Search results for: gender diversity

Authors: Zakia Hbellaq

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The Mediterranean region is considered a hotbed for climate change. Morocco is a semi-arid Mediterranean country facing water shortages and poor water quality. Its limited water resources limit the activities of various economic sectors. Most of Morocco's territory is in arid and desert areas. The potential water resources are estimated at 22 billion m3, which is equivalent to about 700 m3/inhabitant/year, and Morocco is in a state of structural water stress. Strictly speaking, the Kingdom of Morocco is one of the “very riskiest” countries, according to the World Resources Institute (WRI), which oversees the calculation of water stress risk in 167 countries. The surprising results of the Institute (WRI) rank Morocco as one of the riskiest countries in terms of water scarcity, ranking 3.89 out of 5, thus occupying the 23rd place out of a total of 167 countries, which indicates that the demand for water exceeds the available resources. Agriculture with a score of 3.89 is most affected by water stress from irrigation and places a heavy burden on the water table. Irrigation is an unavoidable technical need and has undeniable economic and social benefits given the available resources and climatic conditions. Irrigation, and therefore the agricultural sector, currently uses 86% of its water resources, while industry uses 5.5%. Although its development has undeniable economic and social benefits, it also contributes to the overfishing of most groundwater resources and the surprising decline in levels and deterioration of water quality in some aquifers. In this context, REUSE is one of the proposed solutions to reduce the water footprint of the agricultural sector and alleviate the shortage of water resources. Indeed, wastewater reuse, also known as REUSE (reuse of treated wastewater), is a step forward not only for the circular economy but also for the future, especially in the context of climate change. In particular, water reuse provides an alternative to existing water supplies and can be used to improve water security, sustainability, and resilience. However, given the introduction of organic trace pollutants or, organic micro-pollutants, the absorption of emerging contaminants, and decreasing salinity, it is possible to tackle innovative capabilities to overcome these problems and ensure food and health safety. To this end, attention will be paid to the adoption of an integrated and attractive approach, based on the reinforcement and optimization of the treatments proposed for the elimination of the organic load with particular attention to the elimination of emerging pollutants, to achieve this goal. , membrane bioreactors (MBR) as stand-alone technologies are not able to meet the requirements of WHO guidelines. They will be combined with heterogeneous Fenton processes using persulfate or hydrogen peroxide oxidants. Similarly, adsorption and filtration are applied as tertiary treatment In addition, the evaluation of crop performance in terms of yield, productivity, quality, and safety, through the optimization of Trichoderma sp strains that will be used to increase crop resistance to abiotic stresses, as well as the use of modern omics tools such as transcriptomic analysis using RNA sequencing and methylation to identify adaptive traits and associated genetic diversity that is tolerant/resistant/resilient to biotic and abiotic stresses. Hence, ensuring this approach will undoubtedly alleviate water scarcity and, likewise, increase the negative and harmful impact of wastewater irrigation on the condition of crops and the health of their consumers.

Keywords: water scarcity, food security, irrigation, agricultural water footprint, reuse, emerging contaminants

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Authors: Lakshmi Rao Kandukuri, Mamata Deenadayal, Suma Prasad, Bipin Sethi, Srinadh Buragadda, Lalji Singh

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Worldwide; at least 7.6 million children are born annually with severe genetic or congenital malformations and among them 90% of these are born in mid and low-income countries. Precise prevalence data are difficult to collect, especially in developing countries, owing to the great diversity of conditions and also because many cases remain undiagnosed. The genetic and congenital disorder is the second most common cause of infant and childhood mortality and occurs with a prevalence of 25-60 per 1000 births. The higher prevalence of genetic diseases in a particular community may, however, be due to some social or cultural factors. Such factors include the tradition of consanguineous marriage, which results in a higher rate of autosomal recessive conditions including congenital malformations, stillbirths, or mental retardation. Genetic diseases can vary in severity, from being fatal before birth to requiring continuous management; their onset covers all life stages from infancy to old age. Those presenting at birth are particularly burdensome and may cause early death or life-long chronic morbidity. Genetic testing for several genetic diseases identifies changes in chromosomes, genes, or proteins. The results of a genetic test can confirm or rule out a suspected genetic condition or help determine a person's chance of developing or passing on a genetic disorder. Several hundred genetic tests are currently in use and more are being developed. Chromosomal abnormalities are the major cause of human suffering, which are implicated in mental retardation, congenital malformations, dysmorphic features, primary and secondary amenorrhea, reproductive wastage, infertility neoplastic diseases. Cytogenetic evaluation of patients is helpful in the counselling and management of affected individuals and families. We present here especially chromosomal abnormalities which form a major part of genetic disease burden in India. Different programmes on chromosome research and human reproductive genetics primarily relate to infertility since this is a major public health problem in our country, affecting 10-15 percent of couples. Prenatal diagnosis of chromosomal abnormalities in high-risk pregnancies helps in detecting chromosomally abnormal foetuses. Such couples are counselled regarding the continuation of pregnancy. In addition to the basic research, the team is providing chromosome diagnostic services that include conventional and advanced techniques for identifying various genetic defects. Other than routine chromosome diagnosis for infertility, also include patients with short stature, hypogonadism, undescended testis, microcephaly, delayed developmental milestones, familial, and isolated mental retardation, and cerebral palsy. Thus, chromosome diagnostics has found its applicability not only in disease prevention and management but also in guiding the clinicians in certain aspects of treatment. It would be appropriate to affirm that chromosomes are the images of life and they unequivocally mirror the states of human health. The importance of genetic counseling is increasing with the advancement in the field of genetics. The genetic counseling can help families to cope with emotional, psychological, and medical consequences of genetic diseases.

Keywords: India, chromosome abnormalities, genetic disorders, cytogenetic study

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Authors: Farnaz Alborzi, Angelika Schmitz, Rainer Stamminger

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Reducing water temperatures in the wash phase of a washing programme and increasing the overall cycle durations are the latest trends in decreasing energy consumption of washing programmes. Since the implementation of the new energy efficiency classes in 2010, manufacturers seem to apply the aforementioned washing strategy with lower temperatures combined with longer programme durations extensively to realise energy-savings needed to meet the requirements of the highest energy efficiency class possible. A semi-representative on-line survey in eleven European countries (Czech Republic, Finland, France, Germany, Hungary, Italy, Poland, Romania, Spain, Sweden and the United Kingdom) was conducted by Bonn University in 2015 to shed light on consumer opinion and behaviour regarding the effects of the lower washing temperature and longer cycle duration in laundry washing on consumers’ acceptance of the programme. The risk of the long wash cycle is that consumers might not use the energy efficient Standard programmes and will think of this option as inconvenient and therefore switch to shorter, but more energy consuming programmes. Furthermore, washing in a lower temperature may lead to the problem of cross-contamination. Washing behaviour of over 5,000 households was studied in this survey to provide support and guidance for manufacturers and policy designers. Qualified households were chosen following a predefined quota: -Involvement in laundry washing: substantial, -Distribution of gender: more than 50 % female , -Selected age groups: -20–39 years, -40–59 years, -60–74 years, -Household size: 1, 2, 3, 4 and more than 4 people. Furthermore, Eurostat data for each country were used to calculate the population distribution in the respective age class and household size as quotas for the consumer survey distribution in each country. Before starting the analyses, the validity of each dataset was controlled with the aid of control questions. After excluding the outlier data, the number of the panel diminished from 5,100 to 4,843. The primary outcome of the study is European consumers are willing to save water and energy in a laundry washing but reluctant to use long programme cycles since they don’t believe that the long cycles could be energy-saving. However, the results of our survey don’t confirm that there is a relation between frequency of using Standard cotton (Eco) or Energy-saving programmes and the duration of the programmes. It might be explained by the fact that the majority of washing programmes used by consumers do not take so long, perhaps consumers just choose some additional time reduction option when selecting those programmes and this finding might be changed if the Energy-saving programmes take longer. Therefore, it may be assumed that introducing the programme duration as a new measure on a revised energy label would strongly influence the consumer at the point of sale. Furthermore, results of the survey confirm that consumers are more willing to use lower temperature programmes in order to save energy than accepting longer programme cycles and majority of them accept deviation from the nominal temperature of the programme as long as the results are good.

Keywords: duration, energy-saving, standard programmes, washing temperature

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Authors: Shulamit Sternin, Raymond M. McKie, Carter Winberg, Robb N. Travers, Terry P. Humphreys, Elke D. Reissing

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Issues surrounding sexual consent negotiation have become a major topic of societal concern. The majority of current research focuses on the complexities of sexual consent negotiations and the multitude of nuanced issues that surround the consent obtainment of heterosexual adults in post-secondary educational institutions. To date, the only study that has addressed sexual consent negotiation behaviour in same-sex relationships focused on the extent to which individuals used a variety of different verbal and nonverbal sexual consent behaviours to initiate or respond to sexual activity. The results were consistent with trends found within heterosexual individuals; thus, suggesting that the current understanding of sexual consent negotiation, which is grounded in heterosexual research, can serve as a strong foundation for further exploration of sexual consent negotiation within same-sex relationships populations. The current study quantitatively investigated the differences between heterosexual men and gay and bisexual men (GBM) in their understanding of sexual consent negotiation. Exploring how the perceptions of GBM differ from heterosexual males provides insight into some of the unique challenges faced by GBM. Data were collected from a sample of 252 heterosexual men and 314 GBM from Canada, the United States, and Western Europe. Participants responded to the question, 'do you think sexual consent and sex negotiation is different for heterosexual men compared to gay men? If so, how?' by completed an online survey. Responses were analysed following Braun & Clarke’s (2006) six phase thematic analysis guidelines. Inter-rater coding was validated using Cohen’s Kappa value and was calculated at (ϰ = 0.84), indicating a very strong level of agreement between raters. The final thematic structure yielded four major themes: understanding of sexual interaction, unique challenges, scripted role, and universal consent. Respondents spoke to their understanding of sexual interaction, believing GBM sexual consent negotiation to be faster and more immediate. This was linked to perceptions of emotional attachment and the idea that sexual interaction and emotional involvement were distinct and separate processes in GBM sexual consent negotiation, not believed to be the case in heterosexual interactions. Unique challenges such as different protection concerns, role declaration, and sexualization of spaces were understood to hold differing levels of consideration for heterosexual men and GBM. The perception of a clearly defined sexual script for GBM was suggested as a factor that may create ambiguity surrounding sexual consent negotiation, which in turn holds significant implications on unwanted sexual experiences for GBM. Broadening the scope of the current understanding of sexual consent negotiation by focusing on heterosexual and GBM population, the current study has revealed variations in perception of sexual consent negotiation between these two populations. These differences may be understood within the context of sexual scripting theory and masculinity gender role theory. We suggest that sexual consent negotiation is a health risk factor for GBM that has not yet been adequately understood and addressed. Awareness of the perceptions that surround the sexual consent negotiation of both GBM and heterosexual men holds implications on public knowledge, which in turn can better inform policy making, education, future research, and clinical treatment.

Keywords: sexual consent, negotiation, heterosexual men, GBM, sexual script

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Authors: Areej Al-Khabbaz, Swapna Goerge, Majedah Abdul-Rasoul

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Introduction: The most prevalent periodontal disease among children is gingivitis, and it usually becomes more severe in adolescence. A number of intervention studies suggested that resolution of periodontal inflammation can improve metabolic control in patients diagnosed with diabetes mellitus. Aim: to assess the effect of non-surgical periodontal therapy on glycemic control of children diagnosed with diabetes mellitus. Method: Twenty-eight children diagnosed with diabetes mellitus were recruited with established diagnosis diabetes for at least 1 year. Informed consent and child assent form were obtained from children and parents prior to enrolment. The dental examination for the participants was performed on the same week directly following their annual medical assessment. All patients had their glycosylated hemoglobin (HbA1c%) test one week prior to their annual medical and dental visit and 3 months following non-surgical periodontal therapy. All patients received a comprehensive periodontal examination The periodontal assessment included clinical attachment loss, bleeding on probing, plaque score, plaque index and gingival index. All patients were referred for non-surgical periodontal therapy, which included oral hygiene instruction and motivation followed by supra-gingival and subg-ingival scaling using ultrasonic and hand instruments. Statistical Analysis: Data were entered and analyzed using the Statistical Package for Social Science software (SPSS, Chicago, USA), version 18. Statistical analysis of clinical findings was performed to detect differences between the two groups in term of periodontal findings and HbA1c%. Binary logistic regression analysis was performed in order to examine which factors were significant in multivariate analysis after adjusting for confounding between effects. The regression model used the dependent variable ‘Improved glycemic control’, and the independent variables entered in the model were plaque index, gingival index, bleeding %, plaque Statistical significance was set at p < 0.05. Result: A total of 28 children. The mean age of the participants was 13.3±1.92 years. The study participants were divided into two groups; Compliant group (received dental scaling) and non-complaints group (received oral hygiene instructions only). No statistical difference was found between compliant and non-compliant group in age, gender distribution, oral hygiene practice and the level of diabetes control. There was a significant difference between compliant and non-compliant group in term of improvement of HBa1c before and after periodontal therapy. Mean gingival index was the only significant variable associated with improved glycemic control level. In conclusion, this study has demonstrated that non-surgical mechanical periodontal therapy can improve HbA1c% control. The result of this study confirmed that children with diabetes mellitus who are compliant to dental care and have routine professional scaling may have better metabolic control compared to diabetic children who are erratic with dental care.

Keywords: children, diabetes, metabolic control, periodontal therapy

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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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Authors: Rick Evans

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Despite over 40 years of research into why women choose not to enroll or leave undergraduate engineering programs, along with the subsequent and serious efforts to attract more women, women receiving bachelor's degrees in engineering in the US have remained disappointingly low. We know that even despite their struggles to become more welcoming and inclusive, engineering programs remain gendered, raced and classed. However, our research team has found that women who participate and indeed thrive in undergraduate engineering project teams do so in numbers that far exceed their participation in undergraduate programs. We believe part of the answer lies in the ways that project teams facilitate experiential learning, specifically providing opportunities for members to play, practice and perform. We employ a multi-case study method and assume a feminist, activist and interpretive perspective. We seek to generate concrete and context-dependent knowledge in order to explore potentially new variables and hypotheses. Our focus is to learn from those select women who are thriving. For this oral or e-poster presentation, we will focus on the results of the second of our semi-structured interviews – the learning journey interview. During this interview, we ask participants to tell us the story/ies of their participation in project teams. Our results suggest these women find joy in their experience of developing and applying engineering expertise. They experience this joy and develop their expertise in the highly patterned progression of play, practice and performance. Play is a purposeful activity in which someone enters an imaginary world, a world not yet real to them. However, this imaginary world is still very much connected to the real world, in this case, a particular kind of engineering, in that the ways of engaging are already established, codified and rule-governed. As such, these women are novices motivated to join a community of actors. Practice, better understood as practices, a count noun, is an embodied, materially interconnected collection of actions organized around the shared understandings of that community of actors. Those shared understandings reveal a social order – a particular field of engineering. No longer novices, these women begin to develop and display their emergent identities as engineers. Perform is activity meant either to demonstrate competence and/or to enable, even teach play and practice to others. As performers, these women participants become models for others. They direct play and practice, contextualizing both within a field of engineering and the specific aims of the project team community. By playing, practicing and performing engineering, women claim their identities as engineers and, equally important, have those identities acknowledged by team members. If we hope to transform our gendered, raced, classed institutions, we need to learn more about women who thrive within those institutions. We need to learn more about their processes of becoming and belonging as engineers. Our research presentation begins with a description of project teams and our multi-case study method. We then offer detailed descriptions of play, practice, and performance using the voices of women in project teams.

Keywords: engineering education, gender, identity, project teams

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Authors: Fatima Meirkhankyzy Shaizadina, Alua Oralovna Omarova, Praskovya Mikhailovna Britskaya, Nessipkul Oryntayevna Alysheva

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In recent years in the Republic of Kazakhstan there have been registered outbreaks of measles among the population. The objective of work was the analysis of outbreak of measles in 2014 among the population of North-Kazakhstan region of the Republic of Kazakhstan. For the analysis of the measles outbreak descriptive and analytical research, techniques were used and threshold levels of morbidity were calculated. The increase of incidence was noted from March to July. The peak was registered in May and made 9.0 per 100000 population. High rates were registered in April – 5.7 per 100000 population, and in June and July they made 5.7 and 3.1 respectively. Duration of the period of increase made 5 months. The analysis of monthly incidence of measles revealed spring and summer seasonality. Across the territory it was established that 69.2% of cases were registered in the city, 29.1% in rural areas and 1.7% of cases were brought in from other regions of Kazakhstan. The registered cases and threshold values of measles during the outbreak revealed that from 12 to 24 week, and also during the 40th week the cases exceeding the threshold levels are registered. Thus, for example, for the analyzed 1 week the number of the revealed patients made 4, which exceeds the calculated threshold value (3) by 33.3%. The data exceeding the threshold values confirm the emergence of a disease outbreak or the beginning of epidemic rise in morbidity. Epidemic rise in incidence of the population of North-Kazakhstan region was observed throughout 2014. The risk group includes 0-4 year-old children, who made 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The analysis of measles cases registration by gender revealed that women are registered 1.1 times more often than men. The ratio of women to men made 1:0.87. In social and professional groups often ill are unorganized children – 23.3% and students – 19.8%. Studying clinical manifestations of measles in the hospitalized patients, the typical beginning of a disease with expressed intoxication symptoms – weakness, sickliness was established. In individual cases expressed intoxication symptoms, hemorrhagic and dyspeptic syndromes, complications in the form of overlay of a secondary bacterial infection, which defined high severity of the illness, were registered both in adults and in children. The average duration of stay of patients in the hospital made 6.9 days. The average duration of time between date of getting the disease and date of delivery of health care made 3.6 days. Thus, the analysis of monthly incidence of measles revealed spring and summer seasonality, the peak of which was registered in May. Urban dwellers are ill more often (69.2%), while in rural areas people are ill more rarely (29.1%). Throughout 2014 an epidemic rise in incidence of the population of North-Kazakhstan region was observed. Risk group includes: children under 4 – 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The ratio of women and men made 1:0.87. The typical beginning of a disease in all hospitalized with the expressed intoxication symptoms – weakness, sickliness was established.

Keywords: epidemiological analysis, measles, morbidity, outbreak

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Authors: Alejandra Sierra, Gloria Valadez, Adriana Dávalos, Mirliana Ramírez

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For years, the Pan American Health Organization/World Health Organization and other organizations have made efforts to the improve access and the quality of prenatal care as part of comprehensive programs for maternal and neonatal health, the standards of care have been renewed in order to migrate from a medical perspective to a holistic perspective. However, despite the efforts currently antenatal care models have not been verified by a scientific evaluation in order to determine their effectiveness. The teenage pregnancy is considered as a very important phenomenon since it has been strongly associated with inequalities, poverty and the lack of gender quality; therefore it is important to analyze the antenatal care that’s been given, including not only the clinical intervention but also the activities surrounding the advertising and the health education. In this study, the objective was to describe if the previously established activities (on the prenatal care models) are being performed in the care of pregnant teenagers attending prenatal care in health institutions in two cities in México and Chile during 2013. Methods: Observational and descriptive study, of a transversal cohort. 170 pregnant women (13-19 years) were included in prenatal care in two health institutions (100 women from León-Mexico and 70 from Chile-Coquimbo). Data collection: direct survey, perinatal clinical record card which was used as checklists: WHO antenatal care model WHO-2003, Official Mexican Standard NOM-007-SSA2-1993 and Personalized Service Manual on Reproductive Process- Chile Crece Contigo; for data analysis descriptive statistics were used. The project was approved by the relevant ethics committees. Results: Regarding the fulfillment of interventions focused on physical, gynecological exam, immunizations, monitoring signs and biochemical parameters in both groups was met by more than 84%; the activities of guidance and counseling pregnant teenagers in Leon compliance rates were below 50%, on the other hand, although pregnant women in Coquimbo had a higher percentage of compliance, no one reached 100%. The topics that less was oriented were: family planning, signs and symptoms of complications and labor. Conclusions: Although the coverage of the interventions indicated in the prenatal care models was high, there were still shortcomings in the fulfillment of activities to orientation, education and health promotion. Deficiencies in adherence to prenatal care guidelines could be due to different circumstances such as lack of registration or incomplete filling of medical records, lack of medical supplies or health personnel, absences of people at prenatal check-up appointments, among many others. Therefore, studies are required to evaluate the quality of prenatal care and the effectiveness of existing models, considering the role of the different actors (pregnant women, professionals and health institutions) involved in the functionality and quality of prenatal care models, in order to create strategies to design or improve the application of a complete process of promotion and prevention of maternal and child health as well as sexual and reproductive health in general.

Keywords: adolescent health, health systems, maternal health, primary health care

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Authors: David Tennison

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Epistemic injustice, an injustice done to a person specifically in their capacity as a “knower”, is a subtle form of discrimination, yet its effects can be as dehumanizing and damaging as more overt forms of discrimination. The lens of epistemic injustice has, in recent years, been fruitfully applied to the field of healthcare, examining questions of agency, power, credibility and belief in doctor-patient interactions. Contested illness patients (e.g., those with illnesses lacking scientific consensuses such as fibromyalgia (FM), Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) and Long Covid) face higher levels of scrutiny than other patient groups and are often disbelieved or dismissed when their ailments cannot be easily imaged or tested for- often encapsulated by the expression “it’s all in your head”. Using the case study of FM, the trials of contested illness patients in healthcare can be conceptualized in terms of epistemic injustice, and what is going wrong in these doctor-patient relationships can be effectively diagnosed. This case study also helps reveal epistemic dysfunction (structural epistemic issues embedded in the healthcare system), how this relates to stigma identity-based prejudice, and how the healthcare system upholds existing societal hierarchies and disenfranchises the most vulnerable. In the modern landscape, where cases of these chronic illnesses are not only on the rise but future pandemics threaten to add to their number, this conversation is crucial for the well-being of patients and providers. This presentation will cover what epistemic injustice is and how it can be applied to the politics of the doctor-patient interaction on a micro level and the politics of the healthcare system more broadly. Contested illnesses will be explored in terms of how the “contested” label causes the patient to experience disease stigma and lowers their credibility in healthcare and across other aspects of life. This will be explored in tandem with a discussion of existing identity-based prejudice in the healthcare system and how social identities (such as those of gender, race, and socioeconomic status) intersect with the contested illness label. The effects of epistemic injustice, which include worsening patients’ symptoms of mental health and potentially disenfranchising them from the healthcare system altogether, will be presented alongside the potential ethical quandaries this poses for providers. Finally, issues with the way healthcare appointments and the modern NHS function will be explored in terms of epistemic injustice and solutions to improve doctor-patient communication and patient care will be discussed. The relationship between contested illness patients and healthcare providers is notoriously poor, and while this can mean frustration or feelings of unfulfillment in providers, the negative effects for patients are much more severe. The purpose of this research, then, is to highlight these issues and suggest ways in which to improve the healthcare experience for these patients, along with improving doctor-patient communication and mending the doctor-patient relationship in a tangible and realistic way. This research also aims to provoke important conversations about belief and hierarchy in medical settings and how these aspects intersect with identity prejudices.

Keywords: epistemic injustice, fibromyalgia, contested illnesses, chronic illnesses, doctor-patient relationships, philosophy of medicine

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Authors: Samuel Olajide Babawale, Jonathan Bridge

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Natural Flood Management (NFM) is promoted as part of sustainable flood management (SFM) in response to climate change adaptation. Stakeholder engagement is central to this approach, and current trends are progressively moving towards a collaborative learning approach where stakeholder participation is perceived as one of the indicators of sustainable development. Within this methodology, participation embraces a diversity of knowledge and values underpinned by a philosophy of empowerment, equity, trust, and learning. To identify barriers to NFM uptake, there is a need for a new understanding of how stakeholder participation could be enhanced to benefit individual and community resilience within SFM. This is crucial in light of climate change threats and scientific reliability concerns. In contributing to this new understanding, this research evaluated the proposed interventions on six (6) UK NFM in a catchment known as the Sheffield Lakeland Partnership Area with reference to the Environment Agency Working with Natural Processes (WWNP) Potentials/Opportunities. Three of the opportunities, namely Run-off Attenuation Potential of 1%, Run-off Attenuation Potential of 3.3% and Riparian Woodland Potential, were modeled. In all the models, the interventions, though they have been proposed or already in place, are not in agreement with the data presented by EA WWNP. Findings show some institutional weaknesses, which are seen to inhibit the development of adequate flood management solutions locally with damaging implications for vulnerable communities. The gap in communication from practitioners poses a challenge to the implementation of real flood mitigating measures that align with the lead agency’s nationally accepted measures which are identified as not feasible by the farm management officers within this context. Findings highlight a dominant top-bottom approach to management with very minimal indication of local interactions. Current WWNP opportunities have been termed as not realistic by the people directly involved in the daily management of the farms, with less emphasis on prevention and mitigation. The targeted approach suggested by the EA WWNP is set against adaptive flood management and community development. The study explores dimensions of participation using the self-reliance and self-help approach to develop a methodology that facilitates reflections of currently institutionalized practices and the need to reshape spaces of interactions to enable empowered and meaningful participation. Stakeholder engagement and resilience planning underpin this research. The findings of the study suggest different agencies have different perspectives on “community participation”. It also shows communities in the case study area appear to be least influential, denied a real chance of discussing their situations and influencing the decisions. This is against the background that the communities are in the most productive regions, contributing massively to national food supplies. The results are discussed concerning practical implications for addressing interagency partnerships and conducting grassroots collaborations that empower local communities and seek solutions to sustainable development challenges. This study takes a critical look into the challenges and progress made locally in sustainable flood risk management and adaptation to climate change by the United Kingdom towards achieving the global 2030 agenda for sustainable development.

Keywords: natural flood management, sustainable flood management, sustainable development, working with natural processes, environment agency, run-off attenuation potential, climate change

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Authors: Richard Mababu Mukiur

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Leadership is an important drive that plays a key role in the success and development of organizations, particularly in the current context of digital transformation, highly competitivity and globalization. Leaders are persons that hold a dominant and privileged position within an organization, field, or sector of activities and are able to manage, motivate and exercise a high degree of influence over other in order to achieve the institutional goals. They achieve commitment and engagement of others to embrace change, and to make good decisions. Leadership studies in higher education institutions have examined how effective leaders hold their organizations, and also to find approaches which fit best in the organizations context for its better management, transformation and improvement. Moreover, recent studies have highlighted the impact of leadership styles on organizational performance and innovation capacities, since some styles give better results than others. Effective leadership is part of learning process that take place through day-to-day tasks, responsibilities, and experiences that influence the organizational performance, innovation and engagement of employees. The adoption of appropriate leadership styles can improve organization results and encourage learning process, team skills and performance, and employees' motivation and engagement. In the case of case of Information Technology sector, leadership styles are particularly crucial since this sector is leading relevant changes and transformations in the knowledge society. In this context, the main objective of this study is to analyze managers leadership styles with their relation to organizational performance and innovation that may be mediated by learning organization process and demographic variables. Therefore, it was hypothesized that the transformational and transactional leadership will be the main style adopted in Information Technology sector and will influence organizational performance and innovation capacity. A sample of 540 participants from Information technology sector has been determined in order to achieve the objective of this study. The Multifactor Leadership Questionnaire was administered as the principal instrument, Scale of innovation and Learning Organization Questionnaire. Correlations and multiple regression analysis have been used as the main techniques of data analysis. The findings indicate that leadership styles have a relevant impact on organizational performance and innovation capacity. The transformational and transactional leadership are predominant styles in Information technology sector. The effective leadership style tend to be characterized by the capacity of generating and sharing knowledge that improve organization performance and innovation capacity. Managers are adopting and adapting their leadership styles that respond to the new organizational, social and cultural challenges and realities of contemporary society. Managers who encourage innovation, foster learning process, share experience are useful to the organization since they contribute to its development and transformation. Learning process capacity and demographic variables (age, gender, and job tenure) mediate the relationship between leadership styles, innovation capacity and organizational performance. The transformational and transactional leadership tend to enhance the organizational performance due to their significant impact on team-building, employees' engagement and satisfaction. Some practical implications and future lines of research have been proposed.

Keywords: leadership styles, tranformational leadership, organisational performance, organisational innovation

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Authors: K. C. Tanuja, Mamatha P. Raj

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"People have always lived on streets. They have been the places where children first learned about the world, where neighbours met, the social centres of towns and cities, the rallying points for revolts, the scenes of repression. The street has always been the scene of this conflict, between living and access, between resident and traveller, between street life and the threat of death.” Livable Streets by Donald Appleyard. Urbanisation is happening rapidly all over the world. As population increasing in the urban settlements, its required to provide quality of life to all the inhabitants who live in. Urban design is a place making strategic planning. Urban design principles promote visualising any place environmentally, socially and economically viable. Urban design strategies include building mass, transit development, economic viability and sustenance and social aspects. Cities are wonderful inventions of diversity- People, things, activities, ideas and ideologies. Cities should be smarter and adjustable to present technology and intelligent system. Streets represent the community in terms of social and physical aspects. Streets are an urban form that responds to many issues and are central to urban life. Streets are for livability, safety, mobility, place of interest, economic opportunity, balancing the ecology and for mass transit. Urban streets are places where people walk, shop, meet and engage in different types of social and recreational activities which make urban community enjoyable. Streets knit the urban fabric of activities. Urban streets become livable with the introduction of social network enhancing the pedestrian character by providing good design features which in turn should achieve the minimal impact of motor vehicle use on pedestrians. Livable streets are the spatial definition to the public right of way on urban streets. Streets in India have traditionally been the public spaces where social life happened or created from ages. Streets constitute the urban public realm where people congregate, celebrate and interact. Streets are public places that can promote social interaction, active living and community identity. Streets as potential contributors to a better living environment, knitting together the urban fabric of people and places that make up a community. Livable streets or complete streets are making our streets as social places, roadways and sidewalks accessible, safe, efficient and useable for all people. The purpose of this paper is to understand the concept of livable street and parameters of livability on urban streets. Streets to be designed as the pedestrians are the main users and create spaces and furniture for social interaction which serves for the needs of the people of all ages and abilities. The problems of streets like congestion due to width of the street, traffic movement and adjacent land use and type of movement need to be redesigned and improve conditions defining the clear movement path for vehicles and pedestrians. Well-designed spatial qualities of street enhances the street environment, livability and then achieves quality of life to the pedestrians. A methodology been derived to arrive at the typologies in street design after analysis of existing situation and comparing with livable standards. It was Donald Appleyard‟s Livable Streets laid out the social effects on streets creating the social network to achieve Livable Streets.

Keywords: livable streets, social interaction, pedestrian use, urban design

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Authors: Roshni Raha, Kavya P., Gayathri M.

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India, with a humongous population, remains the world's poorest developing nation in terms of nutritional status, with iron deficiency anaemia (IDA) affecting the population. Despite efforts over the past decades, India's anaemia prevalence has not been reduced. Researchers are interested in developing therapies that will minimize the typical side effects of oral iron and optimize iron salts-based treatment through delivery methods based on the physiology of hepcidin regulation. However, they need to come up with iron therapies that will prevent making the infection worse. This article explores using bio-nanotechnology as the alternative, promising substitution of providing iron supplements for the treatment of diarrhoea and gut inflammation in kids and pregnant women. This article is an exploratory study using a literature survey and secondary research from review papers. In the realm of biotechnology, nanoparticles have become extremely famous due to unexpected variations in surface characteristics caused by particle size. Particle size distribution and shape exhibit unusual, enhanced characteristics when reduced to nanoscale. The article attempts to develop a model for a nanotechnology based solution in iron fortification to combat the problems of diarrhoea and gut inflammation. Certain dimensions that have been considered in the model include the size, shape, source, and biosynthesis of the iron nanoparticles. Another area of investigation addressed in the article is the cost-effective biocompatible production of these iron nanoparticles. Studies have demonstrated that a substantial reduction of metal ions to form nanoparticles from the bulk metal occurs in plants because of the presence of a wide diversity of biomolecules. Using this concept, the paper investigates the effectiveness and impact of how similar sources can be used for the biological synthesis of iron nanoparticles. Results showed that iron particles, when prepared in nano-metre size, offer potential advantages. When the particle size of the iron compound decreases and attains nano configuration, its surface area increases, which further improves its solubility in the gastric acid, leading to higher absorption, higher bioavailability, and producing the least organoleptic changes in food. It has no negative effects and possesses a safe, effective profile to reduce IDA. Considering all the parameters, it has been concluded that iron particles in nano configuration serve as alternative iron supplements for the complete treatment of IDA. Nanoparticles of ferric phosphate, ferric pyrophosphate, and iron oxide are the choices of iron supplements. From a sourcing perspective, the paper concludes green sources are the primary sources for the biological synthesis of iron nanoparticles. It will also be a cost-effective strategy since our goal is to treat the target population in rural India. Bio-nanotechnology serves as an alternative and promising substitution for iron supplements due to its low cost, excellent bioavailability, and strong organoleptic properties. One area of future research can be to explore the type of size and shape of iron nanoparticles that would be suitable for the different age groups of pregnant women and children and whether it would be influenced based on the topography in certain areas.

Keywords: anemia, bio-nanotechnology, iron-fortification, nanoparticle

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Authors: Alexander Vandesompele, Joni Dambre

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The diversity in dendritic arborization, as first illustrated by Santiago Ramon y Cajal, has always suggested a role for dendrites in the functionality of neurons. In the past decades, thanks to new recording techniques and optical stimulation methods, it has become clear that dendrites are not merely passive electrical components. They are observed to integrate inputs in a non-linear fashion and actively participate in computations. Regardless, in simulations of neural networks dendritic structure and functionality are often overlooked. Especially in a machine learning context, when designing artificial neural networks, point neuron models such as the leaky-integrate-and-fire (LIF) model are dominant. These models mimic the integration of inputs at the neuron soma, and ignore the existence of dendrites. In this work, the LIF point neuron model is extended with a simple form of dendritic computation. This gives the LIF neuron increased capacity to discriminate spatiotemporal input sequences, a dendritic functionality as observed in another study. Simulations of the spiking neurons are performed using the Bindsnet framework. In the common LIF model, incoming synapses are independent. Here, we introduce a dependency between incoming synapses such that the post-synaptic impact of a spike is not only determined by the weight of the synapse, but also by the activity of other synapses. This is a form of short term plasticity where synapses are potentiated or depressed by the preceding activity of neighbouring synapses. This is a straightforward way to prevent inputs from simply summing linearly at the soma. To implement this, each pair of synapses on a neuron is assigned a variable,representing the synaptic relation. This variable determines the magnitude ofthe short term plasticity. These variables can be chosen randomly or, more interestingly, can be learned using a form of Hebbian learning. We use Spike-Time-Dependent-Plasticity (STDP), commonly used to learn synaptic strength magnitudes. If all neurons in a layer receive the same input, they tend to learn the same through STDP. Adding inhibitory connections between the neurons creates a winner-take-all (WTA) network. This causes the different neurons to learn different input sequences. To illustrate the impact of the proposed dendritic mechanism, even without learning, we attach five input neurons to two output neurons. One output neuron isa regular LIF neuron, the other output neuron is a LIF neuron with dendritic relationships. Then, the five input neurons are allowed to fire in a particular order. The membrane potentials are reset and subsequently the five input neurons are fired in the reversed order. As the regular LIF neuron linearly integrates its inputs at the soma, the membrane potential response to both sequences is similar in magnitude. In the other output neuron, due to the dendritic mechanism, the membrane potential response is different for both sequences. Hence, the dendritic mechanism improves the neuron’s capacity for discriminating spa-tiotemporal sequences. Dendritic computations improve LIF neurons even if the relationships between synapses are established randomly. Ideally however, a learning rule is used to improve the dendritic relationships based on input data. It is possible to learn synaptic strength with STDP, to make a neuron more sensitive to its input. Similarly, it is possible to learn dendritic relationships with STDP, to make the neuron more sensitive to spatiotemporal input sequences. Feeding structured data to a WTA network with dendritic computation leads to a significantly higher number of discriminated input patterns. Without the dendritic computation, output neurons are less specific and may, for instance, be activated by a sequence in reverse order.

Keywords: dendritic computation, spiking neural networks, point neuron model

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Authors: Poulomi Bhadra, Manjushree Palit, Sanjeev P. Sahni

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Forensic science uses all branches of science for criminal investigation and trial and has increasingly emerged as an important tool in the administration of justice. However, the growth and development of this field in India has not been as rapid or widespread as compared to the more developed Western countries. For successful administration of justice, it is important that all agencies involved in law enforcement adopt an inter-professional approach towards forensic science, which is presently lacking. In light of the alarmingly high average acquittal rate in India, this study aims to examine the lack of understanding and appreciation of the importance and scope of forensic evidence and expert opinions amongst law professionals such as lawyers and judges. Based on a study of trial court cases from Delhi and surrounding areas, the study underline the areas in forensics where the criminal justice system has noticeably erred. Using this information, the authors examine the extent of forensic understanding amongst legal professionals and attempt to conclusively identify the areas in which they need further appraisal. A cross-sectional study done using a structured questionnaire was conducted amongst law professionals across age, gender, type and years of experience in court, to determine their understanding of DNA, fingerprints and other interdisciplinary scientific materials used as forensic evidence. In our study, we understand the levels of understanding amongst lawyers with regards to DNA and fingerprint evidence, and how it affects trial outcomes. We also aim to understand the factors that prevent credible and advanced awareness amongst legal personnel, amongst others. The survey identified the areas in modern and advanced forensics, such as forensic entomology, anthropology, cybercrime etc., in which Indian legal professionals are yet to attain a functional understanding. It also brings to light, what is commonly termed as the ‘CSI-effect’ in the Western courtrooms, and provides scope to study the existence of this phenomenon and its effects on the Indian courts and their judgements. This study highlighted the prevalence of unchallenged expert testimony presented by the prosecution in criminal trials and impressed upon the judicial system the need for independent analysis and evaluation of the scientist’s data and/or testimony by the defense. Overall, this study aims to define a clearer and rigid understanding of why legal professionals should have basic understanding of the interdisciplinary nature of forensic sciences. Based on the aforementioned findings, the author suggests various measures by which judges and lawyers might obtain an extensive knowledge of the advances and promising potentialities of forensic science. This includes promoting a forensic curriculum in legal studies at Bachelor’s and Master’s level as well as in mid-career professional courses. Formation of forensic-legal consultancies, in consultation with the Department of Justice, will not only assist in training police, military and law personnel but will also encourage legal research in this field. These suggestions also aim to bridge the communication gap that presently exists between law practitioners, forensic scientists and the general community’s awareness of the criminal justice system.

Keywords: forensic science, Indian legal professionals, interdisciplinary awareness, legal education

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Authors: Priyoth Kittiteerasack, Alana Steffen, Alicia K. Matthews

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Depression is a leading cause of the worldwide burden of disability and disease burden. Notably, lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to be a high-risk group for depression compared to their heterosexual and cisgender counterparts. To date, little is known about the rates and predictors of depression among Thai LGBT populations. As such, the purpose of this study was to: 1) measure the prevalence of depression among a diverse sample of Thai LGBT adults and 2) determine the influence of minority stress variables (discrimination, victimization, internalized homophobia, and identity concealment), general stress (stress and loneliness), and coping strategies (problem-focused, avoidance, and seeking social support) on depression outcomes. This study was guided by the Minority Stress Model (MSM). The MSM posits that elevated rates of mental health problems among LGBT populations stem from increased exposures to social stigma due to their membership in a stigmatized minority group. Social stigma, including discrimination and violence, represents unique sources of stress for LGBT individuals and have a direct impact on mental health. This study was conducted as part of a larger descriptive study of mental health among Thai LGBT adults. Standardized measures consistent with the MSM were selected and translated into the Thai language by a panel of LGBT experts using the forward and backward translation technique. The psychometric properties of translated instruments were tested and acceptable (Cronbach’s alpha > .8 and Content Validity Index = 1). Study participants were recruited using convenience and snowball sampling methods. Self-administered survey data were collected via an online survey and via in-person data collection conducted at a leading Thai LGBT organization. Descriptive statistics and multivariate analyses using multiple linear regression models were conducted to analyze study data. The mean age of participants (n = 411) was 29.5 years (S.D. = 7.4). Participants were primarily male (90.5%), homosexual (79.3%), and cisgender (76.6%). The mean score for depression of study participant was 9.46 (SD = 8.43). Forty-three percent of LGBT participants reported clinically significant levels of depression as measured by the Beck Depression Inventory. In multivariate models, the combined influence of demographic, stress, coping, and minority stressors explained 47.2% of the variance in depression scores (F(16,367) = 20.48, p < .001). Minority stressors independently associated with depression included discrimination (β = .43, p < .01) victimization (β = 1.53, p < .05), and identity concealment (β = -.54, p < .05). In addition, stress (β = .81, p < .001), history of a chronic disease (β = 1.20, p < .05), and coping strategies (problem-focused coping β = -1.88, p < .01, seeking social support β = -1.12, p < .05, and avoidance coping β = 2.85, p < .001) predicted depression scores. The study outcomes emphasized that minority stressors uniquely contributed to depression levels among Thai LGBT participants over and above typical non-minority stressors. Study findings have important implications for nursing practice and the development of intervention research.

Keywords: depression, LGBT, minority stress, sexual and gender minority, Thailand

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Authors: Kaaryn Cater

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People vary in how they perceive, process, and react to internal, external, social, and emotional environmental factors; some are more sensitive than others. Compassionate people have a highly reactive nervous system and are more impacted by positive and negative environmental conditions (Differential Susceptibility). Further, some sensitive individuals are disproportionately able to benefit from positive and supportive environments without necessarily suffering negative impacts in less supportive environments (Vantage Sensitivity). Environmental sensitivity is underpinned by physiological, genetic, and personality/temperamental factors, and the phenotypic expression of high sensitivity is Sensory Processing Sensitivity. The hallmarks of Sensory Processing Sensitivity are deep cognitive processing, emotional reactivity, high levels of empathy, noticing environmental subtleties, a tendency to observe new and novel situations, and a propensity to become overwhelmed when over-stimulated. Several educational advantages associated with high sensitivity include creativity, enhanced memory, divergent thinking, giftedness, and metacognitive monitoring. High sensitivity can also lead to some educational challenges, particularly managing multiple conflicting demands and negotiating low sensory thresholds. A mixed methods study was undertaken. In the first quantitative study, participants completed the Perceived Success in Study Survey (PSISS) and the Highly Sensitive Person Scale (HSPS-12). Inclusion criteria were current or previous postsecondary education experience. The survey was presented on social media, and snowball recruitment was employed (n=365). The Excel spreadsheets were uploaded to the statistical package for the social sciences (SPSS)26, and descriptive statistics found normal distribution. T-tests and analysis of variance (ANOVA) calculations found no difference in the responses of demographic groups, and Principal Components Analysis and the posthoc Tukey calculations identified positive associations between high sensitivity and three of the five PSISS factors. Further ANOVA calculations found positive associations between the PSISS and two of the three sensitivity subscales. This study included a response field to register interest in further research. Respondents who scored in the 70th percentile on the HSPS-12 were invited to participate in a semi-structured interview. Thirteen interviews were conducted remotely (12 female). Reflexive inductive thematic analysis was employed to analyse data, and a descriptive approach was employed to present data reflective of participant experience. The results of this study found that compassionate students prioritize work-life balance; employ a range of practical metacognitive study and self-care strategies; value independent learning; connect with learning that is meaningful; and are bothered by aspects of the physical learning environment, including lighting, noise, and indoor environmental pollutants. There is a dearth of research investigating sensitivity in the educational context, and these studies highlight the need to promote widespread education sector awareness of environmental sensitivity, and the need to include sensitivity in sector and institutional diversity and inclusion initiatives.

Keywords: differential susceptibility, highly sensitive person, learning, neurosensitivity, sensory processing sensitivity, vantage sensitivity

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Authors: Mahnaz Khalafehnilsaz, Rozina Rahnama

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Introduction: The aging process has been linked to a wide range of non-communicable diseases that cause a loss of health-related quality of life. This process can be worsened if an active and healthy lifestyle is not followed by adults, especially in the workplace. This setting not only may create a sedentary lifestyle but will lead to obesity and overweight in the long term and create unhealthy and inactive aging. In addition, eating habits are always known to be associated with active aging. Therefore, it is very valuable to know the eating patterns of people at work in order to detect and prevent diseases in the coming years. This study aimed to design and test a model to improve eating habits among employees at an industrial complex as a practical strategy. Material and method: The present research was a mixed-method study with a subsequent exploratory design which was carried out in two phases, qualitative and quantitative, in 2018 year. In the first step, participants were selected by purposive sampling (n=34) to ensure representation of different job roles; hours worked, gender, grade, and age groups, and semi-structured interviews were used. All interviews were conducted in the workplace and were audio recorded, transcribed verbatim, and analyzed using the Strauss and Corbin approach. The interview question was, “what were their experiences of eating at work, and how could these nutritional habits affect their health in old age.” Finally, a total of 1500 basic codes were oriented at the open coding step, and they were merged together to create the 17 classes, and six concepts and a conceptual model were designed. The second phase of the study was conducted in the form of a cross-sectional study. After verification of the research tool, the developed questionnaire was examined in a group of employees. In order to test the conceptual model of the study, a total of 500 subjects were included in psychometry. Findings: Six main concepts have been known, including 1. undesirable control of stress, 2. lack of eating knowledge, 3. effect of the social network, 4. lack of motivation for healthy habits, 5. environmental-organizational intensifier, 6. unhealthy eating behaviors. The core concept was “Motivation Loss to do preventive behavior.” The main constructs of the motivational-based model for the promotion of eating habits are “modification and promote of eating habits,” increase of knowledge and competency, convey of healthy nutrition behavior culture and effecting of behavioral model especially in older age, desirable of control stress. Conclusion: A key factor for unhealthy eating behavior at the workplace is a lack of motivation, which can be an obstacle to conduct preventive behaviors at work that can affect the healthy aging process in the long term. The motivational-based model could be considered an effective conceptual framework and instrument for designing interventions for the promotion to create healthy and active aging.

Keywords: aging, eating habits, older age, workplace

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Authors: Laura M. F. Bertens

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There is a long tradition of visually representing the art historical canon, in schematic overviews and diagrams. This is indicative of the desire for scientific, ‘objective’ knowledge of the kind (seemingly) produced in the natural sciences. These diagrams will, however, always retain an element of subjectivity and the modelling methods colour our perception of the represented information. In recent decades visualisations of art historical data, such as hand-drawn diagrams in textbooks, have been extended to include digital, computational tools. These tools significantly increase modelling strength and functionality. As such, they might be used to deconstruct and amend the very problem caused by traditional visualisations of the canon. In this paper, the use of digital tools for modelling the art historical canon is studied, in order to draw attention to the artificial nature of the static models that art historians are presented with in textbooks and lectures, as well as to explore the potential of digital, dynamic tools in creating new models. To study the way diagrams of the canon mediate the represented information, two modelling methods have been used on two case studies of existing diagrams. The tree diagram Stammbaum der neudeutschen Kunst (1823) by Ferdinand Olivier has been translated to a social network using the program Visone, and the famous flow chart Cubism and Abstract Art (1936) by Alfred Barr has been translated to an ontological model using Protégé Ontology Editor. The implications of the modelling decisions have been analysed in an art historical context. The aim of this project has been twofold. On the one hand the translation process makes explicit the design choices in the original diagrams, which reflect hidden assumptions about the Western canon. Ways of organizing data (for instance ordering art according to artist) have come to feel natural and neutral and implicit biases and the historically uneven distribution of power have resulted in underrepresentation of groups of artists. Over the last decades, scholars from fields such as Feminist Studies, Postcolonial Studies and Gender Studies have considered this problem and tried to remedy it. The translation presented here adds to this deconstruction by defamiliarizing the traditional models and analysing the process of reconstructing new models, step by step, taking into account theoretical critiques of the canon, such as the feminist perspective discussed by Griselda Pollock, amongst others. On the other hand, the project has served as a pilot study for the use of digital modelling tools in creating dynamic visualisations of the canon for education and museum purposes. Dynamic computer models introduce functionalities that allow new ways of ordering and visualising the artworks in the canon. As such, they could form a powerful tool in the training of new art historians, introducing a broader and more diverse view on the traditional canon. Although modelling will always imply a simplification and therefore a distortion of reality, new modelling techniques can help us get a better sense of the limitations of earlier models and can provide new perspectives on already established knowledge.

Keywords: canon, ontological modelling, Protege Ontology Editor, social network modelling, Visone

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Authors: Shubhangi Roy

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Relational Contracts (informal understandings not enforceable by law) are a common feature of most economies. However, their dominance is higher in developing countries. Such informality of economic sectors is often co-related to lower economic growth. The aim of this paper is to investigate whether informal arrangements i.e. relational contracts are a cause or symptom of lower levels of economic and/or institutional development. The methodology followed involves an initial survey of 150 test subjects in Northern India. The subjects are all members of occupations where they frequently transact ensuring uniformity in transaction volume. However, the subjects are from varied socio-economic backgrounds to ensure sufficient variance in transaction values allowing us to understand the relationship between the amount of money involved to the method of transaction used, if any. Questions asked are quantitative and qualitative with an aim to observe both the behavior and motivation behind such behavior. An overarching similarity observed during the survey across all subjects’ responses is that in an economy like India with pervasive corruption and delayed litigation, economy participants have created alternative social sanctions to deal with non-performers. In a society that functions predominantly on caste, class and gender classifications, these sanctions could, in fact, be more cumbersome for a potential rule-breaker than the legal ramifications. It, therefore, is a symptom of weak formal regulatory enforcement and dispute settlement mechanism. Additionally, the study bifurcates such informal arrangements into two separate systems - a) when it exists in addition to and augments a legal framework creating an efficient socio-legal equilibrium or; b) in conflict with the legal system in place. This categorization is an important step in regulating informal arrangements. Instead of considering the entire gamut of such arrangements as counter-development, it helps decision-makers understand when to dismantle (latter) and when to pivot around existing informal systems (former). The paper hypothesizes that those social arrangements that support the formal legal frameworks allow for cheaper enforcement of regulations with lower enforcement costs burden on the state mechanism. On the other hand, norms which contradict legal rules will undermine the formal framework. Law infringement, in presence of these norms, will have no impact on the reputation of the business or individual outside of the punishment imposed under the law. It is especially exacerbated in the Indian legal system where enforcement of penalties for non-performance of contracts is low. In such a situation, the social norm will be adhered to more strictly by the individuals rather than the legal norms. This greatly undermines the role of regulations. The paper concludes with recommendations that allow policy-makers and legal systems to encourage the former category of informal arrangements while discouraging norms that undermine legitimate policy objectives. Through this investigation, we will be able to expand our understanding of tools of market development beyond regulations. This will allow academics and policymakers to harness social norms for less disruptive and more lasting growth.

Keywords: distribution of income, emerging economies, relational contracts, sample survey, social norms

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Authors: A. Flaviana da Silva, B. Jenifer Apriani Ximenes, C. Efigenia dos Santos Pereira

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The World Health Organization's 2022 Global Oral Health Status Report reveals a staggering statistic: more than 3.5 billion people, or half of the world's population, currently suffer from untreated oral diseases, encompassing issues like tooth loss, gum disease, and oral cancers. Among these, dental caries, commonly known as tooth decay, affects over 2.5 billion people globally. Dental caries result from acid erosion of teeth due to plaque build-up and consumption of free sugars. Despite being preventable through basic measures such as regular tooth-brushing with fluoride toothpaste and reduced sugar intake, untreated dental caries poses a significant and growing public health crisis. In children, dental caries stands as the most prevalent non-communicable disease worldwide, affecting 60-90% of school children to some extent. This condition severely impacts their physical, emotional, and social well-being, hindering essential activities and overall quality of life. Timor-Leste, a small nation in South-east Asia, grapples with the escalating problem of childhood dental caries, exacerbated by its unique challenges including poor access to healthcare services and limited resources. Methods: This study analysed Secondary, cross-sectional data collected by Maluk Timor in 2022 during the School Outreach Program. A total of 1,008 children aged 4-16 from eight primary schools in the Bazartete administrative post were examined for dental caries in their primary and permanent teeth. All students were invited to participate, and consent was obtained from parents and children. A team comprising one dentist and two dental nurses conducted health promotion sessions, dental examinations, and SDF treatment. A screening form based on WHO guidelines collected demographic data and caries diagnosis, categorized as decayed or healthy. Data analysis involved entering the data into Google Sheets, verifying its accuracy, and importing it into Microsoft Excel for analysis. Variables were created to identify students with carious lesions, and prevalence tables were generated, stratified by age group, gender, and location. Results: Among the 1,008 children analysed, 58.3% had dental caries. Caries prevalence was higher in primary teeth (36.7%) compared to permanent teeth (29.5%). Conclusion: In summary, this report highlights the alarming prevalence of dental caries among children in Timor-Leste and the efforts of Maluk Timor's School Outreach Program in addressing this critical issue. The results emphasize the need for effective preventive measures and improved access to oral healthcare in this region.

Keywords: dental caries, timor-leste, oral health, children, public health, primary health care, teeth

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Authors: A.H.Y. Lai, C. Teyra

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In Taiwan, there are 16 official indigenous groups, accounting for 2.3% of the total population. Like other indigenous populations worldwide, indigenous peoples in Taiwan have poorer mental health because of their history of oppression and colonisation. Amid the negative narratives, the ethnic identity of cultural minorities is their unique psychological and cultural asset. Moreover, positive socialisation is found to be related to strong ethnic identity. Based on Phinney’s theory on ethnic identity development and social support theory, this study adopted a strength-based approach conceptualising ethnic identity as the central organising principle that linked perceived social support and mental health among indigenous adults in Taiwan. Aims. Overall aim is to examine the effect of ethnic identity and social support on mental health. Specific aims were to examine : (1) the association between ethnic identity and mental health; (2) the association between perceived social support and mental health ; (3) the indirect effect of ethnic identity linking perceived social support and mental health. Methods. Participants were indigenous adults in Taiwan (n=200; mean age=29.51; Female=31%, Male=61%, Others=8%). A cross-sectional quantitative design was implemented using data collected in the year 2020. Respondent-driven sampling was used. Standardised measurements were: Ethnic Identity Scale(6-item); Social Support Questionnaire-SF(6 items); Patient Health Questionnaire(9-item); and Generalised Anxiety Disorder(7-item). Covariates were age, gender and economic satisfaction. A four-stage structural equation modelling (SEM) with robust maximin likelihood estimation was employed using Mplus8.0. Step 1: A measurement model was built and tested using confirmatory factor analysis (CFA). Step 2: Factor covariates were re-specified as direct effects in the SEM. Covariates were added. The direct effects of (1) ethnic identity and social support on depression and anxiety and (2) social support on ethnic identity were tested. The indirect effect of ethnic identity was examined with the bootstrapping technique. Results. The CFA model showed satisfactory fit statistics: x^2(df)=869.69(608), p<.05; Comparative ft index (CFI)/ Tucker-Lewis fit index (TLI)=0.95/0.94; root mean square error of approximation (RMSEA)=0.05; Standardized Root Mean Squared Residual (SRMR)=0.05. Ethnic identity is represented by two latent factors: ethnic identity-commitment and ethnic identity-exploration. Depression, anxiety and social support are single-factor latent variables. For the SEM, model fit statistics were: x^2(df)=779.26(527), p<.05; CFI/TLI=0.94/0.93; RMSEA=0.05; SRMR=0.05. Ethnic identity-commitment (b=-0.30) and social support (b=-0.33) had direct negative effects on depression, but ethnic identity-exploration did not. Ethnic identity-commitment (b=-0.43) and social support (b=-0.31) had direct negative effects on anxiety, while identity-exploration (b=0.24) demonstrated a positive effect. Social support had direct positive effects on ethnic identity-exploration (b=0.26) and ethnic identity-commitment (b=0.31). Mediation analysis demonstrated the indirect effect of ethnic identity-commitment linking social support and depression (b=0.22). Implications: Results underscore the role of social support in preventing depression via ethnic identity commitment among indigenous adults in Taiwan. Adopting the strength-based approach, mental health practitioners can mobilise indigenous peoples’ commitment to their group to promote their well-being.

Keywords: ethnic identity, indigenous population, mental health, perceived social support

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

Procedia PDF Downloads 361

Authors: Vanessa Do, Lauren Smith, Leslie Carver

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It is widely known that individuals with autism spectrum disorder (ASD) may exhibit sensitivity to stimuli. Even at a young age, they tend to display stimuli-related discomfort in their behavior during play. Play serves a crucial role in a child’s early years as it helps support healthy brain development, socio-emotional skills, and adaptation to their environment There is research dedicated to studying infant preferences for toys, especially in regard to: gender preferences, the advantages of promoting play, and the caregiver’s role in their child’s play routines. However, there is a disproportionate amount of literature examining how play patterns may differ in children with sensory sensitivity, such as children diagnosed with ASD. Prior literature has studied and found supporting evidence that individuals with ASD have deficits in social communication and have increased presence of repetitive behaviors and/or restricted interests, which also display in early childhood play patterns. This study aims to examine potential differences in toy preference between infants with (FH+) and without (FH-) a familial history of ASD ages 6. 9, and 12 months old. More specifically, this study will address the question, “do FH+ infants tend to play more with toys that require less social engagement compared to FH- infants?” Infants and their caregivers were recruited and asked to engage in a free-play session in their homes that lasted approximately 5 minutes. The sessions were recorded and later coded offline for engagement behaviors categorized by toy; each toy that the infants interacted with was coded as belonging to one of 6 categories: sensory (designed to stimulate one or more senses such as light-up toys or musical toys) , construction (e.g., building blocks, rubber suction cups), vehicles (e.g., toy cars), instructional (require steps to accomplish a goal such as flip phones or books), imaginative (e.g., dolls, stuffed animals), and miscellaneous (toys that do not fit into these categories). Toy engagement was defined as the infant looking and touching the toy (ILT) or looking at the toy while their caregiver was holding it (IL-CT). Results reported include/will include the proportion of time the infant was actively engaged with the toy out of the total usable video time per subject — distractions observed during the session were excluded from analysis. Data collection is still ongoing; however, the prediction is that FH+ infants will have higher engagement with sensory and construction toys as they require the least amount of social effort. Furthermore, FH+ infants will have the least engagement with the imaginative toys as prior literature has supported the claim that individuals with ASD have a decreased likelihood to engage in play that requires pretend play and other social skills. Looking at what toys are more or less engaging to FH+ infants is important as it provides significant contributions to their healthy cognitive, social, and emotional development. As play is one of the first ways for a child to understand the complexities of the larger world, the findings of this study may help guide further research into encouraging play with toys that are more engaging and sensory-sensitive for children with ASD.

Keywords: autism engagement, children’s play, early development, free-play, infants, toy

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Authors: Chalise Kiran

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The prime idea of inclusive education is to mainstream every child in education. However, it will be challenging for implementation when there are policy and practice gaps. It will be even more challenging when children have disabilities. Generally, the focus will be on the policy gap, but the problem may not always be with policy. The proper practice could be a challenge in the countries like Nepal. In determining practice, the teachers’ perceptions toward inclusive will play a vital role. Nepal has categorized disability in 7 types (physical, visual, hearing, vision/hearing, speech, mental, and multiple). Out of these, hearing impairment is the study realm. In the context of a limited number of researches on children with disabilities and rare researches on CWHI and their education in Nepal, this study is a pioneering effort in knowing basically the problems and challenges of CWHI focused on inclusive education in the schools including gaps and barriers in its proper implementation. Philosophically, the paradigm of the study is post-positivism. In the post-positivist worldview, the quantitative approach with the description of the situation and inferential relationship are revealed out in the study. This is related to the natural model of objective reality. The data were collected from an individual survey with the teachers and head teachers of 35 schools in Nepal. The survey questionnaire was prepared and filled by the respondents from the schools where the CWHI study in 7 provincial 20 districts of Nepal. Through these considerations, the perceptions of CWHI focused inclusive education were explored in the study. The data were analyzed using both descriptive and inferential tools on which the Likert scale-based analysis was done for descriptive analysis, and chi-square mathematical tool was used to know the significant relationship between dependent variables and independent variables. The descriptive analysis showed that the majority of teachers have positive perceptions toward implementing CWHI focused inclusive education, and the majority of them have positive perceptions toward CWHI focused inclusive education, though there are some problems and challenges. The study has found out the major challenges and problems categorically. Some of them are: a large number of students in a single class; availability of generic textbooks for CWHI and no availability of textbooks to all students; less opportunity for teachers to acquire knowledge on CWHI; not adequate teachers in the schools; no flexibility in the curriculum; less information system in schools; no availability of educational consular; disaster-prone students; no child abuse control strategy; no disabled-friendly schools; no free health check-up facility; no participation of the students in school activities and in child clubs and so on. By and large, it is found that teachers’ age, gender, years of experience, position, employment status, and disability with him or her show no statistically significant relation to successfully implement CWHI focused inclusive education and perceptions to CWHI focused inclusive education in schools. However, in some of the cases, the set null hypothesis was rejected, and some are completely retained. The study has suggested policy implications, implications for educational authority, and implications for teachers and parents categorically.

Keywords: children with hearing impairment, disability, inclusive education, perception

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Authors: Justyna P. Majewska, Szymon M. Truskolaski

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The growing importance of digitalized services in the so-called new economy, including the e-sports industry, can be observed recently. Various demographic or technological changes lead consumers to modify their needs, not regarding the services themselves but the method of their application (attracting customers, forms of payment, new content, etc.). In the case of leisure-related to competitive spectating activities, there is a growing need to participate in events whose content is not sports competitions but computer games challenge – e-sport. The literature in this area so far focuses on determining the number of e-sport fans with elements of a simple statistical description (mainly concerning demographic characteristics such as age, gender, place of residence). Meanwhile, the development of the industry is influenced by a combination of many different, intertwined demographic, personality and psychosocial characteristics of customers, as well as the characteristics of their environment. Therefore, there is a need for a deeper recognition of the determinants of the behavioral patterns upon selecting digitalized services by customers, which, in the absence of available large data sets, can be achieved by using econometric simulations – multi-agent modeling. The cognitive aim of the study is to reveal internal and external determinants of behavioral patterns of customers taking into account various variants of economic development (the pace of digitization and technological development, socio-demographic changes, etc.). In the paper, an agent-based model with heterogeneous agents (characteristics of customers themselves and their environment) was developed, which allowed identifying a three-stage development scenario: i) initial interest, ii) standardization, and iii) full professionalization. The probabilities regarding the transition process were estimated using the Method of Simulated Moments. The estimation of the agent-based model parameters and sensitivity analysis reveals crucial factors that have driven a rising trend in e-sport spectating and, in a wider perspective, the development of digitalized services. Among the psychosocial characteristics of customers, they are the level of familiarization with the rules of games as well as sports disciplines, active and passive participation history and individual perception of challenging activities. Environmental factors include general reception of games, number and level of recognition of community builders and the level of technological development of streaming as well as community building platforms. However, the crucial factor underlying the good predictive power of the model is the level of professionalization. While in the initial interest phase, the entry barriers for new customers are high. They decrease during the phase of standardization and increase again in the phase of full professionalization when new customers perceive participation history inaccessible. In this case, they are prone to switch to new methods of service application – in the case of e-sport vs. sports to new content and more modern methods of its delivery. In a wider context, the findings in the paper support the idea of a life cycle of services regarding methods of their application from “traditional” to digitalized.

Keywords: agent-based modeling, digitalized services, e-sport, spectators motives

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Authors: Amber Hatch, Eric Wright, Feihong Wang

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Research suggests that attachment in close relationships affects one’s emotional processes, mindfulness, conflict-management behaviors, and interpersonal interactions. Attachment insecurity is often associated with maladaptive social interactions and suboptimal relationship qualities. Past studies have considered how the nature of emotion regulation and mindfulness in teachers may be related to student or classroom outcomes. Still, no research has examined how the relationship between such internal experiences and classroom management outcomes may also be related to teachers’ attachment insecurity. This study examined the interrelationships between teachers’ attachment insecurity, mindfulness tendencies, emotion regulation abilities, and classroom management efficacy as indexed by students’ classroom behavior and teachers’ response effectiveness. Teachers’ attachment insecurity was evaluated using the global ECRS-SF, which measures both attachment anxiety and avoidance. The present study includes a convenient sample of 357 American elementary school teachers who responded to a survey regarding their classroom management efficacy, attachment in/security, dispositional mindfulness, emotion regulation strategies, and difficulties in emotion regulation, primarily assessed via pre-existing instruments. Good construct validity was demonstrated for all scales used in the survey. Sample demographics, including gender (94% female), race (92% White), age (M = 41.9 yrs.), years of teaching experience (M = 15.2 yrs.), and education level were similar to the population from which it was drawn, (i.e., American elementary school teachers). However, white women were slightly overrepresented in our sample. Correlational results suggest that teacher attachment insecurity is associated with poorer classroom management efficacy as indexed by students’ disruptive behavior and teachers’ response effectiveness. Attachment anxiety was a much stronger predictor of adverse student behaviors and ineffective teacher responses to adverse behaviors than attachment avoidance. Mindfulness, emotion regulation abilities, and years of teaching experience predicted positive classroom management outcomes. Attachment insecurity and mindfulness were more strongly related to frequent adverse student behaviors, while emotion regulation abilities were more strongly related to teachers’ response effectiveness. The teaching experience was negatively related to attachment insecurity and positively related to mindfulness and emotion regulation abilities. Although the data were cross-sectional, path analyses revealed that attachment insecurity is directly related to classroom management efficacy. Through two routes, this relationship is further mediated by emotion regulation and mindfulness in teachers. The first route of indirect effect suggests double mediation by teacher’s emotion regulation and then teacher mindfulness in the relationship between teacher attachment insecurity and classroom management efficacy. The second indirect effect suggests mindfulness directly mediated the relationship between attachment insecurity and classroom management efficacy, resulting in improved model fit statistics. However, this indirect effect is much smaller than the double mediation route through emotion regulation and mindfulness in teachers. Given the significant predication of teacher attachment insecurity, mindfulness, and emotion regulation on teachers’ classroom management efficacy both directly and indirectly, the authors recommend improving teachers’ classroom management efficacy via a three-pronged approach aiming at enhancing teachers’ secure attachment and supporting their learning adaptive emotion regulation strategies and mindfulness techniques.

Keywords: Classroom management efficacy, student behavior, teacher attachment, teacher emotion regulation, teacher mindfulness

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Authors: Fadwa Al Bawardi

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In March 2021, the Saudi Arabian Council of Ministers issued a decision to form a committee called the "Higher Committee for Research, Development and Innovation," a committee linked to the Council of Economic and Development Affairs, chaired by the Chairman of the Council of Economic and Development Affairs, and concerned with the development of the research, development and innovation sector in the Kingdom. In order to talk about the dimensions of this wonderful step, let us first try to answer the following questions. Is there a difference between creativity and innovation..? What are the factors of creativity in the individual. Are they mental genetic factors or are they factors that an individual acquires through learning..? The methodology included surveys that have been conducted on more than 500 individuals, males and females, between the ages of 18 till 60. And the answer is. "Creativity" is the creation of a new idea, while "Innovation" is the development of an already existing idea in a new, successful way. They are two sides of the same coin, as the "creative idea" needs to be developed and transformed into an "innovation" in order to achieve either strategic achievements at the level of countries and institutions to enhance organizational intelligence, or achievements at the level of individuals. For example, the beginning of smart phones was just a creative idea from IBM in 1994, but the actual successful innovation for the manufacture, development and marketing of these phones was through Apple later. Nor does creativity have to be hereditary. There are three basic factors for creativity: The first factor is "the presence of a challenge or an obstacle" that the individual faces and seeks thinking to find solutions to overcome, even if thinking requires a long time. The second factor is the "environment surrounding" of the individual, which includes science, training, experience gained, the ability to use techniques, as well as the ability to assess whether the idea is feasible or otherwise. To achieve this factor, the individual must be aware of own skills, strengths, hobbies, and aspects in which one can be creative, and the individual must also be self-confident and courageous enough to suggest those new ideas. The third factor is "Experience and the Ability to Accept Risk and Lack of Initial Success," and then learn from mistakes and try again tirelessly. There are some tools and techniques that help the individual to reach creative and innovative ideas, such as: Mind Maps tool, through which the available information is drawn by writing a short word for each piece of information and arranging all other relevant information through clear lines, which helps in logical thinking and correct vision. There is also a tool called "Flow Charts", which are graphics that show the sequence of data and expected results according to an ordered scenario of events and workflow steps, giving clarity to the ideas, their sequence, and what is expected of them. There are also other great tools such as the Six Hats tool, a useful tool to be applied by a group of people for effective planning and detailed logical thinking, and the Snowball tool. And all of them are tools that greatly help in organizing and arranging mental thoughts, and making the right decisions. It is also easy to learn, apply and use all those tools and techniques to reach creative and innovative solutions. The detailed figures and results of the conducted surveys are available upon request, with charts showing the %s based on gender, age groups, and job categories.

Keywords: innovation, creativity, factors, tools

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Authors: Tomaz Oliveira, Rui Medeiros, André Lacerda

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Introduction: Cleft lip and/or palate are the most frequent forms of congenital craniofacial anomalies, affecting mainly the middle third of the face and manifesting by functional and aesthetic changes. Bilateral cleft lip represents a reconstructive surgical challenge, not only for the labial component but also for the associated nasal deformation. Recently, the paradigm of the approach to this pathology has changed, placing the focus on muscle reconstruction and anatomical repositioning of the nasal cartilages in order to obtain the best aesthetic and functional results. The aim of this study is to carry out a systematic review of the surgical approach to bilateral cleft lip, retrospectively analyzing the case series of Plastic Surgery Service at Hospital Santa Maria (Lisbon, Portugal) regarding this pathology, the global assessment of the characteristics of the operated patients and the study of the different surgical approaches and their complications in the last 20 years. Methods: The present work demonstrates a retrospective and descriptive study of patients who underwent at least one reconstructive surgery for cleft lip and/or palate, in the CPRE service of the HSM, in the period between January 1 of 1997 and December 31 of 2017, in which the data relating to 361 individuals were analyzed who, after applying the exclusion criteria, constituted a sample of 212 participants. The variables analyzed were the year of the first surgery, gender, age, type of orofacial cleft, surgical approach, and its complications. Results: There was a higher overall prevalence in males, with cleft lip and cleft palate occurring in greater proportion in males, with the cleft palate being more common in females. The most frequently recorded malformation was cleft lip and palate, which is complete in most cases. Regarding laterality, alterations with a unilateral labial component were the most commonly observed, with the left lip being described as the most affected. It was found that the vast majority of patients underwent primary intervention up to 12 months of age. The surgical techniques used in the approach to this pathology showed an important chronological variation over the years. Discussion: Cleft lip and/or palate is a medical condition associated with high aesthetic and functional morbidity, which requires early treatment in order to optimize the long-term outcome. The existence of a nasolabial component and its respective surgical correction plays a central role in the treatment of this pathology. The high rates of post-surgical complications and unconvincing aesthetic results have motivated an evolution of the surgical technique, increasingly evident in recent years, allowing today to achieve satisfactory aesthetic results, even in bilateral cleft lip with high deformation complexity. The introduction of techniques that favor nasolabial reconstruction based on anatomical principles has been producing increasingly convincing results. The analyzed sample shows that most of the results obtained in this study are, in general, compatible with the results published in the literature. Conclusion: This work showed that the existence of small variations in the surgical technique can bring significant improvements in the functional and aesthetic results in the treatment of bilateral cleft lip.

Keywords: cleft lip, palate lip, congenital abnormalities, cranofacial malformations

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