perspective. Also, vision is often studied from a prescriptive and instrumental manner. Based on our understanding of the literature, we were able to explain how envisioning, as a process, is a creative one; it takes place in the mind and uses wisdom and intelligence through a process of evaluation, analysis and creation. Through an aggregation of the literature, we build a model of the envisioning process, based on past experiences, perceptions and knowledge and influenced by the context, being the individual, the organization and the environment. With exploratory research in which vision was deciphered through the discourse, through a qualitative and abductive approach and a grounded theory perspective, we explored three extreme cases, with eighteen interviews with experts, leaders, politicians, actors of the industry, etc. and more than twenty hours of interviews in three different countries. We compared the strategy, the business model, and the political and legal forces. We also looked at the history of each industry from an inertial point of view. Our analysis of the data revealed that a legitimacy effect due to the audience, the innovation and the creativity of the institutions was at the cornerstone of what would influence the envisioning process. This allowed us to identify how different the process was for Canadian, French and UK public broadcasters, although we concluded that the three of them had a socially constructed vision for their future, based on stakeholder management and an emerging role for the managers: ideas brokers.

Keywords: envisioning process, international comparison, television, vision

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822 Redefining Doctors' Role in Terms of Medical Errors and Consumer Protection Act to Be in Line with Medical Ethics

Authors: Manushi Srivastava

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Introduction: Doctor’s role, and relation with respect to patient care is at the core of medical ethics. The rapid pace of medical advances along with increasing consumer awareness about their rights and hike in cost of effective health care demand a robust, transparent and patient-friendly medical care system. However, doctors’ role performance is still in the frame of activity-passivity model of Doctor-Patient Relationship (DPR) where doctors act as parent and use to instruct their patients, without their consensus that is not going to help in the 21st century. Thus the current situation is a new challenge for traditional doctor-patient relationship after the introduction of Consumer Protection Act (CPA) in medical profession and the same is evidenced by increasing cases of medical litigation. To strengthen this system of medical services, the doctor plays a vital role, and the same should be reviewed in the present context. Objective: To understand the opinion of consultants regarding medical negligence and effect of Consumer Protection Act in terms of current practices of patient care. Method: This is a cross-sectional study in which both quantitative and qualitative methods are applied. Total 69 consultants were selected from multi-specialty hospitals of densely populated Varanasi city catering a population of about 1.8 million. Two-stage sampling was used for selection of respondents. At the first stage, selection of major wards (Medicine, Surgery, Ophthalmology, Gynaecology, Orthopaedics, and Paediatrics) was carried out, which are more susceptible to medical negligence. At the second stage, selection of consultants from the respective wards was carried out. In-depth Interviews were conducted with the help of semi-structured schedule. Two case studies of medical negligence were also carried out as part of the qualitative study. Analysis: Data were analyzed with the help of SPSS software (21.0 trial version). Semi-structured research tool was used to know consultant’s opinion about the pattern of medical negligence cases, litigations and claims made by patient community and inclusion of government medical services in CPA. Statistical analysis was done to describe data, and non-parametric test was used to observe the association between the variables. Analysis of Verbatim was used in case-study. Findings and Conclusion: Majority (92.8%) of consultants felt changes in the behaviour of community (patient) after implementation of CPA, as it had increased awareness about their rights. Less than half of the consultants opined that Medical Negligence is an Unintentional act of doctors and generally occurs due to communication gap and behavioural problem between doctor and patients. Experienced consultants ( > 10 years) pointed out that unethical practice by doctors and mal-intention of patient to harass doctors were additional reasons of Medical Negligence. In-depth interview revealed that now patients’ community expects more transparency and hence they demand cafeteria approach in diagnosis and management of cases. Thus as study results, we propose ‘Agreement Model’ of DPR to re-ensure ethical practice in medical profession.

Keywords: doctors, communication, consumer protection act (CPA), medical error

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821 Local Ordinances with Sharia Nuances in Pluralism Society of Indonesia: Convergence or Divergence

Authors: Farida Prihatini

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As a largest Muslim country in the world with around 215 Muslim inhabitants, Indonesia interestingly is not an Islamic country. Yet, Indonesia is not a secular country as well. The country has committed to be a unity in diversity country where people from various socio-political background may be coexistent live in this archipelago country. However, many provinces and Muslim groups are disposed of special regulation for Muslim people, namely local ordinances with sharia nuances, applied specifically in provinces, cities or regions where Muslim inhabitants are the majority. For the last two decades, particularly since Indonesia reform movement of 1998, a lot of local ordinances (Peraturan Daerah) with Sharia nuance have been enacted and applied in several provinces, cities and regions in Indonesia. The local ordinances are mostly deal with restriction of alcohol, prohibition of prostitution, Al Qur'an literacy, obligation to wear Muslim attire and zakat or alms management. Some of local ordinances have been warmly welcomed by society, while other ordinances have created tension. Those who oppose the ordinances believe that such things regulated by the ordinances are in violation of human rights and democracy, part of privacy rights of the people and must not be regulated by the State or local government. This paper describes the dynamic of local Ordinances with sharia nuances in Indonesia, in this research is limited to three ordinances: on the restriction of alcohol, prohibition of prostitution and obligation to wear Muslim attire. The researcher employs a normative method by studying secondary data and local ordinances in selected areas in Indonesia. The findings of the paper are that local ordinances with sharia nuances are indeed part of the needs of society, yet, in their implementation must take the pluralism of Indonesia and the state basic foundation, which is Pancasila (five pillars) into account.

Keywords: local, ordinances, sharia, rights

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820 European Union Health Policy and the Response to COVID-19 Pandemic: Building a European Health Union

Authors: Aikaterini Tsalampouni

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The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.

Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe

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819 Impact of Transportation on Access to Reproductive and Maternal Health Services in Northeast Cambodia: A Policy Brief

Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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818 No Space for Subculture, No Space for Disruption: Taming Creativity in Urban Development Projects

Authors: Nadine Osbild

Abstract:

Recent urban development projects often try to cater to both high-tech innovation/start-up culture and local culture/sustainable living. In the process, the so-called “creative class” (Florida 2002) has become a focal point for innovative answers to increasing urban pressures. Our paper explores local subculture and art scenes as a place where current innovation policies and alternative approaches to urban future-making collide. We explore the (re-)making of prevalent understanding of creativity in the context of Munich – an economically successful and over-saturated city with a relatively conservative approach to innovation and disruption and no apparent need for the “creative class” remedy. In particular, we investigate the opportunities and manifestations of subculture in three urban development projects that are envisioned as collaborations between innovators and (sub)culturally oriented creativity. Following a co-production STS approach, we observe that these development projects serve as sites where understandings of innovation and creativity are configured and stabilized in keeping with broader socio-political and economic rationalities. What is more, the projects materialize a de-facto split between the two understandings of a “creative scene,” whereby alternative and potentially disruptive forms of creativity become sidelined or even prevented in Munich’s imagination of urban development in the name of innovation and economic growth. Thus taming the unruliness of creativity, Munich also manages to tame the disruptive threats of innovation, ensuring that the innovation-centered modes of future-making still leave socio-economic hierarchies intact while displacing (counter-)visions rooted in the subculture.

Keywords: creative districts, science and technology studies, public engagement, innovation studies

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817 Job Satisfaction among Brigadista in Nicaragua: A Lesson to Be Considered for Task-Shifting

Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

Abstract:

Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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816 (Re)Calibrating Language Capital among Malay Youths in Singapore

Authors: Mukhlis Abu Bakar

Abstract:

Certain languages are held in higher regard than others given their respective socio-economic and political value, perceived or real. The different positioning of languages manifests in a state’s language-in-education policy, such as Singapore’s which places a premium on English in relation to the mother tongue (MT) languages (Mandarin Chinese, Malay, and Tamil). Among the latter, Mandarin Chinese, as the language of the majority ethnic group, has a more privileged status. The relative positioning of the four official languages shapes Singaporeans’ attitude towards their bilingualism. This paper offers an overview of the attitudes towards English-Malay (EM) bilingualism among Malay youths in Singapore, those who are in school and those already working. It examines how 200 respondents perceive the benefits of their EM bilingualism and their EM bilingual identity. The sample is stratified along gender, socio-economic status, dominant home language and self-rated language proficiency. The online survey comprises questions on the cognitive, communicative, pragmatic and religious benefits of bilingualism, and on language identity. The paper highlight significant trends relating to respondents' positive attitudes towards their EM bilingualism and their bilingual identity. Positive ratings are lowest among young working adults. EM bilinguals also perceive their bilingualism as less useful than English-Chinese bilingualism. These findings are framed within Bourdieu’s metaphor of field and habitus in order to understand why Malay youths make their language choices and why they recalibrate their linguistic capital upon entering the workforce, and in so doing understand the impact a state’s language-in-education policy has on its citizens’ attitude towards their respective English-MT bilingualism.

Keywords: English-Malay bilingualism, language attitude, language identity, recalibrating capital

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815 The Importance of Organized and Non-Organized Bildung for a Comprehensive Term of Bildung

Authors: Christine Pichler

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The German word Bildung in a comprehensive understanding can be defined as the development of the personality and as a process, which lasts from birth, or even before birth, until death. Gaining experience, acquiring abilities and knowledge as a lifelong learning process is what Bildung means. The development of the personality is intransitive because of the personality’s development itself, and transitive because of influences on the formation of a person by individuals and institutions. In public and political discussions, the term Bildung is understood with a constricted usage as education at schools. This leads to the research question, which consequences this limited comprehension of the term Bildung implies and how a comprehensive term of Bildung has to be defined. In discussions, Bildung is limited to its formal part. The limited understanding prevents from accurate analyses and discussions as well as adequate actions. This hypothesis and the research issue will be processed by theoretical analyses of the factors of Bildung, guideline-controlled expert interviews and a qualitative content analysis. The limited understanding on the term Bildung is a methodological problem. This results in inaccuracies in the analysis of the processes of Bildung and their effects on the development of personality structures. On the one hand, an individual is influenced by formal structures in the system of Bildung (e.g. schools) and on the other hand an individual is influenced by gained individual and informal personality and character attributes. In general, too little attention is given to these attributes and individual qualifications. The aim of this work is to demonstrate informative terms so the educational process with all its facets could be considered and applicable analyses can be made. If the informative terms can be defined, it´s also possible to identify and discuss the components of a comprehensive term Bildung to enable correct action.

Keywords: Bildung, development of personality, education, formative process, organized and non-organized Bildung

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814 Psycho-Social Problems Faced by Transgenders in Pakistani Society: A Qualitative Study

Authors: Amna bibi, Hina Rana

Abstract:

In the social, behavioral, and medical sciences, and particularly in Pakistani popular culture and political discourse, transgender issues are a relatively recent subject of research. The present study aimed to explore the lived experiences related to psycho-social issues faced by transgenders in Pakistani society. In this qualitative study, phenomenology research design was used. The purposive and snowball sampling techniques were used for data collection and in-depth interviews were conducted with N= 8 transgenders belonging to Lahore city, Pakistan. All interviews were audio recorded and transcribed properly. Interpretative phenomenological analysis was used to generate results in terms of themes. The results of the current study revealed different major themes such as psychological, social, and financial problems. Several emergent and sub-themes were also generated such as insomnia, suicidal ideation, stress, physical abuse, social rejection, discrimination at work workplace, less job opportunities, and harassment. Current study indicate that transgender suffer from different problems and struggle hard for their daily living. It was concluded that there should be a step taken at government level for the betterment of this community. The findings of the present study can help out transgender communities and activist to uncover their problem and empowering transgender individuals through education, skill development, and opportunities for growth. Their abilities can be utilized by providing education, polishing their skills, and employment opportunities. The data provides the knowledge that there should be strategies at family, society and government level for the betterment of transgenders.

Keywords: psychological issues, social issues, financial issues, transgender, Pakistani society

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813 Psycho-Social Problems Faced by Transgenders in Pakistani Society: A Qualitative Study”

Authors: Amna Bibi, Hina Rana

Abstract:

In the social, behavioral, and medical sciences, and particularly in Pakistani popular culture and political discourse, transgender issues are a relatively recent subject of research. The present study aimed to explore the lived experiences related to psycho-social issues faced by transgenders in Pakistani society. In this qualitative study, phenomenology research design was used. The purposive and snowball sampling techniques were used for data collection and in-depth interviews were conducted with N= 8 transgenders belonging to Lahore city, Pakistan. All interviews were audio recorded and transcribed properly. Interpretative phenomenological analysis was used to generate results in terms of themes. The results of the current study revealed different major themes such as psychological, social, and financial problems. Several emergent and sub-themes were also generated such as insomnia, suicidal ideation, stress, physical abuse, social rejection, discrimination at work workplace, less job opportunities, and harassment. Current study indicate that transgender suffer from different problems and struggle hard for their daily living. It was concluded that there should be a step taken at government level for the betterment of this community. The findings of the present study can help out transgender communities and activist to uncover their problem and empowering transgender individuals through education, skill development, and opportunities for growth. Their abilities can be utilized by providing education, polishing their skills, and employment opportunities. The data provides the knowledge that there should be strategies at family, society and government level for the betterment of transgenders.

Keywords: psychological issues, social issues, financial issues, transgender, Pakistani society

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812 Social Media Diffusion And Implications For Opinion Leadership In Northcentral Nigeria

Authors: Chuks Odiegwu-Enwerem

Abstract:

The classical notion of opinion leadership presupposes that the media is at the center of an effective and successful opinion leadership. Under this idea, an opinion leader is an active media user who consumes, understands, digests and interprets the messages for the understanding and acceptance/adoption by lower-end media users – whose access and understanding of media content are supposedly low. Because of their unique access to and presumed understanding of media functions and their content, opinion leaders are typically esteemed by those who look forward to and accept their opinions. Lazarsfeld and Katz’s two-step flow of communication theory is the basis of opinion leadership – propelled by limited access to the media. With the emergence and spread of social media and its unlimited access by all and sundry, however, the study interrogates the relevance and application of opinion leaders and, by implication, the two-step flow communication theory in Nigeria’s Northcentral region. It seeks to determine whether opinion leaders still exist in the picture and if they still exert considerable influence, especially in matters of political conversations and decision-making among the citizens of this area. It further explores whether the diffusion of social media is a reality and how the ‘low-end’ media users react to the new-found freedom of access to media, and how they are using it to inform their decisions on important matters as well as examines if they are still glued to their opinion leaders. This study explores the empirical dimensions of the two-step flow hypothesis in relation to the activities of social media to determine if a change has occurred and in what direction, using mixed methos of Survey and in-depth interviews. Our understanding and belief in some theoretical assumptions may be enhanced or challenged by the study outcome.

Keywords: Opinion Leadership, Active Media User, Two-Step-Flow, Social media, Northcentral Nigeria

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811 L1 Poetry and Moral Tales as a Factor Affecting L2 Acquisition in EFL Settings

Authors: Arif Ahmed Mohammed Al-Ahdal

Abstract:

Poetry, tales, and fables have always been a part of the L1 repertoire and one that takes the learners to another amazing and fascinating world of imagination. The storytelling class and the genre of poems are activities greatly enjoyed by all age groups. The very significant idea behind their inclusion in the language curriculum is to sensitize young minds to a wide range of human emotions that are believed to greatly contribute to building their social resilience, emotional stability, empathy towards fellow creatures, and literacy. Quite certainly, the learning objective at this stage is not language acquisition (though it happens as an automatic process) but getting the young learners to be acquainted with an entire spectrum of what may be called the ‘noble’ abilities of the human race. They enrich their very existence, inspiring them to unearth ‘selves’ that help them as adults and enable them to co-exist fruitfully and symbiotically with their fellow human beings. By extension, ‘higher’ training in these literature genres shows the universality of human emotions, sufferings, aspirations, and hopes. The current study is anchored on the Reader-Response-Theory in literature learning, which suggests that the reader reconstructs work and re-enacts the author's creative role. Reiteratingly, literary works provide clues or verbal symbols in a linguistic system, widely accepted by everyone who shares the language, but everyone reads their own life experiences and situations into them. The significance of words depends on the reader, even if they have a typical relationship. In every reading, there is an interaction between the reader and the text. The process of reading is an experience in which the reader tries to comprehend the literary work, which surpasses its full potential since it provides emotional and intellectual reactions that are not anticipated from the document but cannot be affirmed just by the reader as a part of the text. The idea is that the text forms the basis of a unifying experience. A reinterpretation of the literary text may transform it into a guiding principle to respond to actual experiences and personal memories. The impulses delivered to the reader vary according to poetry or texts; nevertheless, the readers differ considerably even with the same material. Previous studies confirm that poetry is a useful tool for learning a language. This present paper works on these hypotheses and proposes to study the impetus given to L2 learning as a factor of exposure to poetry and meaningful stories in L1. The driving force behind the choice of this topic is the first-hand experience that the researcher had while teaching a literary text to a group of BA students who, as a reaction to the text, initially burst into tears and ultimately turned the class into an interactive session. The study also intends to compare the performance of male and female students post intervention using pre and post-tests, apart from undertaking a detailed inquiry via interviews with college learners of English to understand how L1 literature plays a great role in the acquisition of L2.

Keywords: SLA, literary text, poetry, tales, affective factors

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810 A Diagnostic Study of Rape Culture in India

Authors: V. U. Ameera

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Rape has become an epidemic in India. Rape becomes a repressive weapon, which used to make them silent or used sometimes as a mode of punishment. Even for marrying above their status or for caste violation through a marriage of their choice, women are sentenced for mass rape, and the retribution is done in the presence of her family and villagers. Dalit or lower class women are brutally raped in a process of chastisement carried out by the upper class to keep the former always under their feet. Even in police stations, women are raped so that, their wretched condition will compel them to blurt out the truth. In a patriarchal society, for every trespass of woman, she is retaliated with a trespass into her body, which they think is the finest fine she can pay, as they are still driven by Victorian morality and believe once ‘the jewel’ is stolen, it is stolen forever. Even when the reports of brutal rapes comes out, those who are in responsible position also take the girls to task for going out in inappropriate time. As it is elsewhere in the world, in India too rape is a destructive weapon used to destroy men folk morally and psychologically, as they deem their honor rest in their protecting the purity of their women. During the communal skirmishes, as it is evident from Gujarat and Muzzafar Nagar recently, women are subjected to mass rape so that they can terrorize their men. Even women writers are threatened with rape for criticizing the maneuvers and manipulations of political parties. This becomes possible because of the undue weight given to the chastity of women. This study intends to analyze the nature of rapes occurring in India, including its use as a tool to establish and perpetuate the dominant position of men in social power structures. The study reveals how society, media and literature have imbibed and spread the notion of this sacred glass bowl which is the proud possession of men, the breaking of which steals them of their honor.

Keywords: guardians of chastity, patriarchal mindset, power tool, punishment rape

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809 Novel Urban Regulation Panorama in Latin America

Authors: Yeimis Milton, Palomino Pichihua

Abstract:

The city, like living organisms, originates from codes, structured information in the form of rules that condition the physical form and performance of urban space. Usually, the so-called urban codes clash with the spontaneous nature of the city, with the urban Kháos that contextualizes the free creation (poiesis) of human collectives. This contradiction is especially evident in Latin America, which, like other developing regions, lacks adequate instruments to guide urban growth. Thus constructing a hybrid between the formal and informal city, categories that are difficult to separate one from the other. This is a comparative study focusing on the urban codes created to address the pandemic. The objective is to build an overview of these innovations in the region. The sample is made up of official norms published in pandemic, directly linked to urban planning and building control (urban form). The countries analyzed are Brazil, Mexico, Argentina, Peru, Colombia, and Chile. The study uncovers a shared interest in facing future urban problems, in contrast to the inconsistency of proposed legal instruments. Factors such as the lack of articulation, validity time, and ambiguity, among others, accentuate this problem. Likewise, it evidences that the political situation of each country has a significant influence on the development of these norms and the possibility of their long-term impact. In summary, the global emergency has produced opportunities to transform urban systems from their internal rules; however, there are very few successful examples in this field. Therefore, Latin American cities have the task of learning from this defeat in order to lay the foundations for a more resilient and sustainable urban future.

Keywords: pandemic, regulation, urban planning, latin America

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808 Exposure to Social Media Shared Video-Clips on Irregularities from the 2023 Election in Nigeria and Audience Perception of the Outcome

Authors: Obiakor Casmir Uchenna, Ikegbunam Peter Chierike, Ezeja Perpetual Chisom

Abstract:

Irregularities have been a major feature of the Nigerian political activities since 1999. The rate at which such impunities thrive in the country has made elections grossly unacceptable among the people because the outcomes have never reflected the wish of the masses. Conscious of this, citizens have subscribed to the use of social media in exposing the ugly faces of the country’s elections which have always been against the less privileged. This study is an exploration of the relationship between exposure to social media shared video-clips and the respondents’ perception of the 2023 presidential election in Nigeria. The general objective of the study is to find out what the respondents make of the election as a result of the video-clips shared on different social media platforms showing electoral irregularities. The study adopted survey research method in studying 378 university undergraduates from NAU, COOU and Paul University selected through purposive sampling technique. The study was premised on the theoretical provision of violation of expectation theory. Findings revealed that the respondents are well exposed to different video-clips showing irregularities on the election. It was also found that the respondents have negative perception of the election. It was concluded that electoral umpire, the government in power and the security apparatus violated the respondents’ expectation from the election based on the pre-election promises made to the citizens. It was recommended among others, that Nigeria must strengthen the various institutions responsible for the conduct of elections if violence will not be made the best option for the poor masses.

Keywords: social media shared video-clips, exposure, irregularities, elections, audience perception, outcome

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807 The Vulnerability of Climate Change to Farmers, Fishermen and Herdsmen in Nigeria

Authors: Nasiru Medugu Idris

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This research is aimed at assessing the vulnerability of climate change to rural communities (farmers, herdsmen and fishermen) in Nigeria with the view to study the underlying causes and degree of vulnerability to climate change and examine the conflict between farmers and herdsmen as a result of climate change. This research employed the use of quantitative and qualitative means of data gathering techniques as well as physical observations. Six states (Kebbi, Adamawa, Nasarawa, Osun, Ebonyi, and Akwa Ibom) have been selected on the ground that they are key food production areas in the country and are therefore essential to continual food security in the country. So also, they also double as fishing communities in order to aid the comprehensive study of all the effects on climate on farmers and fishermen alike. Community focus group discussions were carried out in the various states for an interactive session and also to have firsthand information on their level of awareness on climate change. Climate data from the Nigerian Meteorological Agency over the past decade were collected for the purpose of analyzing trends in climate. The study observed that the level of vulnerability of rural dwellers most especially farmers, herdsmen and fishermen to climate change is very high due to their socioeconomic, ethnic and historical perspective of their trend. The study, therefore, recommends that urgent step needs to be put in place to help control natural hazards and man-made disasters and serious measures are also needed in order to minimize severe societal, economic and political crises; some of which may either escalate to violent conflicts or could be avoided by efforts of conflict resolution and prevention by the initiation of a process of de-escalation. So this study has recommended the best-fit adaptive and mitigation measures to climate change vulnerability in rural communities of Nigeria.

Keywords: adaptation, farmers, fishermen, herdsmen

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806 Effectiveness of Dry Needling with and without Ultrasound Guidance in Patients with Knee Osteoarthritis and Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis

Authors: Johnson C. Y. Pang, Amy S. N. Fu, Ryan K. L. Lee, Allan C. L. Fu

Abstract:

Dry needling (DN) is one of the puncturing methods that involves the insertion of needles into the tender spots of the human body without the injection of any substance. DN has long been used to treat the patient with knee pain caused by knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS), but the effectiveness is still inconsistent. This study aimed to conduct a systematic review and meta-analysis to assess the intervention methods and effects of DN with and without ultrasound guidance for treating pain and dysfunctions in people with KOA and PFPS. Design: This systematic review adhered to the PRISMA reporting guidelines. The registration number of the study protocol published in the PROSPERO database was CRD42021221419. Six electronic databases were searched manually through CINAHL Complete (1976-2020), Cochrane Library (1996-2020), EMBASE (1947-2020), Medline (1946-2020), PubMed (1966-2020), and Psychinfo (1806-2020) in November 2020. Randomized controlled trials (RCTs) and controlled clinical trials were included to examine the effects of DN on knee pain, including KOA and PFPS. The key concepts included were: DN, acupuncture, ultrasound guidance, KOA, and PFPS. Risk of bias assessment and qualitative analysis were conducted by two independent reviewers using the PEDro score. Results: Fourteen articles met the inclusion criteria, and eight of them were high-quality papers in accordance with the PEDro score. There were variations in the techniques of DN. These included the direction, depth of insertion, number of needles, duration of stay, needle manipulation, and the number of treatment sessions. Meta-analysis was conducted on eight articles. DN group showed positive short-term effects (from immediate after DN to less than 3 months) on pain reduction for both KOA and PFPS with the overall standardized mean difference (SMD) of -1.549 (95% CI=-0.588 to -2.511); with great heterogeneity (P=0.002, I²=96.3%). In subgroup analysis, DN demonstrated significant effects in pain reduction on PFPS (p < 0.001) that could not be found in subjects with KOA (P=0.302). At 3-month post-intervention, DN also induced significant pain reduction in both subjects with KOA and PFPS with an overall SMD of -0.916 (95% CI=-0.133 to -1.699, and great heterogeneity (P=0.022, I²=95.63%). Besides, DN induced significant short-term improvement in function with the overall SMD=6.069; 95% CI=8.595 to 3.544; with great heterogeneity (P<0.001, I²=98.56%) when analyzed was conducted on both KOA and PFPS groups. In subgroup analysis, only PFPS showed a positive result with SMD=6.089, P<0.001; while KOA showed statistically insignificant with P=0.198 in short-term effect. Similarly, at 3-month post-intervention, significant improvement in function after DN was found when the analysis was conducted in both groups with the overall SMD=5.840; 95% CI=9.252 to 2.428; with great heterogeneity (P<0.001, I²=99.1%), but only PFPS showed significant improvement in sub-group analysis (P=0.002, I²=99.1%). Conclusions: The application of DN in KOA and PFPS patients varies among practitioners. DN is effective in reducing pain and dysfunction at short-term and 3-month post-intervention in individuals with PFPS. To our best knowledge, no study has reported the effects of DN with ultrasound guidance on KOA and PFPS. The longer-term effects of DN on KOA and PFPS are waiting for further study.

Keywords: dry needling, knee osteoarthritis, patellofemoral pain syndrome, ultrasound guidance

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