Search results for: disrespect and abuse in childbirth

Authors: Raptis Sotirios

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Health and social care (HSc) services planning and scheduling are facing unprecedented challenges due to the pandemic pressure and also suffer from unplanned spending that is negatively impacted by the global financial crisis. Data-driven can help to improve policies, plan and design services provision schedules using algorithms assist healthcare managers’ to face unexpected demands using fewer resources. The paper discusses services packing using statistical significance tests and machine learning (ML) to evaluate demands similarity and coupling. This is achieved by predicting the range of the demand (class) using ML methods such as CART, random forests (RF), and logistic regression (LGR). The significance tests Chi-Squared test and Student test are used on data over a 39 years span for which HSc services data exist for services delivered in Scotland. The demands are probabilistically associated through statistical hypotheses that assume that the target service’s demands are statistically dependent on other demands as a NULL hypothesis. This linkage can be confirmed or not by the data. Complementarily, ML methods are used to linearly predict the above target demands from the statistically found associations and extend the linear dependence of the target’s demand to independent demands forming, thus groups of services. Statistical tests confirm ML couplings making the prediction also statistically meaningful and prove that a target service can be matched reliably to other services, and ML shows these indicated relationships can also be linear ones. Zero paddings were used for missing years records and illustrated better such relationships both for limited years and in the entire span offering long term data visualizations while limited years groups explained how well patients numbers can be related in short periods or can change over time as opposed to behaviors across more years. The prediction performance of the associations is measured using Receiver Operating Characteristic(ROC) AUC and ACC metrics as well as the statistical tests, Chi-Squared and Student. Co-plots and comparison tables for RF, CART, and LGR as well as p-values and Information Exchange(IE), are provided showing the specific behavior of the ML and of the statistical tests and the behavior using different learning ratios. The impact of k-NN and cross-correlation and C-Means first groupings is also studied over limited years and the entire span. It was found that CART was generally behind RF and LGR, but in some interesting cases, LGR reached an AUC=0 falling below CART, while the ACC was as high as 0.912, showing that ML methods can be confused padding or by data irregularities or outliers. On average, 3 linear predictors were sufficient, LGR was found competing RF well, and CART followed with the same performance at higher learning ratios. Services were packed only if when significance level(p-value) of their association coefficient was more than 0.05. Social factors relationships were observed between home care services and treatment of old people, birth weights, alcoholism, drug abuse, and emergency admissions. The work found that different HSc services can be well packed as plans of limited years, across various services sectors, learning configurations, as confirmed using statistical hypotheses.

Keywords: class, cohorts, data frames, grouping, prediction, prob-ability, services

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Authors: Tatiana Butkova, Nikolai Kibrik, Kristina Malsagova, Alexander Izotov, Alexander Stepanov, Anna Kaysheva

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Relevance. The genetic risk of developing schizophrenia is determined by two factors: single nucleotide polymorphisms and gene copy number variations. The search for serological markers for early diagnosis of schizophrenia is driven by the fact that the first five years of the disease are accompanied by significant biological, psychological, and social changes. It is during this period that pathological processes are most amenable to correction. The aim of this study was to analyze single nucleotide polymorphisms (SNPs) that are hypothesized to potentially influence the onset and development of the endogenous process. Materials and Methods It was analyzed 73 single nucleotide polymorphism variants. The study included 48 patients undergoing inpatient treatment at "Psychiatric Clinical Hospital No. 1" in Moscow, comprising 23 females and 25 males. Inclusion criteria: - Patients aged 18 and above. - Diagnosis according to ICD-10: F20.0, F20.2, F20.8, F21.8, F25.1, F25.2. - Voluntary informed consent from patients. Exclusion criteria included: - The presence of concurrent somatic or neurological pathology, neuroinfections, epilepsy, organic central nervous system damage of any etiology, and regular use of medication. - Substance abuse and alcohol dependence. - Women who were pregnant or breastfeeding. Clinical and psychopathological assessment was complemented by psychometric evaluation using the PANSS scale at the beginning and end of treatment. The duration of observation during therapy was 4-6 weeks. Total DNA extraction was performed using QIAamp DNA. Blood samples were processed on Illumina HiScan and genotyped for 652,297 markers on the Infinium Global Chips Screening Array-24v2.0 using the IMPUTE2 program with parameters Ne=20,000 and k=90. Additional filtration was performed based on INFO>0.5 and genotype probability>0.5. Quality control of the obtained DNA was conducted using agarose gel electrophoresis, with each tested sample having a volume of 100 µL. Results. It was observed that several SNPs exhibited gender dependence. We identified groups of single nucleotide polymorphisms with a membership of 80% or more in either the female or male gender. These SNPs included rs2661319, rs2842030, rs4606, rs11868035, rs518147, rs5993883, and rs6269.Another noteworthy finding was the limited combination of SNPs sufficient to manifest clinical symptoms leading to hospitalization. Among all 48 patients, each of whom was analyzed for deviations in 73 SNPs, it was discovered that the combination of involved SNPs in the manifestation of pronounced clinical symptoms of schizophrenia was 19±3 out of 73 possible. In study, the frequency of occurrence of single nucleotide polymorphisms also varied. The most frequently observed SNPs were rs4849127 (in 90% of cases), rs1150226 (86%), rs1414334 (75%), rs10170310 (73%), rs2857657, and rs4436578 (71%). Conclusion. Thus, the results of this study provide additional evidence that these genes may be associated with the development of schizophrenia spectrum disorders. However, it's impossible cannot rule out the hypothesis that these polymorphisms may be in linkage disequilibrium with other functionally significant polymorphisms that may actually be involved in schizophrenia spectrum disorders. It has been shown that missense SNPs by themselves are likely not causative of the disease but are in strong linkage disequilibrium with non-functional SNPs that may indeed contribute to disease predisposition.

Keywords: gene polymorphisms, genotyping, single nucleotide polymorphisms, schizophrenia.

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Authors: Adam J. Bowen

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Abstract— Should robots have rights or legal protections. Often debates concerning whether robots and AI should be afforded rights focus on conditions of personhood and the possibility of future advanced forms of AI satisfying particular intrinsic cognitive and moral attributes of rights-holding persons. Such discussions raise compelling questions about machine consciousness, autonomy, and value alignment with human interests. Although these are important theoretical concerns, especially from a future design perspective, they provide limited guidance for addressing the moral and legal standing of current and near-term AI that operate well below the cognitive and moral agency of human persons. Robots and AI are already being pressed into service in a wide range of roles, especially in healthcare and biomedical contexts. The design and large-scale implementation of robots in the context of core societal institutions like healthcare systems continues to rapidly develop. For example, we bring them into our homes, hospitals, and other care facilities to assist in care for the sick, disabled, elderly, children, or otherwise vulnerable persons. We enlist surgical robotic systems in precision tasks, albeit still human-in-the-loop technology controlled by surgeons. We also entrust them with social roles involving companionship and even assisting in intimate caregiving tasks (e.g., bathing, feeding, turning, medicine administration, monitoring, transporting). There have been advances to enable severely disabled persons to use robots to feed themselves or pilot robot avatars to work in service industries. As the applications for near-term AI increase and the roles of robots in restructuring our biomedical practices expand, we face pressing questions about the normative implications of human-robot interactions and collaborations in our collective worldmaking, as well as the moral and legal status of robots. This paper argues that robots operating in public and private spaces be afforded some protections as either moral patients or legal agents to establish prohibitions on robot abuse, misuse, and mistreatment. We already implement robots and embed them in our practices and institutions, which generates a host of human-to-machine and machine-to-machine relationships. As we interact with machines, whether in service contexts, medical assistance, or home health companions, these robots are first encountered in relationship to us and our respective roles in the encounter (e.g., surgeon, physical or occupational therapist, recipient of care, patient’s family, healthcare professional, stakeholder). This proposal aims to outline a framework for establishing limiting factors and determining the extent of moral or legal protections for robots. In doing so, it advocates for a relational approach that emphasizes the priority of mapping the complex contextually sensitive roles played and the relations in which humans and robots stand to guide policy determinations by relevant institutions and authorities. The relational approach must also be technically informed by the intended uses of the biomedical technologies in question, Design History Files, extensive risk assessments and hazard analyses, as well as use case social impact assessments.

Keywords: biomedical robots, robot ethics, robot laws, human-robot interaction

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Authors: Abdul Wohab

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Context: The role of religion in the transformation of Bangladesh society has been significant since 1975. There has been a rise in religious presence, particularly Islam, in both private and public spheres supported by the state apparatuses. In 2009, a 'secular' political party came into power for the second time since independence and initiated the modernization of religious education systems. This research focuses on the transformation observed among the educated middle class who now prefer their children to attend modern, English medium madrasas that offer both religion-based and secular education. Research Aim: This research aims to investigate two main questions: a) what motivates the educated middle class to send their children to madrasa education? b) To what extent can it be argued that Bangladeshi society is transforming from its secular nature to being more religious?Methodology: The research applies a combination of primary and secondary methods. Case studies serve as the primary method, allowing for an in-depth exploration of the motivations of the educated middle class. The secondary method involves analyzing published news articles, op-eds, and websites related to madrasa education, as well as studying the reading syllabus of Aliya and Qwami madrasas in Bangladesh. Findings: Preliminary findings indicate that the educated middle class chooses madrasa education for reasons such as remembering and praying for their departed relatives, keeping their children away from substance abuse, fostering moral and ethical values, and instilling respect for seniors and relatives. The research also reveals that religious education is believed to help children remain morally correct according to the Quran and Hadith. Additionally, the establishment of madrasas in Bangladesh is attributed to economic factors, with demand and supply mechanisms playing a significant role. Furthermore, the findings suggest that government-run primary education institutions in rural areas face more challenges in enrollment compared to religious educational institutions like madrasas. Theoretical Importance: This research contributes to the understanding of societal transformation and the role of religion in this process. By examining the case of Bangladesh, it provides insights into how religion influences education choices and societal values. Data Collection and Analysis Procedures: Data for this research is collected through case studies, including interviews and observations of educated middle-class families who send their children to madrasas. In addition, analysis is conducted on relevant published materials such as news articles, op-eds, and websites. The reading syllabus of Aliya and Qwami madrasas is also analyzed to gain a comprehensive understanding of the education system. Questions Addressed: The research addresses two questions: a) what motivates the educated middle class to choose madrasa education for their children? b) To what extent can it be argued that Bangladeshi society is transforming from its secular nature to being more religious?Conclusion: The preliminary findings of this research highlight the motivations of the educated middle class in opting for madrasa education, including the desire to maintain religious traditions, promote moral values, and provide a strong foundation for their children. It also suggests that Bangladeshi society is experiencing a transformation towards a more religious orientation. This research contributes to the understanding of societal changes and the role of religion within Bangladesh, shedding light on the complex dynamics between religion and education.

Keywords: madrasa education, transformation, Bangladesh, religion and society, education

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Authors: Ruth Leitch, Joanne Hughes

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This paper presents the findings of a three-year government-funded study (ILiAD) that aimed to understand the reasons for differential educational achievement within and between socially and economically deprived areas in Northern Ireland. Previous international studies have concluded that there is a positive correlation between deprivation and underachievement. Our preliminary secondary data analysis suggested that the factors involved in educational achievement within multiple deprived areas may be more complex than this, with some areas of high multiple deprivation having high levels of student attainment, whereas other less deprived areas demonstrated much lower levels of student attainment, as measured by outcomes on high stakes national tests. The study proposed that no single explanation or disparate set of explanations could easily account for the linkage between levels of deprivation and patterns of educational achievement. Using a social capital perspective that centralizes the connections within and between individuals and social networks in a community as a valuable resource for educational achievement, the ILiAD study involved a multi-level case study analysis of seven community sites in Northern Ireland, selected on the basis of religious composition (housing areas are largely segregated by religious affiliation), measures of multiple deprivation and differentials in educational achievement. The case study approach involved three (interconnecting) levels of qualitative data collection and analysis - what we have termed Micro (or community/grassroots level) understandings, Meso (or school level) explanations and Macro (or policy/structural) factors. The analysis combines a statistical mapping of factors with qualitative, in-depth data interpretation which, together, allow for deeper understandings of the dynamics and contributory factors within and between the case study sites. Thematic analysis of the qualitative data reveals both cross-cutting factors (e.g. demographic shifts and loss of community, place of the school in the community, parental capacity) and analytic case studies of explanatory factors associated with each of the community sites also permit a comparative element. Issues arising from the qualitative analysis are classified either as drivers or inhibitors of educational achievement within and between communities. Key issues that are emerging as inhibitors/drivers to attainment include: the legacy of the community conflict in Northern Ireland, not least in terms of inter-generational stress, related with substance abuse and mental health issues; differing discourses on notions of ‘community’ and ‘achievement’ within/between community sites; inter-agency and intra-agency levels of collaboration and joined-up working; relationship between the home/school/community triad and; school leadership and school ethos. At this stage, the balance of these factors can be conceptualized in terms of bonding social capital (or lack of it) within families, within schools, within each community, within agencies and also bridging social capital between the home/school/community, between different communities and between key statutory and voluntary organisations. The presentation will outline the study rationale, its methodology, present some cross-cutting findings and use an illustrative case study of the findings from a community site to underscore the importance of attending to community differences when trying to engage in research to understand and improve educational attainment for all.

Keywords: educational achievement, multiple deprivation, community case studies, social capital

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Authors: Farwa Rizvi, Joanne Williams, Humaira Maheen, Elizabeth Hoban

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There is an increase in risky sexual behavior and unsafe sex in adolescent girls and young women aged 15 to 24 years in Cambodia, which negatively affects their reproductive health by increasing the risk of contracting sexually transmitted infections and unintended pregnancies. Risky sexual behavior includes ‘having sex at an early age, having multiple sexual partners, having sex while under the influence of alcohol or drugs, and unprotected sexual behaviors’. A systematic review of quantitative research conducted in Cambodia was undertaken, using the theoretical framework of the Social Ecological Model to identify the personal, social and cultural factors associated with risky sexual behavior and unsafe sex in young Cambodian women. PRISMA guidelines were used to search databases including Medline Complete, PsycINFO, CINAHL Complete, Academic Search Complete, Global Health, and Social Work Abstracts. Additional searches were conducted in Science Direct, Google Scholar and in the grey literature sources. A risk-of-bias tool developed explicitly for the systematic review of cross-sectional studies was used. Summary item on the overall risk of study bias after the inter-rater response showed that the risk-of-bias was high in two studies, moderate in one study and low in one study. The search strategy included a combination of subject terms and free text terms. The medical subject headings (MeSH) terms included were; contracept* or ‘birth control’ or ‘family planning’ or pregnan* or ‘safe sex’ or ‘protected intercourse’ or ‘unprotected intercourse’ or ‘protected sex’ or ‘unprotected sex’ or ‘risky sexual behaviour*’ or ‘abort*’ or ‘planned parenthood’ or ‘unplanned pregnancy’ AND ( barrier* or obstacle* or challenge* or knowledge or attitude* or factor* or determinant* or choic* or uptake or discontinu* or acceptance or satisfaction or ‘needs assessment’ or ‘non-use’ or ‘unmet need’ or ‘decision making’ ) AND Cambodia*. Initially, 300 studies were identified by using key words and finally, four quantitative studies were selected based on the inclusion criteria. The four studies were published between 2010 and 2016. The study participants ranged in age from 10-24 years, single or married, with 3 to 10 completed years of education. The mean age at sexual debut was reported to be 18 years. Using the perspective of the Social Ecological Model, risky sexual behavior was associated with individual-level factors including young age at sexual debut, low education, unsafe sex under the influence of alcohol and substance abuse, multiple sexual partners or transactional sex. Family level factors included living away from parents, orphan status and low levels of family support. Peer and partner level factors included peer delinquency and lack of condom use. Low socioeconomic status at the society level was also associated with risky sexual behaviour. There is scant research on sexual and reproductive health of adolescent girls and young women in Cambodia. Individual, family and social factors were significantly associated with risky sexual behaviour. More research is required to inform potential preventive strategies and policies that address young women’s sexual and reproductive health.

Keywords: adolescents, high-risk sex, sexual activity, unplanned pregnancies

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Authors: Ronahlee Asuncion

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The nature of their work and employment relationship make domestic workers easy prey to abuse, maltreatment, and exploitation. Considering their plight, this research was conceptualized and examined the: a) level of awareness of Filipino domestic workers on occupational safety and health (OSH); b) their issues/problems/concerns on OSH; c) their intervention strategies at work to address OSH related issues/problems/concerns; d) issues/problems/concerns of government, employers, and non-government organizations with regard to implementation of OSH to Filipino domestic workers; e) the role of government, employers and non-government organizations to help Filipino domestic workers address OSH related issues/problems/concerns; and f) the necessary policy amendments/initiatives/programs to address OSH related issues/problems/concerns of Filipino domestic workers. The study conducted a survey using non-probability sampling, two focus group discussions, two group interviews, and fourteen face-to-face interviews. These were further supplemented with an email correspondence to a key informant based in another country. Books, journals, magazines, and relevant websites further substantiated and enriched data of the research. Findings of the study point to the fact that domestic workers have low level of awareness on OSH because of poor information drive, fragmented implementation of the Domestic Workers Act, inactive campaign at the barangay level, weakened advocacy for domestic workers, absence of law on OSH for domestic workers, and generally low safety culture in the country among others. Filipino domestic workers suffer from insufficient rest, long hours of work, heavy workload, occupational stress, poor accommodation, insufficient hours of sleep, deprivation of day off, accidents and injuries such as cuts, burns, slipping, stumbling, electrical grounding, and fire, verbal, physical and sexual abuses, lack of medical assistance, none provision of personal protective equipment (PPE), absence of knowledge on the proper way of lifting, working at heights, and insufficient food provision. They also suffer from psychological problems because of separation from one’s family, limited mobility in the household where they work, injuries and accidents from using advanced home appliances and taking care of pets, low self-esteem, ergonomic problems, the need to adjust to all household members who have various needs and demands, inability to voice their complaints, drudgery of work, and emotional stress. With regard to illness or health problems, they commonly experience leg pains, back pains, and headaches. In the absence of intervention programs like those offered in the formal employment set up, domestic workers resort to praying, turn to family, relatives and friends for social and emotional support, connect with them through social media like Facebook which also serve as a means of entertainment to them, talk to their employer, and just try to be optimistic about their situation. Promoting OSH for domestic workers is very challenging and complicated because of interrelated factors such as cultural, knowledge, attitudinal, relational, social, resource, economic, political, institutional and legal problems. This complexity necessitates using a holistic and integrated approach as this is not a problem requiring simple solutions. With this recognition comes the full understanding that its success involves the action and cooperation of all duty bearers in attaining decent work for domestic workers.

Keywords: decent work, Filipino domestic workers, occupational safety and health, working conditions

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Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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Authors: E. O. Aluta, C. A. Booth, D. G. Proverbs, T. Appleby

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Challenges in the effective management of potable water have attracted global attention in recent years and remain many world regions’ major priorities. Scarcity and unavailability of potable water may potentially escalate poverty, obviate democratic expression of views and militate against inter-sectoral development. These challenges contra-indicate the inherent potentials of the resource. Thus, while creation of poverty may be regarded as a broad-based problem, it is capable of reflecting life-span reduction diseases, the friction of interests manifesting in threats and warfare, the relegation of democratic principles for authoritarian definitions and Human Rights abuse. The challenges may be identified as manifestations of ineffective management of potable water resource and therefore, regarded as major problems in environmental protection. In reaction, some nations have re-examined their laws and policies, while others have developed innovative projects, which seek to ameliorate difficulties of providing sustainable potable water. The problems resonate in Nigeria, where the legal framework supporting the supply and management of potable water has been criticized as ineffective. This has impacted more on rural community members, often regarded as ‘voiceless’. At that level, the participation of non-state actors has been identified as an effective strategy, which can improve water supply. However, there are indications that there is no pragmatic application of this, resulting in over-centralization and top-down management. Thus, this study focuses on how the participatory process may enable the development of participatory water governance framework, for use in Nigeria rural communities. The Rural Advisory Board (RAB) is proposed as a governing body to promote proximal relationships, institute democratisation borne out of participation, while enabling effective accountability and information. The RAB establishes mechanisms for effectiveness, taking into consideration Transparency, Accountability and Participation (TAP), advocated as guiding principles of decision-makers. Other tools, which may be explored in achieving these are, Laws and Policies supporting the water sector, under the direction of the Ministries and Law Courts, which ensure non-violation of laws. Community norms and values, consisting of Nigerian traditional belief system, perceptions, attitude and reality (often undermined in favour of legislations), are relied on to pave the way for enforcement. While the Task Forces consist of community members with specific designation of duties, which ensure compliance and enforceability, a cross-section of community members are assigned duties. Thus, the principle of participation is pragmatically reflected. A review of the literature provided information on the potentials of the participatory process, in potable water governance. Qualitative methodology was explored by using the semi-structured interview as strategy for inquiry. The purposive sampling strategy, consisting of homogeneous, heterogeneous and criterion techniques was applied to enable sampling. The samples, sourced from diverse positions of life, were from the study area of Delta State of Nigeria, involving three local governments of Oshimili South, Uvwie and Warri South. From the findings, there are indications that the application of the participatory process is inhered with empowerment of the rural community members to make legitimate demands for TAP. This includes the obviation of mono-decision making for the supply and management of potable water. This is capable of restructuring the top-down management to a top-down/bottom-up system.

Keywords: participation, participatory process, participatory water governance, rural advisory board

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Authors: Kristina F. Wolff

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Background: In the Federal Republic of Germany, violence against women is deeply embedded in society. Germany is, as of March 2020, the most populous member state of the European Union with 83.2 million inhabitants and, although more than half of its inhabitants are women, gender equality was not certified in the Basic Law until 1957. Women have only been allowed to enter paid employment without their husband's consent since 1977 and have marital rape prosecuted only since 1997. While the lack of equality between men and women is named in the preamble of the Istanbul Convention as the cause of gender-specific, structural, traditional violence against women, Germany continues to sink on the latest Gender Equality Index. According to Police Crime Statistics (PCS), women are significantly more often victims of lethal violence, emanating from men than vice versa. The PCS, which, since 2015, also collects gender-specific data on violent crimes, is kept by the Federal Criminal Police Office, but without taking into account the relevant criteria for targeted prevention, such as the history of violence of the perpetrator/killer, weapon, motivation, etc.. Institutions such as EIGE or the World Health Organization have been asking Germany for years in vain for comparable data on violence against women in order to gain an overview or to develop cross-border synergies. The PCS are the only official data collection on violence against women. All players involved are depend on this data set, which is published only in November of the following year and is thus already completely outdated at the time of publication. In order to combat German femicides causally, purposefully and efficiently, evidence-based data was urgently needed. Methodology: Beginning in January 2019, a database was set up that now tracks more than 600 German femicides, broken down by more than 100 crime-related individual criteria, which in turn go far beyond the official PCS. These data are evaluated on the one hand by daily media research, and on the other hand by case-specific inquiries at the respective public prosecutor's offices and courts nationwide. This quantitative long-term study covers domestic violence as well as a variety of different types of gender-specific, lethal violence, including, for example, femicides committed by German citizens abroad. Additionallyalcohol/ narcotic and/or drug abuse, infanticides and the gender aspect in the judiciary are also considered. Results: Since November 2020, evidence-based data from a scientific survey have been available for the first time in Germany, supplementing the rudimentary picture of reality provided by PCS with a number of relevant parameters. The most important goal of the study is to identify "red flags" that enable general preventive awareness, that serve increasingly precise hazard assessment in acute hazard situations, and from which concrete instructions for action can be identified. Already at a very early stage of the study it could be proven that in more than half of all femicides with a sexual perpetrator/victim constellation there was an age difference of five years or more. Summary: Without reliable data and an understanding of the nature and extent, cause and effect, it is impossible to sustainably curb violence against girls and women, which increasingly often culminates in femicide. In Germany, valid data from a scientific survey has been available for the first time since November 2020, supplementing the rudimentary reality picture of the official and, to date, sole crime statistics with several relevant parameters. The basic research provides insights into geo-concentration, monthly peaks and the modus operandi of male violent excesses. A significant increase of child homicides in the course of femicides and/or child homicides as an instrument of violence against the mother could be proven as well as a danger of affected persons due to an age difference of five years and more. In view of the steadily increasing wave of violence against women, these study results are an eminent contribution to the preventive containment of German femicides.

Keywords: femicide, violence against women, gender specific data, rule Of law, Istanbul convention, gender equality, gender based violence

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