Search results for: stigma and discrimination
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 807

Search results for: stigma and discrimination

207 The Embodiment of Violence and Liminal Space in Illegality: Rohingya Refugees

Authors: E. Xavier, B. Nandita

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Rohingyas are an ethnic and religious minority that resides in the Rakhine State of Myanmar. Post the military coup in 1962, Rohingyas have not been recognized as one of the ethnic tribes of Burma under the legislation. They have lost citizenship, education, health care rights, and instantly became illegal immigrants. While the historicization of this conflict is crucial, this paper wants to humanize the Rohingya population’s embodiment of violence on three different levels – individual, social, and political. In addition, the study focuses on their liminal existence in refugee camps in Bangladesh and in other parts of the world, such as Malaysia and the United States of America. A multi-medium study, it includes first-hand interviews with the Rohingya community in Wisconsin and Chicago, second-hand interviews from documentaries and past ethnographies from scholars to draw meaningful conclusions about their experience as a community. In the end, it focuses on the group of Rohingyas who have managed to resettle in another country and their transitioning experience. Rohingyas embody violence on their individual, social, and political bodies in different ways. Along with rape, murder, and physical harm, the community also encounters sexually transmitted infections, post-traumatic stress disorder symptoms, and poor mental health. On a social level, they encounter heightened gender discrimination, work industry shifting, and immense, shared emotional pain. As for their political body, the news media and journalism industry uses their bodies for purposes that benefit both parties and flirts with a tone of sensationalism in their reporting. In addition, the Rohingya community fluctuates with the concept of nationality, patriotism, citizenship, and refugee when they think about the future. This study provides a framework that future aid or health programs can use to determine the type of community need and its significance in the Rohingya community.

Keywords: embodiment, liminal, refugee, Rohingya

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206 Access to Livelihoods for Urban Refugees in Kenya: The Case Study of Somalis Living in Eastleigh

Authors: Nancy Njoka, Manuela Ramos Cacciatore

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In Kenya, refugee situations are becoming increasingly protracted, stretching over the years or even decades. As urbanization rates increase, so do the numbers of urban refugees in the country. Refugees living in urban areas face a range of challenges. In their efforts to pursue livelihoods, refugees have identified strategies to confront these challenges. In the same manner, humanitarian actors have come up with different interventions to promote access to livelihoods working through obstacles and barriers created by host governments. This paper seeks to understand the experience of Somali urban refugees living in the urban area of Eastleigh, Nairobi, both by investigating their own actions towards creating avenues to access livelihoods and by understanding their social, economic and policy context in which they forge livelihoods. The empirical data collected through fieldwork in Nairobi in 2020 serves as the basis of this qualitative case study. Drawing upon the themes of urban refugee movement, Somali ethnicity, citizenship discrimination and the livelihoods of refugees, the paper highlights how the actions of the Kenyan government and international non-governmental organization (INGO)s affect access to livelihoods and the consequences of these actions for Somali urban refugees. The results of the paper found that Somali urban refugees are taking active steps to create livelihoods for themselves. This is seen in the growth of Eastleigh as an economic hub in Kenya which is owned and run mostly by Somalis. Indeed, the Somali community is central to the establishment of networks in the neighborhood. Somali urban refugees are marginalized by the Kenyan government, reducing their opportunity to create dignified lives in Eastleigh. Findings also point out the community-based approaches used by INGOs in livelihood interventions. The relevance of this research lies in the interconnection of humanitarian development interventions for protracted refugees and the promotion of livelihoods in an urban and global context.

Keywords: Kenya, livelihoods, Somali, urban refugees

Procedia PDF Downloads 149
205 Hyperspectral Imaging and Nonlinear Fukunaga-Koontz Transform Based Food Inspection

Authors: Hamidullah Binol, Abdullah Bal

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Nowadays, food safety is a great public concern; therefore, robust and effective techniques are required for detecting the safety situation of goods. Hyperspectral Imaging (HSI) is an attractive material for researchers to inspect food quality and safety estimation such as meat quality assessment, automated poultry carcass inspection, quality evaluation of fish, bruise detection of apples, quality analysis and grading of citrus fruits, bruise detection of strawberry, visualization of sugar distribution of melons, measuring ripening of tomatoes, defect detection of pickling cucumber, and classification of wheat kernels. HSI can be used to concurrently collect large amounts of spatial and spectral data on the objects being observed. This technique yields with exceptional detection skills, which otherwise cannot be achieved with either imaging or spectroscopy alone. This paper presents a nonlinear technique based on kernel Fukunaga-Koontz transform (KFKT) for detection of fat content in ground meat using HSI. The KFKT which is the nonlinear version of FKT is one of the most effective techniques for solving problems involving two-pattern nature. The conventional FKT method has been improved with kernel machines for increasing the nonlinear discrimination ability and capturing higher order of statistics of data. The proposed approach in this paper aims to segment the fat content of the ground meat by regarding the fat as target class which is tried to be separated from the remaining classes (as clutter). We have applied the KFKT on visible and nearinfrared (VNIR) hyperspectral images of ground meat to determine fat percentage. The experimental studies indicate that the proposed technique produces high detection performance for fat ratio in ground meat.

Keywords: food (ground meat) inspection, Fukunaga-Koontz transform, hyperspectral imaging, kernel methods

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204 Understanding the Underutilization of Electroconvulsive Therapy in Children and Adolescents

Authors: Carlos M. Goncalves, Luisa Duarte, Teresa Cartaxo

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The aim of this work was to understand the reasons behind the underutilization of electroconvulsive therapy (ECT) in the younger population and raise possible solutions. We conducted a non-systematic review of literature throughout a search on PubMed, using the terms ‘children’, ‘adolescents’ and ‘electroconvulsive’, ‘therapy’. Candidate articles written in languages other than English were excluded. Articles were selected according to title and/or abstract’s content relevance, resulting in a total of 5 articles. ECT is a recognized effective treatment in adults for several psychiatric conditions. As in adults, ECT in children and adolescents is proven most beneficial in the treatment of severe mood disorders, catatonia, and, to a lesser extent, schizophrenia. ECT in adults has also been used to treat autism’s self-injurious behaviours, Tourette’s syndrome and resistant first-episode schizophrenia disorder. Despite growing evidence on its safety and effectiveness in children and adolescents, like those found in adults, ECT remains a controversial and underused treatment in patients this age, even when it is clearly indicated. There are various possible reasons to this; limited awareness among professionals (lack of knowledge and experience among child psychiatrists), stigmatic public opinion (despite positive feedback from patients and families, there is an unfavourable and inaccurate representation in the media, contributing to a negative public opinion), legal restrictions and ethical controversies (restrictive regulations such as a minimum age for administration), lack of randomized trials (the currently available studies are retrospective, with small size samples, and most of the publications are either case reports or case series). This shows the need to raise awareness and knowledge, not only for mental health professionals, but also to the general population, through the media, regarding indications, methods and safety of ECT in order to provide reliable information to the patient and families. Large-scale longitudinal studies are also useful to further demonstrate the efficacy and safety of ECT and can aid in the formulation of algorithms and guidelines as without these changes, the availability of ECT to the younger population will remain restricted by regulations and social stigma. In conclusion, these results highlight that lack of adequate knowledge and accurate information are the most important factors behind the underutilization of ECT in younger population. Mental healthcare professionals occupy a cornerstone position; if data is given by a well-informed healthcare professional instead of the media, general population (including patients and their families) will probably regard the procedure in a more favourable way. So, the starting point should be to improve health care professional’s knowledge and experience on this choice of treatment.

Keywords: adolescents, children, electroconvulsive, therapy

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203 An Exploratory Research on Awareness towards Human Rights among Public Representatives of Bihar, India

Authors: Saba Farheen, Uday Shankar

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Background- Attaining equality among all humans and eliminating all forms of discrimination against them are fundamental human rights. These rights are based on the belief that all human beings are born free with equal dignity, esteem, and honour. In India, more than 30 percent politicians are having criminal background. They are also illiterate, which obstacle them in governing the system. They do not know the basic human rights. Because of this, they cannot decide what to do for the sake of the nation. Bihar is the third largest populated state of India and is characterized by corrupt politicians and poor literacy rate. If the politicians can aware about the human rights, then they will show positive attitude towards these. Aim- The main goal of the present research was to study the subjects’ knowledge or awareness towards their human rights. It was an attempt to identify social-psychological conditions that inhibit or facilitate awareness among public representatives towards their human rights in the special context of Bihar, India. Thus the main variable awareness towards human rights has been treated as the main dependent variable. The other two variables-socio economic status and Educational status, have been treated as independent variables. Method- The subjects were 400 public representatives in the age group of 35 to 50 years. They were from High socio economic status (N=150), Middle socio economic status (N=150), and Low socio economic status (N=100). The subjects were either educated (N=200) or Uneducated (N=200). The subjects were selected randomly from the different districts of Bihar, India. “Human Rights Awareness Scale” by Dr. Iftekhar Hossain, Dr. Saba Farheen, and Dr. Uday Shankar was applied in this study. Results- Results have shown that the public representatives have very low level of awareness towards the human rights. Also, the subjects from Middle SES have highest awareness in comparison with subjects of High and Low SES. Uneducated public representatives have less awareness than the educated one about human rights. Conclusion- Conclusively, it can be stated that human rights awareness among the public representatives of India is very low, and it is being affected by their Socio economic status and literacy level.

Keywords: human rights, awareness, public representatives, bihar, India

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202 Predictive Spectral Lithological Mapping, Geomorphology and Geospatial Correlation of Structural Lineaments in Bornu Basin, Northeast Nigeria

Authors: Aminu Abdullahi Isyaku

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Semi-arid Bornu basin in northeast Nigeria is characterised with flat topography, thick cover sediments and lack of continuous bedrock outcrops discernible for field geology. This paper presents the methodology for the characterisation of neotectonic surface structures and surface lithology in the north-eastern Bornu basin in northeast Nigeria as an alternative approach to field geological mapping using free multispectral Landsat 7 ETM+, SRTM DEM and ASAR Earth Observation datasets. Spectral lithological mapping herein developed utilised spectral discrimination of the surface features identified on Landsat 7 ETM+ images to infer on the lithology using four steps including; computations of band combination images; band ratio images; supervised image classification and inferences of the lithological compositions. Two complementary approaches to lineament mapping are carried out in this study involving manual digitization and automatic lineament extraction to validate the structural lineaments extracted from the Landsat 7 ETM+ image mosaic covering the study. A comparison between the mapped surface lineaments and lineament zones show good geospatial correlation and identified the predominant NE-SW and NW-SE structural trends in the basin. Topographic profiles across different parts of the Bama Beach Ridge palaeoshorelines in the basin appear to show different elevations across the feature. It is determined that most of the drainage systems in the northeastern Bornu basin are structurally controlled with drainage lines terminating against the paleo-lake border and emptying into the Lake Chad mainly arising from the extensive topographic high-stand Bama Beach Ridge palaeoshoreline.

Keywords: Bornu Basin, lineaments, spectral lithology, tectonics

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201 Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression amongst HIV-Infected Prisoners in South Ethiopia: A Prospective Cohort Study

Authors: Terefe Fuge, George Tsourtos , Emma Miller

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Objectives: Maintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of adherence and viral suppression, as well as its associated factors in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors to this amongst prisoners in South Ethiopia. Methods: A prospective cohort study was conducted between June 1, 2019 and July 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration-related characteristics was collected using a structured questionnaire. Adherence was determined based on participants’ self-report and pharmacy refill records, and plasma viral load measurements which were undertaken within the study period were prospectively extracted to determine viral suppression. Various univariate and multivariate regression models were used to analyse data. Results: Self-reported dose adherence was approximately similar between ILWHA and non-incarcerated PLWHA (81% and 83% respectively), but ILWHA had a significantly higher medication possession ratio (MPR) (89% vs 75%). The prevalence of viral failure (VF) was slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31-35 years and in those who experienced social stigma, regardless of their incarceration status. Conclusions: This study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to doses and so to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors was found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

Keywords: Adherence , Antiretroviral therapy, Incarceration, South Ethiopia, Viral suppression

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200 Body Shaming and Its Psychological Consequences: A Comprehensive Analysis

Authors: Aryan Sood, Shruti Pathak, Dipanshu Chaudhary, Shreyanshi, Yogesh Pal

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In this comprehensive meta-analysis, the study delves into the widespread issue of body shaming, revealing its pervasive impact on various aspects of human life and its profound implications for mental health. The paper first explores the origins of body shaming, including societal norms, media influences, and interpersonal dynamics. It highlights the various forms it takes and its detrimental effects on self-esteem, body image, and psychological well-being. Particularly among adolescents and teenagers in today's social media-driven world, the pressure to conform to idealized beauty standards is significant, leading to negative consequences for their development and health. The research emphasizes the long-lasting mental health effects of body shaming, including depression, body dysmorphia, low self-esteem, and eating disorders. The study also discusses the emergence of body positivity movements as a means to challenge societal norms and promote inclusivity and empathy. Furthermore, the research addresses body shaming in the workplace and presents strategies to combat it, stressing the importance of awareness campaigns, education, and policy changes. In conclusion, the study underscores the critical need for a culture of acceptance and support, the promotion of positive body image, and efforts to mitigate the severe mental health toll that body shaming takes on individuals and communities. Overall, this research provides a comprehensive overview of body shaming, its root causes, and its far-reaching impacts on mental health and well-being. It highlights the urgency of addressing this issue in various contexts, from adolescence to the workplace, and offers solutions, such as awareness campaigns and societal changes, to foster a more inclusive and empathetic future.

Keywords: body shaming, mental health, age, gender, societal norms, appearance-based discrimination, cyberbullying, self-esteem, social media, depression, acceptance

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199 Seismic Inversion for Geothermal Exploration

Authors: E. N. Masri, E. Takács

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Amplitude Versus Offset (AVO) and simultaneous model-based impedance inversion techniques have not been utilized for geothermal exploration commonly; however, some recent publications called the attention that they can be very useful in the geothermal investigations. In this study, we present rock physical attributes obtained from 3D pre-stack seismic data and well logs collected in a study area of the NW part of Pannonian Basin where the geothermal reservoir is located in the fractured zones of Triassic basement and it was hit by three productive-injection well pairs. The holes were planned very successfully based on the conventional 3D migrated stack volume prior to this study. Subsequently, the available geophysical-geological datasets provided a great opportunity to test modern inversion procedures in the same area. In this presentation, we provide a summary of the theory and application of the most promising seismic inversion techniques from the viewpoint of geothermal exploration. We demonstrate P- and S-wave impedance, as well as the velocity (Vp and Vs), the density, and the Vp/Vs ratio attribute volumes calculated from the seismic and well-logging data sets. After a detailed discussion, we conclude that P-wave impedance and Vp/Vp ratio are the most helpful parameters for lithology discrimination in the study area. They detect the hot water saturated fracture zone very well thus they can be very useful in mapping the investigated reservoir. Integrated interpretation of all the obtained rock-physical parameters is essential. We are extending the above discussed pre-stack seismic tools by studying the possibilities of Elastic Impedance Inversion (EII) for geothermal exploration. That procedure provides two other useful rock-physical properties, the compressibility and the rigidity (Lamé parameters). Results of those newly created elastic parameters will also be demonstrated in the presentation. Geothermal extraction is of great interest nowadays; and we can adopt several methods have been successfully applied in the hydrocarbon exploration for decades to discover new reservoirs and reduce drilling risk and cost.

Keywords: fractured zone, seismic, well-logging, inversion

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198 Acculturation Impact on Mental Health Among Arab Americans

Authors: Sally Kafelghazal

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Introduction: Arab Americans, who include immigrants, refugees, or U.S. born persons of Middle Eastern or North African descent, may experience significant difficulties during acculturation to Western society. Influential stressors include relocation, loss of social support, language barriers, and economic factors, all of which can impact mental health. There is limited research investigating the effects of acculturation on the mental health of the Arab American population. Objectives: The purpose of this study is to identify ways in which acculturation impacts the mental health of Arab Americans, specifically the development of depression and anxiety. Method: A literature search was conducted using PubMed and PsycArticles (ProQuest), utilizing the following search terms: “Arab Americans,” “Arabs,” “mental health,” “depression,” “anxiety,” “acculturation.” Thirty-nine articles were identified and of those, nine specifically investigated the relationship between acculturation and mental health in Arab Americans. Three of the nine focused exclusively on depression. Results: Several risk factors were identified that contribute to poor mental health associated with acculturation, which include immigrant or refugee status, facing discrimination, and religious ideology. Protective factors include greater levels of acculturation, being U.S. born, and greater heritage identity. Greater mental health disorders were identified in Arab Americans compared to normative samples, perhaps particularly depression; none of the articles specifically addressed anxiety. Conclusion: The current research findings support the potential association between the process of acculturation and greater levels of mental health disorders in Arab Americans. However, the diversity of the Arab American population makes it difficult to draw consistent conclusions. Further research needs to be conducted in order to assess which subgroups in the Arab American population are at highest risk for developing new or exacerbating existing mental health disorders in order to devise more effective interventions.

Keywords: arab americans, arabs, mental health, anxiety, depression, acculturation

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197 Predictive Value of Hepatitis B Core-Related Antigen (HBcrAg) during Natural History of Hepatitis B Virus Infection

Authors: Yanhua Zhao, Yu Gou, Shu Feng, Dongdong Li, Chuanmin Tao

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The natural history of HBV infection could experience immune tolerant (IT), immune clearance (IC), HBeAg-negative inactive/quienscent carrier (ENQ), and HBeAg-negative hepatitis (ENH). As current biomarkers for discriminating these four phases have some weaknesses, additional serological indicators are needed. Hepatits B core-related antigen (HBcrAg) encoded with precore/core gene contains denatured HBeAg, HBV core antigen (HBcAg) and a 22KDa precore protein (p22cr), which was demonstrated to have a close association with natural history of hepatitis B infection, but no specific cutoff values and diagnostic parameters to evaluate the diagnostic efficacy. This study aimed to clarify the distribution of HBcrAg levels and evaluate its diagnostic performance during the natural history of infection from a Western Chinese perspective. 294 samples collected from treatment-naïve chronic hepatitis B (CHB) patients in different phases (IT=64; IC=72; ENQ=100, and ENH=58). We detected the HBcrAg values and analyzed the relationship between HBcrAg and HBV DNA. HBsAg and other clinical parameters were quantitatively tested. HBcrAg levels of four phases were 9.30 log U/mL, 8.80 log U/mL, 3.00 log U/mL, and 5.10 logU/mL, respectively (p < 0.0001). Receiver operating characteristic curve analysis demonstrated that the area under curves (AUCs) of HBcrAg and quantitative HBsAg at cutoff values of 9.25 log U/mL and 4.355 log IU/mL for distinguishing IT from IC phases were 0.704 and 0.694, with sensitivity 76.39% and 59.72%, specificity 53.13% and 79.69%, respectively. AUCs of HBcrAg and quantitative HBsAg at cutoff values of 4.15 log U/mlmL and 2.395 log IU/mlmL for discriminating between ENQ and ENH phases were 0.931 and 0.653, with sensitivity 87.93% and 84%, specificity 91.38% and 39%, respectively. Therefore, HBcrAg levels varied significantly among four natural phases of HBV infection. It had higher predictive performance than quantitative HBsAg for distinguishing between ENQ-patients and ENH-patients and similar performance with HBsAg for the discrimination between IT and IC phases, which indicated that HBcrAg could be a potential serological marker for CHB.

Keywords: chronic hepatitis B, hepatitis B core-related antigen, hepatitis B surface antigens, hepatitis B virus

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196 Community, Identity, and Resistance in Minority Literature: Arab American Poets - Samuel Hazo, Nathalie Handal, and Naomi Shihab Nye

Authors: Reem Saad Alqahtani

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Drawing on minority literature, this research highlights the role of three contemporary Arab American writers, considering the significance of the historical and cultural contexts of the brutal attacks of 9/11. The focus of the research is to draw attention to the poetry of Samuel Hazo, Nathalie Handal, and Naomi Shihab Nye as representatives of the identity crisis, whose experiences left them feeling marginalized and alienated in both societies, and reflected as one of the ethnic American minority groups, as demonstrated in their poetry, with a special focus on hybridity, resistance, identity, and empowerment. The study explores the writers’ post-9/11 experience, affected by the United States’ long history of marginalization and discrimination against people of colour, placing Arab American literature with that of other ethnic American groups who share the same experience and contribute to composing literature characterized by the aesthetics of cultural hybridity, cultural complexity, and the politics of minorities to promote solidarity and coalition building. Indeed, the three selected Arab American writers have found a link between their narration and the identity of the exiled by establishing an identity that is a kind of synthesis of diverse identities of Western reality and Eastern nostalgia. The approaches applied in this study will include historical/biographical, postcolonial, and discourse analysis. The first will be used to emphasize the influence of the biographical aspects related to the community, identity, and resistance of the three poets on their poetry. The second is used to investigate the effects of postcolonialism on the poets and their responses to it, while the third understand the sociocultural, political, and historical dimensions of the texts, establishing these poets as representative of the Arab American experience. This study is significant because it will help shed light on the importance of the Arabic hybrid identity in creating resistance to minority communities within American society.

Keywords: Arab American, identity, hybridity, post-9/11

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195 Retrospective Demographic Analysis of Patients Lost to Follow-Up from Antiretroviral Therapy in Mulanje Mission Hospital, Malawi

Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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194 Battle of Narratives: Georgia between Dialogue and Confrontation

Authors: Ketevan Epadze

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The paper aims to examine conflicting historical narratives proposed by the Georgian and Abkhazian scholars on the territorial affiliation of Abkhazia in the 1950s, explain how these narratives were connected to the Soviet nationalities policy after WW II and demonstrate the dynamic of the narratives’ battle in the last years of the Soviet system, which was followed by military conflict in the post-Soviet era. Abkhazia –a breakaway region of Georgia- self-declared its independence in 1992. Historical dispute on the territorial rights of Abkhazia emerged long before the military conflict began and was connected to the theory of Abkhazian ethnogenesis written by the Georgian literary scholar Pavle Ingorokva. He argued that medieval Abkhazians were Georgians, while modern Abkhazians are newcomers in Abkhazia. After the de-Stalinization, Abkhazian historians developed historical narrative opposed to Ingorokva’s theory. In the 1980s, Georgian dissidents who strove for Georgia’s independence used Ingorokva’s thesis to oppose Abkhazians desire for self-determination and sovereignty. Abkhazian political actors in their turn employed opposite historical arguments to legitimate their rights over autonomy. Ingorokva’s theory is one of the principal issues, discussed during the Georgian-Abkhazian dialogue; it often confuses Georgians and gives the reasons to Abkhazians for complaining about the Georgian discrimination in the Soviet past. The study is based on the different kind of sources: archival materials of the 1950s (Communist Party Archive of Georgia, Soviet Journal ‘Mnatobi’), the book by Pavle Ingorokva ‘Giorgi Merchule’ (1947-1954) and Zurab Anchabadze’s responsive work to Ingorokva’s book – ‘From the medieval history of Abkhazia’ (1956-1959), political speeches of the Georgian and Abkhazian political actors in the 1980s, secondary sources on the Soviet nationalities policy from the 1950s to the 1990s.

Keywords: Soviet, history, ethnicity, nationalism, politics, post-Soviet, conflict

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193 Examining Patterns in Ethnoracial Diversity in Los Angeles County Neighborhoods, 2016, Using Geographic Information System Analysis and Entropy Measure of Diversity

Authors: Joseph F. Cabrera, Rachael Dela Cruz

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This study specifically examines patterns that define ethnoracially diverse neighborhoods. Ethnoracial diversity is important as it facilitates cross-racial interactions within neighborhoods which have been theorized to be associated with such outcomes as intergroup harmony, the reduction of racial and ethnic prejudice and discrimination, and increases in racial tolerance. Los Angeles (LA) is an ideal location to study ethnoracial spatial patterns as it is one of the most ethnoracially diverse cities in the world. A large influx of Latinos, as well as Asians, have contributed to LA’s urban landscape becoming increasingly diverse over several decades. Our dataset contains all census tracts in Los Angeles County in 2016 and incorporates Census and ACS demographic and spatial data. We quantify ethnoracial diversity using a derivative of Simpson’s Diversity Index and utilize this measure to test previous literature that suggests Latinos are one of the key drivers of changing ethnoracial spatial patterns in Los Angeles. Preliminary results suggest that there has been an overall increase in ethnoracial diversity in Los Angeles neighborhoods over the past sixteen years. Patterns associated with this trend include decreases in predominantly white and black neighborhoods, increases in predominantly Latino and Asian neighborhoods, and a general decrease in the white populations of the most diverse neighborhoods. A similar pattern is seen in neighborhoods with large Latino increases- a decrease in white population, but with an increase in Asian and black populations. We also found support for previous research that suggests increases in Latino and Asian populations act as a buffer, allowing for black population increases without a sizeable decrease in the white population. Future research is needed to understand the underlying causes involved in many of the patterns and trends highlighted in this study.

Keywords: race, race and interaction, racial harmony, social interaction

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192 Challenges & Barriers for Neuro Rehabilitation in Developing Countries

Authors: Muhammad Naveed Babur, Maria Liaqat

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Background & Objective: People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it. Objectives: The objective of the study was to determine the challenges and to evaluate the barriers for neuro-rehabilitation services in developing countries. Methods: This is Exploratory sequential qualitative study based on the Panel discussion forum in International rehabilitation sciences congress and national rehabilitation conference 2017. Panel group discussion has been conducted in February 2017 with a sample size of eight professionals including Rehabilitation medicine Physician, Physical Therapist, Speech Language therapist, Occupational Therapist, Clinical Psychologist and rehabilitation nurse working in multidisciplinary/Interdisciplinary team. A comprehensive audio-videography have been developed, recorded, transcripted and documented. Data was transcribed and thematic analysis along with characteristics was drawn manually. Data verification was done with the help of two separate coders. Results: After extraction of two separate coders following results are emerged. General category themes are disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. Barriers identified at the level are high cost, stigma, lengthy course of recovery. Hospital related barriers are lack of social support and individually tailored goal setting processes. Organizational barriers identified are lack of basic diagnostic facilities, lack of funding and human resources. Recommendations given by panelists were investment in education, capacity building, infrastructure, governance support, strategies to promote communication and realistic goals. Conclusion: It is concluded that neurorehabilitation in developing countries need attention in following categories i.e. disease profile, demographic profile, training and education, research, barriers, governance, global funding, informal care, resources and cultural beliefs and public awareness. This study also revealed barriers at the level of patient, hospital, organization. Recommendations were also given by panelists.

Keywords: disability, neurorehabilitation, telerehabilitation, disability

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191 The Impact of COVID-19 on Antibiotic Prescribing in Primary Care in England: Evaluation and Risk Prediction of the Appropriateness of Type and Repeat Prescribing

Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

Abstract:

Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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190 Formulation of Building Design Principles for Little People in Hong Kong

Authors: Yung Yau

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'Little people' are those who have extremely short stature as they suffer from rare bone diseases. They are commonly known as 'dwarves' or 'people with dwarfism'. Dwarfism is generally regarded as a type of rare disease for its extremely small odds (~1 in 15,000). On account of its rarity, dwarfism, unlike other types of disability, has attracted relatively little attention from the general public and in various academic fields (e.g. architecture, psychology and sociology) except medical science. In view of the extant research gaps, this study aims to investigate the physical barriers facing the little people in the built environment in Hong Kong. Between November 2017 and July 2018, ten little people or their family members participated in in-depth interviews. Responses of the interviewees were transcribed (i.e., speech being converted to text word for word). Interview data were then analyzed using the interpretative phenomenological analysis methodology developed by J. Smith and others in 2009. The findings of the project reveal that although Hong Kong's built environment has been designed barrier-free pursuant to the prevailing building standards, those standards do not cater to the special anthropometric characteristics of little people. As a result, little people face a lot of challenges when using built facilities. For example, most water closets, urinals, and wash hand basins are not fit for little people's use. As indicated by the project findings, we are still far away from providing a discrimination-free and barrier-free living environment for the little people in Hong Kong. To make Hong Kong society more inclusive to the little people, there is a need for further tailored building design. A set of building design principles for better inclusion of the little people in our society are highlighted. These principles include 'the building design should accommodate individuals with different heights' and 'the building design should allow individuals to use comfortably and efficiently with a minimum of fatigue'. At the end of the paper, the author also calls for an agenda for further studies. For instance, we need an anthropometric study on little people for developing practical building design guidelines.

Keywords: dwarfism, little people, inclusive buildings, people with disabilities, social sustainability

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189 'Disability' and Suffering: The Case of Workers Affected by Repetitive Strain Injury/Work Related Musculoskeletal Disorder in a Removal from Work Situation in Santos, São Paulo, Brazil

Authors: Maria Do Carmo Baracho De Alencar, Marciene Campos Fialho, Maria Do Carmo Vitório Ramos

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The subjects affected by Repetitive Strain Injury/Work Related Musculoskeletal Disorder (RSI/WRMSD) face an everyday life marked by pain, feelings of worthlessness and incapacity caused by the disease, and aggravated often because of discrimination society. Aim: To investigate the experiences and feelings of workers affected by RSI/WRMSD in removal from work situations and to understand the repercussions on mental health. Methods: Clinical records of workers were consulted, opened from July 1, 2014, to July 1, 2015, at the Reference Center for Worker's Health, in Santos city-SP. Selection of workers affected by RSI /WRMSD and who had experienced the removal from work situation due to the disease, and invitation to participate in the study. Semi-structured and individual interviews were carried out based on a pre-elaborated script, and for thematic content analysis. Results: Of a total of 502 medical records, 157 were selected, and of these, 18 workers participated in the interviews, both gender, most of them with low education level, aged between 35 and 56 years, and from different professions. Diseases affected several physical body regions and some workers had more than one body region affected by chronic pain. In the testimonies emerged the psychic suffering by the process of illness at work, fear of dismissal, invisibility of pain, in medical expertise attendance, by the incapacity to perform tasks that were easily achievable, with feelings of uselessness, revolt, and injustice, among others. Conclusion: The workers need to be readapted to new life situations, and the study promotes reflections on the need for more interdisciplinary actions and of the Psychology to the workers affected by RSI/ WRMSD.

Keywords: repetitive strain injury, cumulative trauma disorder, absence from work, mental health, occupational health

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188 Autistic Traits and Multisensory Integration–Using a Size-Weight Illusion Paradigm

Authors: Man Wai Lei, Charles Mark Zaroff

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Objective: A majority of studies suggest that people with Autism Spectrum Disorder (ASD) have multisensory integration deficits. However, normal and even supranormal multisensory integration abilities have also been reported. Additionally, little of this work has been undertaken utilizing a dimensional conceptualization of ASD; i.e., a broader autism phenotype. Utilizing methodology that controls for common potential confounds, the current study aimed to examine if deficits in multisensory integration are associated with ASD traits in a non-clinical population. The contribution of affective versus non-affective components of sensory hypersensitivity to multisensory integration was also examined. Methods: Participants were 147 undergraduate university students in Macau, a Special Administrative Region of China, of Chinese ethnicity, aged 16 to 21 (Mean age = 19.13; SD = 1.07). Participants completed the Autism-Spectrum Quotient, the Sensory Perception Quotient, and the Adolescent/Adult Sensory Profile, in order to measure ASD traits, non-affective, and affective aspects of sensory/perceptual hypersensitivity, respectively. In order to explore multisensory integration across visual and haptic domains, participants were asked to judge which one of two equally weighted, but different sized cylinders was heavier, as a means of detecting the presence of the size-weight illusion (SWI). Results: ASD trait level was significantly and negatively correlated with susceptibility to the SWI (p < 0.05); this correlation was not associated with either accuracy in weight discrimination or gender. Examining the top decile of the non-normally distributed SWI scores revealed a significant negative association with sensation avoiding, but not other aspects of effective or non-effective sensory hypersensitivity. Conclusion and Implications: Within the normal population, a greater degree of ASD traits is associated with a lower likelihood of multisensory integration; echoing was often found in individuals with a clinical diagnosis of ASD, and providing further evidence for the dimensional nature of this disorder. This tendency appears to be associated with dysphoric emotional reactions to sensory input.

Keywords: Autism Spectrum Disorder, dimensional, multisensory integration, size-weight illusion

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187 Preparedness for Microbial Forensics Evidence Collection on Best Practice

Authors: Victor Ananth Paramananth, Rashid Muniginin, Mahaya Abd Rahman, Siti Afifah Ismail

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Safety issues, scene protection, and appropriate evidence collection must be handled in any bio crime scene. There will be a scene or multi-scene to be cordoned for investigation in any bio-incident or bio crime event. Evidence collection is critical in determining the type of microbial or toxin, its lethality, and its source. As a consequence, from the start of the investigation, a proper sampling method is required. The most significant challenges for the crime scene officer would be deciding where to obtain samples, the best sampling method, and the sample sizes needed. Since there could be evidence in liquid, viscous, or powder shape at a crime scene, crime scene officers have difficulty determining which tools to use for sampling. To maximize sample collection, the appropriate tools for sampling methods are necessary. This study aims to assist the crime scene officer in collecting liquid, viscous, and powder biological samples in sufficient quantity while preserving sample quality. Observational tests on sample collection using liquid, viscous, and powder samples for adequate quantity and sample quality were performed using UV light in this research. The density of the light emission varies upon the method of collection and sample types. The best tools for collecting sufficient amounts of liquid, viscous, and powdered samples can be identified by observing UV light. Instead of active microorganisms, the invisible powder is used to assess sufficient sample collection during a crime scene investigation using various collection tools. The liquid, powdered and viscous samples collected using different tools were analyzed using Fourier transform infrared - attenuate total reflection (FTIR-ATR). FTIR spectroscopy is commonly used for rapid discrimination, classification, and identification of intact microbial cells. The liquid, viscous and powdered samples collected using various tools have been successfully observed using UV light. Furthermore, FTIR-ATR analysis showed that collected samples are sufficient in quantity while preserving their quality.

Keywords: biological sample, crime scene, collection tool, UV light, forensic

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186 Developing a Culturally Adapted Family Intervention for Relatives Living with Schizophrenia in Oman

Authors: Aziza Al-Sawafi

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Introduction: The evidence of family interventions in schizophrenia is robust primarily in high-income settings. However, they have been adapted to other settings and cultures to improve effectiveness and acceptability. In Oman, there is limited integration of psychosocial interventions in the treatment of schizophrenia. Therefore, the adaptation of family intervention to the Omani culture may facilitate its uptake. Most service users in Oman live with their families outside the healthcare system, and nothing is known about their experience, needs, or resources. Furthermore, understanding caregivers' and mental health professionals' preferences, perceptions, and experience is a fundamental element in the process of intervention development. Therefore, this study aims to develop a culturally sensitive, feasible, and acceptable family intervention for relatives living with schizophrenia in Oman. Method: The Medical Research Council's framework for the evaluation of complex health care interventions provided the conceptual structure for the study. The development phase was carried out, which involved three stages: 1) systematically reviewing the available literature regarding culturally adapted family interventions in the Arab world 2) In-depth interviews with caregivers to explore their experience and perceived needs and preferences regarding intervention 3) A focus group study involving health professionals to explore the acceptability and feasibility of delivering the family intervention in the Omani context. Data synthesis determined the design of the proposed intervention according to the findings obtained from the previous stages. Results: Stage one: The systematic review found limited evidence of culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. Stage two: The experience of family caregivers illuminated four main themes: burden, stigma, violence, and family needs. Burdens of care included objective and subjective burdens, positive feelings, and coping mechanisms. Caregivers gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the components of the intervention to ensure its acceptability and feasibility in the local setting. Data synthesis was carried out, and the intervention was designed. Conclusion: This study provides evidence of the potential applicability and acceptability of a culturally sensitive family intervention for families of individuals with schizophrenia in Oman. However, more work needs to be done to test the feasibility of the study and overcome the practical challenges.

Keywords: cultural-adaptation, family intervention, Oman, schizophrenia

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185 Coping with Incompatible Identities in Russia: Case of Orthodox Gays

Authors: Siuzan Uorner

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The era of late modernity is characterized, on the one hand, by social disintegration, values of personal freedom, tolerance, and self-expression. Boundaries between the accessible and the elitist, normal and abnormal are blurring. On the other hand, traditional social institutions, such as religion (especially Russian Orthodox Church), exist, criticizing lifestyle and worldview other than conventionally structured canons. Despite the declared values and opportunities in late modern society, people's freedom is ambivalent. Personal identity and its aspects are becoming a subject of choice. Hence, combinations of identity aspects can be incompatible. Our theoretical framework is based on P. Ricoeur's concept of narrative identity and hermeneutics, E. Goffman’s theory of social stigma, self-presentation, discrepant roles and W. James lectures about varieties of religious experience. This paper aims to reconstruct ways of coping with incompatible identities of Orthodox gays (an extreme sampling of a combination of sexual orientation and religious identity in a heteronormative society). This study focuses on the discourse of Orthodox gay parishioners and ROC gay priests in Russia (sampling ‘hard to reach’ populations because of the secrecy of gay community in ROC and sensitivity of the topic itself). We conducted a qualitative research design, using in-depth personal semi-structured online-interviews. Recruiting of informants took place in 'Nuntiare et Recreare' (Russian movement of religious LGBT) page in VKontakte through the post with an invitation to participate in the research. In this work, we analyzed interview transcripts using axial coding. We chose the Grounded Theory methodology to construct a theory from empirical data and contribute to the growing body of knowledge in ways of harmonizing incompatible identities in late modern societies. The research has found that there are two types of conflicts Orthodox gays meet with: canonic contradictions (postulates of Scripture and its interpretations) and problems in social interaction, mainly with ROC priests and Orthodox parishioners. We have revealed semantic meanings of most commonly used words that appear in the narratives (words such as ‘love’, ‘sin’, ‘religion’ etc.). Finally, we have reconstructed biographical patterns of LGBT social movements’ involvement. This paper argues that all incompatibilities are harmonizing in the narrative itself. As Ricoeur has suggested, the narrative configuration allows the speaker to gather facts and events together and to compose causal relationships between them. Sexual orientation and religious identity are getting along and harmonizing in the narrative.

Keywords: gay priests, incompatible identities, narrative identity, Orthodox gays, religious identity, ROC, sexual orientation

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184 Socio-Economic Analysis of Child Homelessness in South Africa: Implication for Policy Making

Authors: Chigozie Azunna, Lucius Botes

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Child homelessness is one of the critical challenges in South Africa in recent times. While children constitute a very significant demography of South Africa, child homeless broods a socio-economic crisis of varying magnitude. In order for the UN 2030 Agenda for Sustainable Development Goals (SDGs) to be achieved, especially with respect to equality and non-discrimination, child homeless needs to be effectively curbed. This will, in turn, contribute positively to the economic derivative of South Africa’s dynamic demography. Methodically, this research employed content analysis involving a comprehensive review of existing literature on child homelessness in South Africa. The study found a convergence of national policy and international agenda on curbing child homelessness in South Africa in spite of the following is a representation of the statistics of child homelessness in South Africa: in the metros, homelessness was (74,1%), while in non-metro is at 25.9%. The figure shows that the City of Tshwane has the highest number of homeless persons (18,1%), followed by the City of Johannesburg (15,6%) while the Nelson Mandela Bay metropolitan has the lowest percentage of homeless persons (2,7%). The study concluded that despite the existence of national policy options, child homeless has remained persistent. Worse still, there is a lack of accurate data, while the Covid pandemic, poverty, economic challenges, the HIV/AIDS epidemic, and implementation gaps in government policies have contributed to the widening challenge. The implication is severe, affecting children's physical and emotional health, education, and future opportunities. The study recommends strengthening actionable policies in addressing child homelessness by bridging the urban-rural gap as well as providing an intra-community network that ensures that child homelessness is effectively addressed, including addressing those manifold challenges like access to education and susceptibility to diseases and vulnerability of the homeless child.

Keywords: South Africa, child, homeless, SDGs, covid, urban, rural

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183 Research Study on the Concept of Unity of Ummah and Its Sources in the Light of Islamic Teachings

Authors: Ghazi Abdul Rehman Qasmi

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Islam is the preacher and torch-bearer of unity and solidarity. All the followers of Islam are advised to be united. Islam strongly condemns those elements which disunite the unity of Muslim Ummah. Like pearls in a rosary, Islam has united the Muslims from all over the world in the wreath of unity and forbade the Muslims to avoid separation and to be disintegrated. The aspect of unity is prominent in all divine injunctions and about worship. By offering five times obligatory congregational prayers, passion of mutual love and affection is increased and on the auspicious days like Friday, Eid-ul-fiter and Eid-ul-azha, majority of the Muslims come together at central places to offer these congregational prayers. Thus unity and harmony among the Muslims can be seen. Similarly the Muslim pilgrims from all over the world eliminate all kind of worldly discrimination to perform many rituals of pilgrimage while wearing white color cloth as a dress. Pilgrimage is a demonstration of Islamic strength. When the Muslims from all over the world perform the same activities together and they offer their prayers under the leadership of one leader (IMAM). Muslims come together on the occasion of pilgrimage to perform Tawaf (seven circuits,first three circuits at a hurried pace(Rammal) and followed by four times, more closely, at a leisurely pace, round the Holy Kaabah to perform circumambulation known as Tawaf in religious terminology,Saee(running or walking briskly seven times between two small hills Safa&Marwa), Ramy-al-jamarat (throwing pebbles at the stone pillars, symbolizing the devil). In this way dignity and sublimity of Islam is increased and unity and integrity of Muslim Ummah is promoted also. By studying the life history of Hazrat Muhammad (P.B.U.H) we come to know that our Holy Prophet (P.B.U.H) has put emphasis on unity and integrity. We have to follow the Islamic teachings to create awareness among the members of Muslim Ummah. In the light of the Holy Quran and Sunnah, we have to utilize all the sources and potential for this noble cause.

Keywords: unity, Ummah, sources, Islamic teaching

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182 'I Broke the Line Back to the Ancient Ones': Rethinking Intersectional Theory through Wounded Histories in Once Were Warriors (1994) and Whale Rider (2002).

Authors: Kerry Mackereth

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Kimberle Crenshaw’s theory of intersectionality has become immensely influential in the fields of women’s and gender studies. However, intersectionality’s widespread use among feminist scholars and activists has been accompanied by critiques of its reliance upon subject categorization. These critiques are of particular import when connected to Wendy Brown’s characterization of identity politics as static 'wounded attachments'. Together, these critiques show how the gridlock model proposed by intersectionality’s primary metaphor, the traffic accident at the intersection, is useful for identifying discrimination but not for remembering historical injustices or imagining feminist and anti-racist resistance. Through the lens of New Zealand Maori film, focusing upon Once Were Warriors (1994) and Whale Rider (2002), this article examines how wounded histories need not be passively reproduced by contemporaneously oppressed groups. Instead, the metaphor of the traffic intersection should be complemented by the metaphor of the wound. Against Brown’s characterization of wounded attachments as negative, static identities, Gloria Anzaldua’s account of the borderland between the United States and Mexico as “una herida abierta”, an open wound, offers an alternative reading of the wound. Through Anzaldua’s and Hortense Spillers’ political thought, the wound is reconceptualized as not only a site of suffering but also as a regenerative space. The coexistence of deterioration and regeneration at the site of the wound underpins the narrative arc of both Once Were Warriors and Whale Rider. In both films, the respective child protagonists attempt to reconcile the pain of wounded histories with the imagination of cultural regeneration. The metaphor of the wound thus serves as an alternative theoretical resource for mapping experiences of oppression, one that enriches feminist theory by balancing the remembrance of historical grievance with the forging of hopeful political projects.

Keywords: gender theory, historical grievance, intersectionality, New Zealand film, postcolonialism

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181 Validating the Cerebral Palsy Quality of Life for Children (CPQOL-Child) Questionnaire for Use in Sri Lanka

Authors: Shyamani Hettiarachchi, Gopi Kitnasamy

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Background: The potentially high level of physical need and dependency experienced by children with cerebral palsy could affect the quality of life (QOL) of the child, the caregiver and his/her family. Poor QOL in children with cerebral palsy is associated with the parent-child relationship, limited opportunities for social participation, limited access to healthcare services, psychological well-being and the child's physical functioning. Given that children experiencing disabilities have little access to remedial support with an inequitable service across districts in Sri Lanka, and given the impact of culture and societal stigma, there may be differing viewpoints across respondents. Objectives: The aim of this study was to evaluate the psychometric properties of the Tamil version of the Cerebral Palsy Quality of Life for Children (CPQOL-Child) Questionnaire. Design: An instrument development and validation study. Methods: Forward and backward translations of the CPQOL-Child were undertaken by a team comprised of a physiotherapist, speech and language therapist and two linguists for the primary caregiver form and the child self-report form. As part of a pilot phase, the Tamil version of the CPQOL was completed by 45 primary caregivers with children with cerebral palsy and 15 children with cerebral palsy (GMFCS level 3-4). In addition, the primary caregivers commented on the process of filling in the questionnaire. The psychometric properties of test-retest reliability, internal consistency and construct validity were undertaken. Results: The test-retest reliability and internal consistency were high. A significant association (p < 0.001) was found between limited motor skills and poor QOL. The Cronbach's alpha for the whole questionnaire was at 0.95.Similarities and divergences were found between the two groups of respondents. The child respondents identified limited motor skills as associated with physical well-being and autonomy. Akin to this, the primary caregivers associated the severity of motor function with limitations of physical well-being and autonomy. The trend observed was that QOL was not related to the level of impairment but connected to environmental factors by the child respondents. In addition to this, the main concern among primary caregivers about the child's future and on the child's lack of independence was not fully captured by the QOL questionnaire employed. Conclusions: Although the initial results of the CPQOL questionnaire show high test-retest reliability and internal consistency of the instrument, it does not fully reflect the socio-cultural realities and primary concerns of the caregivers. The current findings highlight the need to take child and caregiver perceptions of QOL into account in clinical practice and research. It strongly indicates the need for culture-specific measures of QOL.

Keywords: cerebral palsy, CPQOL, culture, quality of life

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180 From Stigma to Solutions: Harnessing Innovation and Local Wisdom to Tackle Harms Associated with Menstrual Seclusion (Chhaupadi) in Nepal

Authors: Sara E. Baumann, Megan A. Rabin, Mary Hawk, Bhimsen Devkota, Kajol Upadhyaya, Guna Raj Shrestha, Brigit Joseph, Annika Agarwal, Jessica G. Burke

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In Nepal, prevailing sociocultural norms associated with menstruation prompt adherence to stringent rules that limit participation in daily activities. Chhaupadi is a specific menstrual tradition in Nepal in which women and girls segregate themselves and follow a series of restrictions during menstruation. Despite having numerous physical and mental health implications, extant interventions have yet to sustainably address the harms associated with chhaupadi. In this study, the authors describe insights garnered from a collaboration with community members in Dailekh district, who formulated their own approaches to mitigate the adverse facets of chhaupadi. Envisaged as an entry point to improve women’s menstrual health experiences, this investigation employed an approach that uses Human-centered Design and a community-engaged approach. The authors conducted a four-day design workshop which unfolded in two phases: The Discovery Phase, to uncover chhaupadi context and key stakeholders, and the Design Phase, to design contextually relevant interventions. Diverse community-members, including those with lived experience practicing chhaupadi, developed five intervention concepts: 1) harnessing Female Community Health Volunteers as role models, for counseling, and raising awareness; 2) focusing on mothers and mother’s groups to instigate behavioral shifts; 3) engaging the broader community in behavior change efforts; 4) empowering fathers to effect change in their homes through counseling and education; and 5) training and emboldening youth to advocate for positive change through advocacy in their schools and homes. This research underscores the importance of employing multi-level approaches tailored to specific stakeholder groups, given Nepal’s rich cultural diversity. The engagement of Female Community Health Volunteers emerged as a promising yet underexplored intervention concept for chhaupadi, warranting broader implementation. Crucially, it is also imperative for interventions to prioritize tackling deleterious aspects of the chhaupadi tradition, emphasizing safety considerations, all while acknowledging chhaupadi’s entrenched cultural history; for some, there are positive aspects of the tradition that women and girls wish to preserve.

Keywords: human-centered design, menstrual health, Nepal, community-engagement, intervention development, women's health, rural health

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179 Developing an Online Application for Mental Skills Training and Development

Authors: Arjun Goutham, Chaitanya Sridhar, Sunita Maheshwari, Robin Uthappa, Prasanna Gopinath

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In alignment with the growth in the sporting industry, a number of people playing and competing in sports are growing exponentially across the globe. However, the number of sports psychology experts are not growing at a similar rate, especially in the Asian and more so, Indian context. Hence, the access to actionable mental training solutions specific to individual athletes is limited. Also, the time constraint an athlete faces due to their intense training schedule makes one-on-one sessions difficult. One of the means to bridge that gap is through technology. Technology makes individualization possible. It allows for easy access to specific-qualitative content/information and provides a medium to place individualized assessments, analysis, solutions directly into an athlete's hands. This enables mental training awareness, education, and real-time actionable solutions possible for athletes in-spite of the limitation of available sports psychology experts in their region. Furthermore, many athletes are hesitant to seek support due to the stigma of appearing weak. Such individuals would prefer a more discreet way. Athletes who have strong mental performance tend to produce better results. The mobile application helps to equip athletes with assessing and developing their mental strategies directed towards improving performance on an ongoing basis. When an athlete understands their strengths and limitations in their mental application, they can focus specifically on applying the strategies that work and improve on zones of limitation. With reports, coaches get to understand the unique inner workings of an athlete and can utilize the data & analysis to coach them with better precision and use coaching styles & communication that suits better. Systematically capturing data and supporting athletes(with individual-specific solutions) or teams with assessment, planning, instructional content, actionable tools & strategies, reviewing mental performance and the achievement of objectives & goals facilitate for a consistent mental skills development at all levels of sporting stages of an athlete's career. The mobile application will help athletes recognize and align with their stable attributes such as their personalities, learning & execution modalities, challenges & requirements of their sport, etc and help develop dynamic attributes like states, beliefs, motivation levels, focus etc. with practice and training. It will provide measurable analysis on a regular basis and help them stay aligned to their objectives & goals. The solutions are based on researched areas of influence on sporting performance individually or in teams.

Keywords: athletes, mental training, mobile application, performance, sports

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178 Domestic Violence in Haryana: A Grassroot Picture of Justice System

Authors: Vandana Dave, Neelam Kumari

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India, a fast growing global power, is climbing the ladder of success very swiftly and has been attracting the world’s attention in recent decades. But unfortunately in the modern society, women who constitute half the population of our country have been the victims of violence in different fields of life both physically, socially, mentally and economically. Women face a lot of societal pressure, gender based violence – including rape, domestic violence, dowry death, murder and sexual abuse. But none the less, it is not considered as a problem of serious concern. Among the issues related to women, domestic violence is one of the major issue in our society which is occurring within the safe confines of home at the hands of close family members and cuts across line of race, nationality, language, culture, economics, sexual orientation, physical ability and religion to affect women from all walks of life. It is not to be perceived as a law and order problem alone but it is a socio- cultural problem and it is directly affecting the family life, health of women and life of children. Structural imbalance of power, systematic gender based discrimination; inequality between women and men and other kind of subordination are the context and cause of violence against women. Understanding it as a major problem of our society, the present study was conducted to assess the status of women of Rohtak, district of Haryana. The present study is based on primary and secondary data, adopting feminist research methodology. Case study method was incorporated during the research. It was observed that violence varied according to different age groups of women, marital status, education status, economic status and sociodemography factors. The case studies depicted the inadequate justice system for the victims of domestic violence. The study also revealed that the victims failed to understand the judiciary system and considered themselves helpless and hopeless. The study indicates the need of women friendly justice system for the upliftment of the society.

Keywords: domestic violence, women, victim, justice

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