Search results for: older persons with ESRD

Authors: Arlinda Memetaj

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A sound system of administrative justice represents a vital element of democratic governance. The proper control of public administration consists not only of a sound civil service framework and legislative oversight, but empowerment of the public and courts to hold public officials accountable for their decision-making through the application of fair administrative procedural rules and the use of appropriate administrative appeals processes and judicial review. The establishment of both effective public administration and administrative justice system has been for a long period of time among the most ‘important and urgent’ final strategic objectives of almost any country in the Balkans region, including Macedonia, Albania and Kosovo. Closely related to this is their common strategic goal to enter the membership in the European Union, which requires fulfilling of many criteria and standards as incorporated in EU acquis communautaire. The latter is presently done with the framework of the Stabilization and Association Agreement which each of these countries has concluded with the EU accordingly. To above aims, each of the three countries has so far adopted a huge series of legislative and strategic documents related to any aspects of their individual administrative justice system. ‘Changes and reforms’ in this field have been thus the most frequent terms being used in any of these countries. The three countries have already established their own national administrative judiciary, while permanently amending their laws on the general administrative procedure introducing thereby considerable innovations concerned. National administrative courts are expected to have crucial important role within the broader judiciary systems-related reforms of these countries; they are designed to check the legality of decisions of the state administration with the aim to guarantee an effective protection of human rights and legitimate interests of private persons through a regular, conform, fast and reasonable judicial administrative process. Further improvements in this field are presently an integral crucial part of all the relevant national strategic documents including the ones on judiciary reform and public administration reform, as adopted by each of the three countries; those strategic documents are designed among others to provide effective protection of their citizens` rights` of administrative justice. On the basis of the later, the paper finally is aimed at highlighting selective common challenges and problems of the three countries on their European road, while claiming (among others) that the current status quo situation in each of them may be overcome only if there is a proper implementation of the administrative courts decisions and a far stricter international monitoring process thereof. A new approach and strong political commitment from the highest political leadership is thus absolutely needed to ensure the principles of transparency, accountability and merit in public administration. The main methods used in this paper include the analytical and comparative ones due to the very character of the paper itself.

Keywords: administrative courts , administrative justice, administrative procedure, benefit, effective administrative justice, human rights, implementation, monitoring, reform

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Authors: Mikko Salminen, Niklas Ravaja

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Emotional intelligence (EI) consists of skills for monitoring own emotions and emotions of others, skills for discriminating different emotions, and skills for using this information in thinking and actions. EI enhances, for example, work outcomes and organizational climate. We suggest that the role and manifestations of EI should also be studied in real leadership situations, especially during the emotional, social interaction. Leadership is essentially a process to influence others for reaching a certain goal. This influencing happens by managerial processes and computer-mediated communication (e.g. e-mail) but also by face-to-face, where facial expressions have a significant role in conveying emotional information. Persons with high EI are typically perceived more positively, and they have better social skills. We hypothesize, that during social interaction high EI enhances the ability to detect other’s emotional state and controlling own emotional expressions. We suggest, that emotionally intelligent leader’s experience less stress during social leadership situations, since they have better skills in dealing with the related emotional work. Thus the high-EI leaders would be more able to enjoy these situations, but also be more efficient in choosing appropriate expressions for building constructive dialogue. We suggest, that emotionally intelligent leaders show more positive emotional expressions than low-EI leaders. To study these hypotheses we observed performance review discussions of 40 leaders (24 female) with 78 (45 female) of their followers. Each leader held a discussion with two followers. Psychophysiological methods were chosen because they provide objective and continuous data from the whole duration of the discussions. We recorded sweating of the hands (electrodermal activation) by electrodes placed to the fingers of the non-dominant hand to assess the stress-related physiological arousal of the leaders. In addition, facial electromyography was recorded from cheek (zygomaticus major, activated during e.g. smiling) and periocular (orbicularis oculi, activated during smiling) muscles using electrode pairs placed on the left side of the face. Leader’s trait EI was measured with a 360 questionnaire, filled by each leader’s followers, peers, managers and by themselves. High-EI leaders had less sweating of the hands (p = .007) than the low-EI leaders. It is thus suggested that the high-EI leaders experienced less physiological stress during the discussions. Also, high scores in the factor “Using of emotions” were related to more facial muscle activation indicating positive emotional expressions (cheek muscle: p = .048; periocular muscle: p = .076, almost statistically significant). The results imply that emotionally intelligent managers are positively relaxed during s social leadership situations such as a performance review discussion. The current study also highlights the importance of EI in face-to-face social interaction, given the central role facial expressions have in interaction situations. The study also offers new insight to the biological basis of trait EI. It is suggested that the identification, forming, and intelligently using of facial expressions are skills that could be trained during leadership development courses.

Keywords: emotional intelligence, leadership, performance review discussion, psychophysiology, social interaction

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Authors: Soumya Rajan

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While delving into the heart of any organization, the structural pre-requisites which form the framework of its system, allures and sometimes invokes great interest. In an attempt to understand the ecosystem of Knowledge that existed in organizations with diverse ownership and legal blueprints, Cooperative Societies, which form a crucial part of the neo-liberal movement in India, was studied. The exploration surprisingly led to the re-designing of at least a set of premises of the researcher on the drivers of engagement in an otherwise structured trade environment. The liberal organizational structure of Cooperative Societies has been empowered with certain terminologies: Voluntary, Democratic, Equality and Distributive Justice. To condense in Hubert Calvert’ words, ‘Co-operation is a form of organization wherein persons voluntarily associated together as human beings on the basis of equality for the promotion of the economic interest of themselves.’ In India, largely the institutions which work under this principle is registered under Cooperative Societies Act of the Central or State laws. A Worker Cooperative Society which originated as a movement in the state of Kerala and spread its wings across the country - Indian Coffee House was chosen as the enterprise for further inquiry for it being a living example and a highly successful working model in the designated space. The exploratory study reached out to employees and key stakeholders of Indian Coffee House to understand the nuances of the structure and the scope it provides for engagement. The key questions which formed shape in the mind of researcher while engaging in the inquiry were: How has the organization sustained despite its principle of accepting employees with no skills into employment and later training and empowering them? How can a system which has pre-independence and post-independence (independence here means the colonial independence from Great Britain) existence seek to engage employees within the premise of equality? How was the value of socialism ingrained in a commercial enterprise which has a turnover of several hundreds of Crores each year? How did the vision of a flat structure, way back in the 1940’s find its way into the organizational structure and has continued to remain as the way of life? These questions were addressed by the Case study research that ensued and placing Knowledge as the key premise, the possibilities of engagement of the organization man was pictured. Understanding that although the macro or holistic unit of analysis is the organization, it is pivotal to understand the structures and processes which best reflect on the actors. The embedded design which was adopted in this study delivered insights from the different stakeholder actors from diverse departments. While moving through variables which define and sometimes defy bounds in rationality, the study brought to light the inherent features of the organization structure and how it influences the actors who form a crucial part of the scheme of things. The research brought forth the key enablers for engagement and specifically explored the standpoint of knowledge in the larger structure of the Cooperative Society.

Keywords: knowledge, organizational structure, engagement, worker cooperative

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Authors: Ashish Thakur

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This technical paper was written in view of focusing the biomaterials and its various applications in modern industries. Author tires to elaborate not only the medical, infect plenty of application in other industries. The scope of the research area covers the wide range of physical, biological and chemical sciences that underpin the design of biomaterials and the clinical disciplines in which they are used. A biomaterial is now defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure. Biomaterials are invariably in contact with living tissues. Thus, interactions between the surface of a synthetic material and biological environment must be well understood. This paper reviews the benefits and challenges associated with surface modification of the metals in biomedical applications. The paper also elaborates how the surface characteristics of metallic biomaterials, such as surface chemistry, topography, surface charge, and wettability, influence the protein adsorption and subsequent cell behavior in terms of adhesion, proliferation, and differentiation at the biomaterial–tissue interface. The chapter also highlights various techniques required for surface modification and coating of metallic biomaterials, including physicochemical and biochemical surface treatments and calcium phosphate and oxide coatings. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials. In addition to this, chapter introduces nanomedicine and the use of both natural and synthetic polymeric biomaterials, focuses on specific current polymeric nanomedicine applications and research, and concludes with the challenges of nanomedicine research. Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. Polymeric nanomaterial-based therapeutics plays a key role in the field of medicine in treatment areas such as drug delivery, tissue engineering, cancer, diabetes, and neurodegenerative diseases. Advantages in the use of polymers over other materials for nanomedicine include increased functionality, design flexibility, improved processability, and, in some cases, biocompatibility.

Keywords: nanomedicine, tissue, infections, biomaterials

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Authors: Shamsher Singh

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The Diaspora Literature involves a concept of native land, from where the displacement occurs and a record of harsh journeys undertaken on account of economic compulsions. Basically, Diaspora is a splintered community living in eviction. The scattering (initially) signifies the location of a fluid human autonomous space involving a complex set of negotiations and exchange between the nostalgia and desire for the native land and the making of a new home, adapting to the relationships between the minority and majority, being spokes persons for minority rights and their people back native place and significantly transacting the Contact Zone - a space changed with the possibility of multiple challenges. They write in the background of the sublime qualities of their homeland and, at the same time, try to fit themselves into the traditions and cultural values of other strange communities or land. It also serves as an interconnection of the various cultures involved, and it is used to understand the customs of different cultures and countries; it is also a source of inspiration globally. Although diasporic literature originated back in the 20th century, it spread to other countries like Britain, Canada, America, Denmark, Netherland, Australia, Kenya, Sweden, Kuwait and different parts of Europe. Meaning of Diaspora is the combination of two words which means the movement of people away from their own country or motherland. From a historical point of view, the ‘Diaspora’ is often associated with Jewish bigotry. At the moment, the Diaspora is used for the dispersal of social or cultural groups. This group will be living in two different streams of cultures at the same time. One who left behind his culture and the other has to adapt himself to new cultural situations. The diasporic mind hangs between his birth land and place of work at the same time. A person’s mental state, living in dual existence, gives birth to Dysphoria sensation. Litterateurs had different experiences in this type of sensation e.g., social, universal, political, economic and experiences from the strange land. The struggle of these experiences is seen in diasporic literature. When a person moves to different land or country to fulfill his dreams, the discrimination of language, work and other difficulties with strangers make his relationship more emotional and deeper into his past. These past memories and relations create more difficulties in settling in a foreign land. He lives there physically, but his mental state is in his past constantly, and he ends up his life in those background memories. A person living in Diaspora is actually a dual visionary man. Although this double vision expands his global consciousness, due to this vision, he gains judgemental qualities to understand others. At the same time, he weighs his respect for his native land and the situations of foreign land he experiences, and he finds it difficult to survive in those conditions. It can be said that diaspora literature indicates a person or social organization who lives dual life inquisition structure which becomes the cause of diasporic literature.

Keywords: homeland sickness, language problem, quest for identity, materialistic desire

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Authors: Emma Worley, Mhairi De Sainte Croix, Savneet Lochab, Christopher Roberts, Mark Stroud, Mo Salehan, Kevin Jones

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Awareness about the importance of teaching about diversity at medical school is growing. In the realm of diversity includes discussion around the LGBTQ+ community. At Bristol, diversity is taught in first or second year. However, echoing and expanding that teaching throughout the curriculum is needed. This feeds into the spiral curriculum but also highlights the relevance of the topic. It is well known that some people in the LGBTQ+ community struggle the access healthcare due to previous negative experiences. In 2019, 1 in 7 LGBTQ+ people avoided seeking medical care due to fears about discrimination. If people have fears about seeking medical help, then seeking help from Palliative care when they are at their most vulnerable situation can be even harder. To improve positive healthcare situations for people who identify as LGBTQ+ needs to start with talking. Along with some of our CTAs (clinical teaching assistants) we created a teaching session to explore the barriers faced by LGBTQ+ and incorporated communication stations into this. Our plan is to run this session as a three-hour session first discussing different topics: ethnical diversity, ‘coming out’, LGBTQ+ in the older generation, transgender. This will be followed by looking more closely at the barriers to accessing the hospice. The next part of the session will encompass two or three communication scenarios hopefully prompting further discussion and reflection on ways to improve our communication. The first scenario outline is a gay man/lesbian woman with lung cancer discussing options around the hospice. The second scenario is a transgender person with female genitalia who now has cervical cancer (as was not followed up on pap smears after the change of name). The third scenario is a HIV homosexual male patient who has been admitted with dementia. He has a partner but is not married. His next of kin is down as his parents but his parents do not know about his sexuality and HIV status. It allows discussion around confidentiality as well as broaching the meaning of ‘family’ in the LGBTQ+ community. We have chosen to pitch this teaching session to Bristol Year 4 students. They will be currently doing their 6-week Palliative care block, which fits in well. Each session will have four students attend. We have been lucky enough to have two CTAs (clinical teaching assistants) who identify as LGBTQ+ offer their experiences and help. They have been able to help us with the preparation and delivery of the session. Given anecdotal evidence and stories helps to highlight the importance and relevance of this session. The aim is to increase awareness of some factors that may contribute to people who identify as LGBTQ+ having a negative healthcare experience. By starting to talk about it allows awareness and only then will we be able to start to change and improve. Our aim, if the sessions run well, is to expand these sessions to different academy hospitals. Therefore, all Bristol 4th year students would have the opportunity to take part in the teaching session. We would like to expand our portfolio of case scenarios, to address so tricker topics such as a transgender person with dementia who reverts back to a different gender. We would also like to recruit a diverse range of actors, ideally people who identify as the patient in the scenario does. For example, a transgender person acts the transgender scenario. This would give authenticity and enhance the student’s learning experience.

Keywords: communication skills, healthcare barriers, LGBTQ+, palliative care

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Authors: Noam Markovitz

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People with physical disabilities constitute a very large and simultaneously a diverse group of general population, as the term physical disabilities is extensive and covers a wide range of disabilities. Therefore, individuals with physical disabilities are often faced with a new, threatening and stressful reality leading possibly to a multi-crisis in their lives due to the great changes they experience in somatic, socio-economic, occupational and psychological level. The current study seeks to advance understanding of the complex adaptation to physical disabilities by expanding the dynamic-adaptational model of the pursuit of happiness in a hostile world with a new conception of physical self-integrity. Physical self-integrity incorporates an objective dimension, namely physical self-functioning (PSF), and a subjective dimension, namely physical self-concept (PSC). Both of these dimensions constitute an experience of wholeness in the individual’s identification with her or his physical body. The model guiding this work is dialectical in nature and depicts two systems in the individual’s sense of happiness: subjective well-being (SWB) and meaning in life (MIL). Both systems serve as self-adaptive agents that moderate the complementary system of the hostile-world scenario (HWS), which integrates one’s perceived threats to one’s integrity. Thus, in situations of increased HWS, the moderation may take a form of joint activity in which SWB and MIL are amplified or a form of compensation in which one system produces a stronger effect while the other system produces a weaker effect. The current study investigated PSC in relations to SWB and MIL through pleasantness and meanings that are physically or metaphorically grounded in one’s body. In parallel, PSC also relates to HWS by activating representations of inappropriateness, deformation and vulnerability. In view of possibly dialectical positions of opposing and complementary forces within the current model, the current field study that aims to explore PSC as appearing in an independent, cross-sectional, design addressing the model’s variables in a focal group of people with physical disabilities. This study delineated the participation of the PSC in the adaptational functions of SWB and MIL vis-à-vis HWS-related life adversities. The findings showed that PSC could fully complement the main variables of the pursuit of happiness in a hostile world model. The assumed dialectics in the form of a stronger relationship between SWB and MIL in the face of physical disabilities was not supported. However, it was found that when HWS increased, PSC and MIL were strongly linked, whereas PSC and SWB were weakly linked. This highlights the compensatory role of MIL. From a conceptual viewpoint, the current investigation may clarify the role of PSC as an adaptational agent of the individual’s positive health in complementary senses of bodily wholeness. Methodologically, the advantage of the current investigation is the application of an integrative, model-based approach within a specially focused design with a particular relevance to PSC. Moreover, from an applicative viewpoint, the current investigation may suggest how an innovative model may be translated to therapeutic interventions used by clinicians, counselors and practitioners in improving wellness and psychological well-being, particularly among people with physical disabilities.

Keywords: older adults, physical disabilities, physical self-concept, pursuit of happiness in a hostile-world

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Authors: Stacia E. H. Sitohang, S.Mn., Socrates Rudy Sirait

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The first movie theater in Indonesia was established in December 1900. The movie industry started with international movie penetration. After a while, local movie producers started to rise and created local Indonesian movies. The industry is growing through ups and downs in Indonesia. In 2008, Visinema was founded in Jakarta, Indonesia, by AnggaDwimasSasongko, one of the most respected movie director in Indonesia. After getting achievements and recognition, Visinema chose to grow the company horizontally as opposed to only grow vertically and gain another similar achievement. Visinemachose to build the ecosystem that enables them to obtain many more opportunities and generatebusiness sustainability. The company proceed as an agile company. They created several business subsidiaries to support the company’s Intellectual Property (IP) development. This research was done through interview with the key persons in the company and questionnaire to get market insights regarding Visinema. The is able to transform their IP that initially started from movies to different kinds of business model. Interestingly, Angga chose to use the start up approach to create Visinema. In 2019, the company successfully gained Series A funding from Intudo Ventures and got other various investment schemes to support the business. In early 2020, Covid-19 pandemic negatively impacted many industries in Indonesia, especially the entertainment and leisure businesses. Fortunately, Visinema did not face any significant problem regarding survival during the pandemic, there were nolay-offs nor work hour reductions. Instead, they were thinking of much bigger opportunities and problems. While other companies suffer during the pandemic, Visinema created the first focused Transactional Video On Demand (TVOD) in Indonesia named Bioskop Online. The platform was created to keep the company innovating and adapting with the new online market as the result of the Covid-19 pandemic. Other than a digital platform, Visinemainvested heavily in animation to target kids and family business. They believed that penetrating the technology and animation market is going to be the biggest opportunity in Visinema’s road map. Besides huge opportunities, Visinema is also facing problems. The first is company brand positioning. Angga, as the founder, felt the need to detach his name from the brand image of Visinema to create system sustainability and scalability. Second, the company has to create a strategy to refocus in a particular business area to maintain and improve the competitive advantages. The third problem, IP piracy is a huge structural problem in Indonesia, the company considers IP thieves as their biggest competitors as opposed to other production company. As the recommendation, we suggest a set of branding and management strategy to detach the founder’s name from Visinema’s brand and improve the competitive advantages. We also suggest Visinema invest in system building to prevent IP piracy in the entertainment industry, which later can be another business subsidiary of Visinema.

Keywords: business ecosystem, agile, sustainability, scalability, start Up, intellectual property, digital platform

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Authors: Kotaro Sasai, Daijiro Mizutani, Kiyoyuki Kaito

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Expressways in Japan have been built in an accelerating manner since the 1960s with the aid of rapid economic growth. About 40 percent in length of expressways in Japan is now 30 years and older and has become superannuated. Time-related deterioration has therefore reached to a degree that administrators, from a standpoint of operation and maintenance, are forced to take prompt measures on a large scale aiming at repairing inner damage deep in pavements. These measures have already been performed for bridge management in Japan and are also expected to be embodied for pavement management. Thus, planning methods for the measures are increasingly demanded. Deterioration of layers around road surface such as surface course and binder course is brought about at the early stages of whole pavement deterioration process, around 10 to 30 years after construction. These layers have been repaired primarily because inner damage usually becomes significant after outer damage, and because surveys for measuring inner damage such as Falling Weight Deflectometer (FWD) survey and open-cut survey are costly and time-consuming process, which has made it difficult for administrators to focus on inner damage as much as they have been supposed to. As expressways today have serious time-related deterioration within them deriving from the long time span since they started to be used, it is obvious the idea of repairing layers deep in pavements such as base course and subgrade must be taken into consideration when planning maintenance on a large scale. This sort of maintenance requires precisely predicting degrees of deterioration as well as grasping the present situations of pavements. Methods for predicting deterioration are determined to be either mechanical or statistical. While few mechanical models have been presented, as far as the authors know of, previous studies have presented statistical methods for predicting deterioration in pavements. One describes deterioration process by estimating Markov deterioration hazard model, while another study illustrates it by estimating Proportional deterioration hazard model. Both of the studies analyze deflection data obtained from FWD surveys and present statistical methods for predicting deterioration process of layers around road surface. However, layers of base course and subgrade remain unanalyzed. In this study, data collected from FWD surveys are analyzed to predict deterioration process of layers deep in pavements in addition to surface layers by a means of estimating a deterioration hazard model using continuous indexes. This model can prevent the loss of information of data when setting rating categories in Markov deterioration hazard model when evaluating degrees of deterioration in roadbeds and subgrades. As a result of portraying continuous indexes, the model can predict deterioration in each layer of pavements and evaluate it quantitatively. Additionally, as the model can also depict probability distribution of the indexes at an arbitrary point and establish a risk control level arbitrarily, it is expected that this study will provide knowledge like life cycle cost and informative content during decision making process referring to where to do maintenance on as well as when.

Keywords: deterioration hazard model, falling weight deflectometer, inner damage, load bearing capacity, pavement

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Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

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Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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Authors: B. Baran, S. N. Kaptanoglu, M. Ocal, Y. Kagnici, E. Esen, E. Siyez, D. M. Siyez

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Infertility is the fact that couples cannot have children despite 1 year of unprotected sexual life. Infertility can be considered as an important problem affecting not only sexual life but also social and psychological conditions of couples. Learning about information about preventable factors related to infertility during university years plays an important role in preventing a possible infertility case in older ages. The possibility to facilitate access to information with the internet has provided the opportunity to reach a broad audience in the diverse learning environments and educational environment. Moreover, the internet has become a basic resource for the 21st-century learners. Providing information about infertility over the internet will enable more people to reach in a short time. When studies conducted abroad about infertility are examined, interactive websites and online education programs come to the fore. In Turkey, while there is no comprehensive online education program for university students, it seems that existing studies are aimed to make more advertisements for doctors or hospitals. In this study, it was aimed to design and develop online infertility prevention education for university students. Mayer’s Multimedia Learning Theory made up the framework for the online learning environment in this study. The results of the needs analysis collected from the university students in Turkey who were selected with sampling to represent the audience for online learning contributed to the design phase. In this study, an infertility prevention online education environment designed as a 4-week education was developed by explaining the theoretical basis and needs analysis results. As a result; in the development of the online environment, different kind of visual aids that will increase teaching were used in the environment of online education according to Mayer’s principles of extraneous processing (coherence, signaling, spatial contiguity, temporal contiguity, redundancy, expectation principles), essential processing (segmenting, pre-training, modality principles) and generative processing (multimedia, personalization, voice principles). For example, the important points in reproductive systems’ expression were emphasized by visuals in order to draw learners’ attention, and the presentation of the information was also supported by the human voice. In addition, because of the limited knowledge of university students in the subject, the issue of female reproductive and male reproductive systems was taught before preventable factors related to infertility. Furthermore, 3D video and augmented reality application were developed in order to embody female and male reproductive systems. In conclusion, this study aims to develop an interactive Online Infertility Prevention Education in which university students can easily access reliable information and evaluate their own level of knowledge about the subject. It is believed that the study will also guide the researchers who want to develop online education in this area as it contains design-stage decisions of interactive online infertility prevention education for university students.

Keywords: infertility, multimedia learning theory, online education, reproductive health

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Authors: Minjung Maing, Sibei Liu

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This research discusses the results of a study of window opening behavior of large housing developments in the high-density megacity of Hong Kong. The methods used for the study involved field observations using photo documentation of the four cardinal elevations (north, south-east, and west) of two large housing developments in a very dense urban area of approx. 46,000 persons per square meter within the city of Hong Kong. The targeted housing developments (A and B) are large public housing with a population of about 13,000 in each development of lower income. However, the mean income level in development A is about 40% higher than development B and home ownership is 60% in development A and 0% in development B. Mapping of the surrounding amenities and layout of the developments were also studied to understand the available activities to the residents. The photo documentation of the elevations was taken from November 2016 to February 2018 to gather a full spectrum of different seasons and both in the morning and afternoon (am/pm) times. From the photograph, the window opening behavior was measured by counting the amount of windows opened as a percentage of all the windows on that façade. For each date of survey data collected, weather data was recorded from weather stations located in the same region to collect temperature, humidity and wind speed. To further understand the behavior, simulation studies of microclimate conditions of the housing development was conducted using the software ENVI-met, a widely used simulation tool by researchers studying urban climate. Four major conclusions can be drawn from the data analysis and simulation results. Firstly, there is little change in the amount of window opening during the different seasons within a temperature range of 10 to 35 degrees Celsius. This means that people who tend to open their windows have consistent window opening behavior throughout the year and high tolerance of indoor thermal conditions. Secondly, for all four elevations the lower-income development B opened more windows (almost two times more units) than higher-income development A meaning window opening behavior had strong correlations with income level. Thirdly, there is a lack of correlation between outdoor horizontal wind speed and window opening behavior, as the changes of wind speed do not seem to affect the action of opening windows in most conditions. Similar to the low correlation between horizontal wind speed and window opening percentage, it is found that vertical wind speed also cannot explain the window opening behavior of occupants. Fourthly, there is a slightly higher average of window opening on the south elevation than the north elevation, which may be due to the south elevation being well shaded from high angle sun during the summer and allowing heat into units from lower angle sun during the winter season. These findings are important to providing insight into how to better design urban environments and indoor thermal environments for a liveable high density city.

Keywords: high-density housing, subtropical climate, urban behavior, window opening

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Authors: Nadezhda F. Mikahailova, Margarita E. Fattakhova, Mirgarita A. Mironova, Ekaterina V. Vyacheslavova, Vladimir A. Mikahailov

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Stigma is a significant obstacle to the successful adaptation of deaf students to the conditions of an educational institution, especially for those who study in inclusion. The aim of the study was to identify the spheres of life which are the most significant for developing of the stigma of deaf students; to assess the influence of factors associated with deafness on the degree of their self-stigmatization (time and degree of hearing loss, type of education - inclusion / differentiation) and to find out who is more prone to stigma - which characteristics of personality, identity, mental health and coping are specific for those deaf who demonstrates stigmatizing attitudes. The study involved 154 deaf and hard-of-hearing students (85 male and 69 female) aged from 18 to 45 years - 28 students of the Herzen State Pedagogical University (St. Petersburg), who study in inclusion, 108 students of the National Research Technological University and 18 students of the Aviation Technical College (Kazan) - students in groups with a sign language interpreter. We used the following methods: modified questionnaire 'Self-assessment and coping strategies' (Jambor & Elliot, 2005), Scale of self-esteem (Rosenberg et al, 1995), 'Big-Five' (Costa&McCrae, 1997), TRF (Becker, 1989), WCQ (Lazarus & Folkman, 1988), self-stigma scale (Mikhailov, 2008). The severity of self-stigmatization of deaf and hard of hearing students was determined by the degree of deafness and the time they live with hearing loss, learning conditions, the type of self-identification (acculturation), personality traits, and the specifics of coping behavior. Persons with congenital hearing loss more often noted a benevolent and sympathetic attitude towards them on the part of the hearers and less often, due to deafness, limited themselves to visiting public places than late deaf people, which indicates 'get rid of' the experience of their defect and normalization of the state. Students studying in conditions of inclusion more often noted the dismissive attitude of society towards deaf people. Individuals with mild to moderate hearing loss were more likely to fear marriage and childbearing because of their deafness than students with profound hearing loss. Those who considered themselves disabled (49% of all respondents) were more inclined to cope with seeking social support and less used 'distancing' coping. Those who believed that their quality of life and social opportunities were most influenced by the attitude of society towards the deaf (39%) were distinguished by a less pronounced sense of self-worth, a desire for autonomy, and frequent usage of 'avoidance' coping strategies. 36.4% of the respondents noted that there have been situations in their lives when people learned that they are deaf, began to treat them worse. These respondents had predominantly deaf acculturation, but more often, they used 'bicultural skills,' specific coping for the deaf, and had a lower level of extraversion and emotional stability. 31.2% of the respondents tried to hide from others that they have hearing problems. They considered themselves to be in a culture of hearing, used coping strategies 'bicultural skills,' and had lower levels of extraversion, cooperation, and emotional stability. Acknowledgment: Supported by the RFBR № 19-013-0040

Keywords: acculturation, coping, deafness, stigmatization

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Authors: Mikko Salminen, Niklas Ravaja

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Previous studies have shown that emotional intelligence (EI) has an important role in leadership and social interaction. On the other hand, physiological synchronization between two interacting participants has been related to, for example, intensity of the interaction, and interestingly also to empathy. It is suggested that the amount of covariation in physiological signals between the two interacting persons would also be related to how the discussion is perceived subjectively. To study the interrelations between physiological synchronization, emotional intelligence, and subjective perception of the interaction, performance review discussions between real manager – subordinate dyads were studied using psychophysiological measurements and self-reports. The participants consisted of 40 managers, of which 24 were female, and 78 of their subordinates, of which 45 were female. The participants worked in various fields, for example banking, education, and engineering. The managers had a normal performance review discussion with two subordinates, except two managers who, due to scheduling issues, had discussion with only one subordinate. The managers were on average 44.5 years old, and the subordinates on average 45.5 years old. Written consent, in accordance with the Declaration of Helsinki, was obtained from all the participants. After the discussion, the participants filled a questionnaire assessing their emotions during the discussion. This included a self-assessment manikin (SAM) scale for the emotional valence during the discussion, with a 9-point graphical scale representing a manikin whose facial expressions ranged from smiling and happy to frowning and unhappy. In addition, the managers filled EI360, a 37-item self-report trait emotional intelligence questionnaire. The psychophysiological activity of the participants was recorded using two Varioport-B portable recording devices. Cardiac activity (ECG, electrocardiogram) was measured with two electrodes placed on the torso. Inter-beat interval (IBI, time between two successive heart beats) was calculated from the ECG signals. The facial muscle activation (EMG, electromyography) was recorded on three sites of the left side of the face: zygomaticus major (cheek muscle), orbicularis oculi (periocular muscle), and corrugator supercilii (frowning muscle). The facial-EMG signals were rectified and smoothed, and cross-coherences were calculated between members of each dyad, for all the three EMG signals, for the baseline and discussion periods. The values were natural-log transformed to normalize the distributions. Higher cross-coherence during the discussion between the manager’s and the subordinate’s zygomatic muscles was related to more positive valence self-reported emotions, F(1; 66,137) = 7,051; p=0,01. Thus, synchronized cheek muscle activation, either due to synchronous smiling or talking, was related to more positive perception of the discussion. In addition, higher IBI synchronization between the manager and the subordinate during the discussion was related to the manager’s higher self-reported emotional intelligence, F(1; 27,981)=4,58; p=0,041. That is, the EI was related to synchronous cardiac activity and possibly to similar physiological arousal levels. The results imply that the psychophysiological synchronization could be a potentially useful index in the study of social interaction and a valuable tool in the coaching of leadership skills in organizational contexts.

Keywords: emotional intelligence, leadership, psychophysiology, social interaction, synchronization

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Authors: Magda Milleyde de Sousa Lima, Letícia Lima Aguiar, Marina Guerra Martins, Erika Veríssimo Dias Sousa, Lizandra Sampaio de Oliveira, Lívia Moreira Barros, Joselany Áfio Caetano

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Patients with chronic kidney disease are vulnerable to episodes which make the safety of their health vulnerable, mainly due to the treatment process that exposes them to high rates of interventions during hemodialysis sessions. Some factors associated with health care contribute to the risk of death and complications. However, there are a small number of scientific studies evaluating the level of safety of hemodialysis clinics, and the sociodemographic characteristics of patients and professionals associated with this safety. Therefore, the present study aims to examine the level of patient safety in hemodialysis clinics in the Brazilian capital, to identify the sociodemographic and clinical factors of patients and nursing staff associated with the level of safety. This is an observational, descriptive and quantitative research conducted in three hemodialysis clinics placed in the city of Fortaleza-CE, Brazil, from September to November 2019. The sample was formed after a sample calculation for finite inhabitants of correlation with 200 chronic renal patients, 30 nursing technicians and seven nurses. Conventional sampling was used based on the inclusion criteria: being present at the hemodialysis session on the day the researcher performed the data collection and being 18 years of age or older. Participants who presented communication difficulties to listen to and/or answer the sociodemographic and clinical questionnaire were excluded. Two instruments were applied: sociodemographic and clinical characterization form and Chronic Renal Patient Safety Assessment Scale on Hemodialysis (EASPRCH). The data were analyzed using the Kruskal Walls Test for categorical variables and Spearman correlation coefficient for non-categorical variables, using the Statistical Package SPSS version 20.0. The present study respected the ethical and legal principles determined by resolution 466/2012 of the National Health Council, under the approval of the Ethics and Research Committee with an opinion number: 3,255,635. The results showed that a hemodialysis clinic presented unsafe care practices of 32 points in the EASPRCH (p=0.001). A statistical association was identified between the level of safety and the variables of the patients: level of education (p=0.018), family income (p=0.049), type of employment (p=0.012), venous access site (p=0.009), use of medication during the session (p=0.008) and time of hemodialysis (p=0.002). When evaluating the profile of nurses, a statistical association was evidenced between the level of safety with the variables: marital status (p=0.000), race (p=0.017), schooling (p= 0.000), income (p=0.013), age (p=0.000), clinic workload (p=0.000), time working with hemodialysis (p=0.000), time working in the clinic (p= 0.007) and clinic sizing (p=0.000). In order, the sociodemographic factors of nursing technicians associated with the level of patient safety were: race (p= 0.001) and weekly workload at (p=0.010). Therefore, it is concluded that there is a non-conformity in the level of patient safety in one of the clinics studied and, that sociodemographic and clinical factors of patients and health professionals corroborate the level of safety of the health unit.

Keywords: hemodialysis, nursing, patient safety, quality improvement

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Authors: Mojtaba Eshraghi Arani

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Ship financing is the vital element in the development of shipping industry because while the ship constitutes the owners’ main asset, she is considered a reliable security in the financiers’ viewpoint as well. However, it is most probable that a financier who has accepted a ship as security will face many creditors who are privileged and rank before him for collecting, out of the ship, the money that they are owed. In fact, according to the current rule of maritime law, which was established by “Convention Internationale pour l’Unification de Certaines Règles Relatives aux Privilèges et Hypothèques Maritimes, Brussels, 10 April 1926”, the mortgages, hypotheques, and other charges on vessels rank after several secured claims referred to as “maritime liens”. Such maritime liens are an exhaustive list of claims including but not limited to “expenses incurred in the common interest of the creditors to preserve the vessel or to procure its sale and the distribution of the proceeds of sale”, “tonnage dues, light or harbour dues, and other public taxes and charges of the same character”, “claims arising out of the contract of engagement of the master, crew and other persons hired on board”, “remuneration for assistance and salvage”, “the contribution of the vessel in general average”, “indemnities for collision or other damage caused to works forming part of harbours, docks, etc,” “indemnities for personal injury to passengers or crew or for loss of or damage to cargo”, “claims resulting form contracts entered into or acts done by the master”. The same rule survived with only some minor change in the categories of maritime liens in the substitute conventions 1967 and 1993. The status que in maritime law have always been considered as a major obstacle to the development of shipping market and has inevitably led to increase in the interest rates and other related costs of ship financing. It seems that the national and international policy makers have yet to change their mind being worried about the deviation from the old marine traditions. However, it is crystal clear that the continuation of status que will harm, to a great extent, the shipowners and, consequently, the international merchants as a whole. It is argued in this article that the raison d'être for many categories of maritime liens cease to exist anymore, in view of which, the international community has to recognize only a minimum category of maritime liens which are created in the common interests of all creditors; to this effect, only two category of “compensation due for the salvage of ship” and “extraordinary expenses indispensable for the preservation of the ship” can be declared as taking priority over the mortgagee rights, in anology with the Geneva Convention on the International Recognition of Rights in Aircrafts (1948). A qualitative method with the concept of interpretation of data collection has been used in this manuscript. The source of the data is the analysis of international conventions and domestic laws.

Keywords: ship finance, mortgage, maritime liens, brussels convenion, geneva convention 1948

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Authors: Afentoula Mavrodi, Andreas Georgiou, Georgios Tsiotras, Vassilis Aletras

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Placing a monetary value on a quality-adjusted-life-year (QALY) is of utmost importance in economic evaluation. Identifying the population’s preferences is critical in order to understand some of the reasons driving variations in the assigned monetary value. Yet, evidence of the motives behind value assignment to a QALY by the general public is limited. Developing an instrument that would capture the population’s motives could be proven valuable to policy-makers, to guide them in allocating different values to a QALY based on users’ motivations. The aim of this study was to identify the most relevant motives and develop an appropriate instrument to assess them. To design the instrument, we employed: a) the EQ-5D-3L tool to assess participants’ current health status, and b) the Willingness-to-Pay (WTP) approach, within the Contingent Valuation (CV) Method framework, to elicit the monetary value. Advancing the open-ended approach adopted to assess solely protest bidders’ motives; a variety of follow-up item-specific statements were designed (deductive approach), aiming to evaluate motives of both protest bidders and participants willing to pay for the hypothetical treatment under consideration. The initial design of the survey instrument was the outcome of an extensive literature review. This instrument was revised based on 15 semi-structured interviews that took place in September 2018 and a pilot study held during two months (October-November) in 2018. Individuals with different educational, occupational and economical backgrounds and adequate verbal skills were recruited to complete the semi-structured interviews. The follow-up motivation statements of both protest bidders and those willing to pay were revised and rephrased after the semi-structured interviews. In total 4 statements for protest bidders and 3 statements for those willing to pay for the treatment were chosen to be included in the survey tool. Using the CATI (Computer Assisted Telephone Interview) method, a randomly selected sample of 97 persons living in Thessaloniki, Greece, completed the questionnaire on two occasions over a period of 4 weeks. Based on pilot study results, a test-retest reliability assessment was performed using the intra-class correlation coefficient (ICC). All statements formulated for protest bidders showed acceptable reliability (ICC values of 0.84 (95% CI: 0.67, 0.92) and above). Similarly, all statements for those willing to pay for the treatment showed high reliability (ICC values of 0.86 (95% CI: 0.78, 0.91) and above). Overall, the instrument designed in this study was reliable with regards to the item-specific statements assessing participants’ motivation. Validation of the instrument will take place in a future study. For a holistic WTP per QALY instrument, participants’ motivation must be addressed broadly. The instrument developed in this study captured a variety of motives and provided insight with regards to the method through which the latter are evaluated. Last but not least, it extended motive assessment to all study participants and not only protest bidders.

Keywords: contingent valuation method, instrument, motives, quality-adjusted life-year, willingness-to-pay

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Authors: Shierwin Agagen Cabunilas

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Countless Filipinos are reeling in dire economic inequality while many others are victims of human trafficking. Where there is extreme economic inequality, majority of the Filipinos are deprived of basic needs to have a good life, i.e., decent shelter, safe environment, food, quality education, social security, etc. The problem on human trafficking poses a scandal and threat in respect to human rights and dignity of a person on matters of sex, gender, ethnicity and race among others. The economic inequality and trafficking in persons are social pathologies that needed considerable amount of attention and visible solution both in the national and international level. However, the Philippine government seems falls short in terms of goals to lessen, if not altogether eradicate, the dire fate of many Filipinos. The lack of solidarity among Filipinos seems to further aggravate injustice and create hindrances to economic equity and protection of Filipinos from syndicated crimes, i.e., human trafficking. Indifference towards the welfare and well-being of the Filipino people trashes them into an unending cycle of marginalization and neglect. A transnational solidaristic action in response to these concerns is imperative. The subsequent sections will first discuss the notion of solidarity and the motivating factors for collective action. While solidarity has been previously thought of as stemming from and for one’s own community and people, it can be argued as a value that defies borders. Solidarity bridges peoples of diverse societies and cultures. Although there are limits to international interventions on another’s sovereignty, such as, internal political autonomy, transnational solidarity may not be an opposition to solidarity with people suffering injustices. Governments, nations and institutions can work together in securing justice. Solidarity thus is a positive political action that can best respond to issues of economic, class, racial and gender injustices. This is followed by a critical analysis of some data on Philippine economic inequality and human trafficking and link the place of transnational solidaristic arrangements. Here, the present work is interested on the normative aspect of the problem. It begins with the section on economic inequality and subsequently, human trafficking. It is argued that a transnational solidarity is vital in assisting the Philippine governing bodies and authorities to seriously execute innovative economic policies and developmental programs that are justice and egalitarian oriented. Transnational solidarity impacts a corrective measure in the economic practices, and activities of the Philippine government. Moreover, it is suggested that in order to mitigate Philippine economic inequality and human trafficking concerns it involves a (a) historical analysis of systems that brought about economic anomalies, (b) renewed and innovated economic policies, (c) mutual trust and relatively high transparency, and (d) grass-root and context-based approach. In conclusion, the findings are briefly sketched and integrated in an optimistic view that transnational solidarity is capable of influencing Philippine governing bodies towards socio-economic transformation and development of the lives of Filipinos.

Keywords: Philippines, Filipino, economic inequality, human trafficking, transnational solidarity

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Authors: Fouzia Khanam, Belal Hossain, Kaosar Afsana, Mahfuzar Rahman

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Aim: Although cardiovascular diseases (CVD) has already been recognized as a major cause of death in developed countries, its prevalence is rising in developing countries as well, and engendering a challenge for the health sector. Bangladesh has experienced an epidemiological transition from communicable to non-communicable diseases over the last few decades. So, the rising prevalence of CVD and its risk factors are imposing a major problem for the country. We aimed to examine the prevalence of CVDs and socioeconomic and lifestyle factors related to it from a population-based survey. Methods: The data used for this study were collected as a part of a large-scale cross-sectional study conducted to explore the overall health status of children, mothers and senior citizens of Bangladesh. Multistage cluster random sampling procedure was applied by considering unions as clusters and households as the primary sampling unit to select a total of 11,428 households for the base survey. Present analysis encompassed 12338 respondents of ≥ 35 years, selected from both rural areas and urban slums of the country. Socio-economic, demographic and lifestyle information were obtained through individual by a face-to-face interview which was noted in ODK platform. And height, weight, blood pressure and glycosuria were measured using standardized methods. Chi-square test, Univariate modified Poisson regression model, and multivariate modified Poisson regression model were done using STATA software (version 13.0) for analysis. Results: Overall, the prevalence of CVD was 4.51%, of which 1.78% had stroke and 3.17% suffered from heart diseases. Male had higher prevalence of stroke (2.20%) than their counterparts (1.37%). Notably, thirty percent of respondents had high blood pressure and 5% population had diabetes and more than half of the population was pre-hypertensive. Additionally, 20% were overweight, 77% were smoker or consumed smokeless tobacco and 28% of respondents were physically inactive. Eighty-two percent of respondents took extra salt while eating and 29% of respondents had deprived sleep. Furthermore, the prevalence of risk factor of CVD varied according to gender. Women had a higher prevalence of overweight, obesity and diabetes. Women were also less physically active compared to men and took more extra salt. Smoking was lower in women compared to men. Moreover, women slept less compared to their counterpart. After adjusting confounders in modified Poisson regression model, age, gender, occupation, wealth quintile, BMI, extra salt intake, daily sleep, tiredness, diabetes, and hypertension remained as risk factors for CVD. Conclusion: The prevalence of CVD is significant in Bangladesh, and there is an evidence of rising trend for its risk factors such as hypertension, diabetes especially in older population, women and high-income groups. Therefore, in this current epidemiological transition, immediate public health intervention is warranted to address the overwhelming CVD risk.

Keywords: cardiovascular diseases, diabetes, hypertension, stroke

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Authors: Ana Rodrigues, Maria Cadilhe, Filipa Ferreira, Claudia Pereira, Marta Santos

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Professional paths must be understood in the multiplicity of their possible configurations. While some actors tend to represent their path as a harmonious succession of positions in the life cycle, most recognize the existence of unforeseen and uncontrollable bifurcations, caused, for example, by a work accident or by going through a period of unemployment. Considering the intensified challenges posed by the ongoing societal changes (e.g., technological and demographic), and looking at the Portuguese context, where the unemployment rate continues to be more evident in certain age groups, like in individuals aged 45 years or over, it is essential to support those adults by providing strategies capable of supporting them during professional transitions, being this a joint responsibility of governments, employers, workers, educational institutions, among others. Concerned about those issues, Porto City Council launched the challenge of designing and implementing a Lifelong Career Guidance program, which was answered with the presentation of a customized conceptual and operational model: groWing|Lifelong Career Guidance. A pilot project targeting working-age adults (35 or older) who were unemployed was carried out, aiming to support them to reconstruct their professional paths, through the recovery of their past experiences and through a reflection about dimensions such as skills, interests, constraints, and labor market. A research action approach was used to assess the proposed model, namely the perceived relevance of the theme and of the project, by adults themselves (N=44), employment professionals (N=15) and local companies (N=15), in an integrated manner. A set of activities were carried out: a train the trainer course and a monitoring session with employment professionals; collective and individual sessions with adults, including a monitoring session as well; and a workshop with local companies. Support materials for individual/collective reflection about professional paths were created and adjusted for each involved agent. An evaluation model was co-build by different stakeholders. Assessment was carried through a form created for the purpose, completed at the end of the different activities, which allowed us to collect quantitative and qualitative data. Statistical analysis was carried through SPSS software. Results showed that the participants, as well as the employment professionals and the companies involved, considered both the topic and the project as extremely relevant. Also, adults saw the project as an opportunity to reflect on their paths and become aware of the opportunities and the necessary conditions to achieve their goals; the professionals highlighted the support given by an integrated methodology and the existence of tools to assist the process; companies valued the opportunity to think about the topic and the possible initiatives they could implement within the company to diversify their recruitment pool. The results allow us to conclude that, in the local context under study, there is an alignment between different agents regarding the pertinence of supporting adults with work experience in professional transitions, seeing the project as a relevant strategy to address this issue, which justifies that it can be extended in time and to other working-age adults in the future.

Keywords: professional paths, research action, turning points, lifelong career guidance, relevance

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Authors: Drew Commandeur, Ryan Brodie, Sandra Hundza, Marc Klimstra

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The amplitude of raw electromyography (EMG) is affected by recording conditions and often requires normalization to make meaningful comparisons. Bioelectric methods normalize with an EMG signal recorded during a standardized task or from the experimental protocol itself, while biomechanical methods often involve measurements with an additional sensor such as a force transducer. Common bioelectric normalization techniques for treadmill walking include maximum voluntary isometric contraction (MVIC), dynamic EMG peak (EMGPeak) or dynamic EMG mean (EMGMean). There are several concerns with using MVICs to normalize EMG, including poor reliability and potential discomfort. A limitation of bioelectric normalization techniques is that they could result in a misrepresentation of the absolute magnitude of force generated by the muscle and impact the interpretation of EMG between functionally disparate groups. Additionally, methods that normalize to EMG recorded during the task may eliminate some real inter-individual variability due to biological variation. This study compared biomechanical and bioelectric EMG normalization techniques during treadmill walking to assess the impact of the normalization method on the functional interpretation of EMG data. For the biomechanical method, we normalized EMG to a target torque (EMGTS) and the bioelectric methods used were normalization to the mean and peak of the signal during the walking task (EMGMean and EMGPeak). The effect of normalization on muscle activation pattern, EMG amplitude, and inter-individual variability were compared between disparate cohorts of OLD (76.6 yrs N=11) and YOUNG (26.6 yrs N=11) adults. Participants walked on a treadmill at a self-selected pace while EMG was recorded from the right lower limb. EMG data from the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), vastus lateralis (VL), and biceps femoris (BF) were phase averaged into 16 bins (phases) representing the gait cycle with bins 1-10 associated with right stance and bins 11-16 with right swing. Pearson’s correlations showed that activation patterns across the gait cycle were similar between all methods, ranging from r =0.86 to r=1.00 with p<0.05. This indicates that each method can characterize the muscle activation pattern during walking. Repeated measures ANOVA showed a main effect for age in MG for EMGPeak but no other main effects were observed. Interactions between age*phase of EMG amplitude between YOUNG and OLD with each method resulted in different statistical interpretation between methods. EMGTS normalization characterized the fewest differences (four phases across all 5 muscles) while EMGMean (11 phases) and EMGPeak (19 phases) showed considerably more differences between cohorts. The second notable finding was that coefficient of variation, the representation of inter-individual variability, was greatest for EMGTS and lowest for EMGMean while EMGPeak was slightly higher than EMGMean for all muscles. This finding supports our expectation that EMGTS normalization would retain inter-individual variability which may be desirable, however, it also suggests that even when large differences are expected, a larger sample size may be required to observe the differences. Our findings clearly indicate that interpretation of EMG is highly dependent on the normalization method used, and it is essential to consider the strengths and limitations of each method when drawing conclusions.

Keywords: electromyography, EMG normalization, functional EMG, older adults

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Authors: Jessica Vasil'chuk, Elena Ivanova, Pavel Krechetov, Vladimir Litvinsky, Nadine Budantseva, Julia Chizhova, Yurij Vasil'chuk

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Carbonate minerals’ isotopic composition is widely used as a proxy for environmental parameters of the past. Pedogenic carbonate coatings on lower surfaces of coarse rock fragments are studied in order to indicate the climatic conditions and predominant vegetation under which they were formed. The purpose of the research is to characterize the isotopic composition of carbonate pedofeatures in soils of Minusink Hollow and estimate its correlation with isotopic composition of soil pore water, precipitation, vegetation and parent material. The samples of pedogenic carbonates, vegetation, carbonate parent material, soil water and precipitation water were analyzed using the Delta-V mass spectrometer with options of a gas bench and element analyser. The soils we studied are mainly Kastanozems that are poorly moisturized, therefore soil pore water was extracted by ethanol. Oxygen and carbon isotopic composition of pedogenic carbonates was analyzed in 3 key sites. Kazanovka Khakass state national reserve, Hankul salt lake, region of Sayanogorsk aluminum smelter. Vegetation photosynthetic pathway in the region is mainly C3. δ18O values of carbonate coatings in soils of Kazanovka vary in a range from −7.49 to −10.5‰ (vs V-PDB), and the smallest value −13.9‰ corresponds the coatings found between two buried soil horizons which 14C dates are 4.6 and 5.2 kyr BP. That may indicate cooler conditions of late Holocene than nowadays. In Sayanogorsk carbonates’ δ18O range is from −8.3 to −11.1‰ and near the Hankul Lake is from −9.0 to −10.2‰ all ranges are quite similar and may indicate coatings’ uniform formation conditions. δ13C values of carbonate coatings in Kazanovka vary from −2.5 to −6.7‰, the highest values correspond to the soils of Askiz and Syglygkug rivers former floodplains. For Sayanogorsk the range is from −4.9 to −6.8‰ and for Hankul from −2.3 to −5.7‰, where the highest value is for the modern salt crust. δ13C values of coatings strongly decrease from inner (older) to outer (younger) layers of coatings, that can indicate differences connected with the diffusion of organic material. Carbonate parent material δ18O value in the region vary from −11.1 to −12.0‰ and δ13C values vary from −4.9 to −5.7‰. Soil pore water δ18O values that determine the oxygen isotope composition of carbonates vary due to the processes of transpiration and mixing in the studied sites in a wide range of −2.0 to −13.5‰ (vs V-SMOW). Precipitation waters show δ18O values from -6.6‰ in May and -19.0‰ in January (snow) due to the temperature difference. The main conclusions are as follows: pedogenic carbonates δ13C values (−7…−2,5‰) show no correlation with modern C3 vegetation δ13C values (−30…−26‰), expected values under such vegetation are (−19…−15‰) but are closer to C4 vegetation. Late Holocene climate for the Minusinsk Hollow according to obtained data on isotope composition of carbonates and soil pore water chemical composition was dryer and cooler than present, that does not contradict with paleocarpology data obtained for the region. The research was supported by Russian Science Foundation (grant №14-27-00083).

Keywords: carbon, oxygen, pedogenic carbonates, South Siberia, stable isotopes

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Authors: Purushottam P. Khatiwada, Bikash Paudel, Ram B. Rana, Parshuram Biswakarma, Roshan Pudasaini

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Nepal has been putting its efforts into securing food and nutrition security for its citizens adopting different models and approaches. Home Garden approach, that integrates vegetables, fruits, small livestock, poultry along with other components like fish, honeybee, mushroom, spices for the promotion of nutritional security of resource-poor and disadvantaged groups was implemented during March 2009 to July 2013 spreading over 16 districts of Nepal covering 115 farmers groups, directly working with 3500 households. Sustained long-term impact of development interventions targeted to the resource-poor and disadvantaged groups has been a recurrent issue for donors, policymakers and practitioners alike. Considering the issue, a post-project evaluation was carried out in a selected project group (Dangibari of Jhapa) after four years of project completion in 2017 in order to evaluate the impact and understand the factors associated with its success. Qualitative information was collected through focus group discussion with group members and associated local institutions. For quantitative information, a quick survey was carried out to the same group members only selecting few indicators. The results are compared with the data obtained from the baseline study conducted by the project in March 2009. The impact of project intervention was evident as compared to the benchmarks established during the baseline, even after four years of project completion. The area under home garden is increased to 729 m² from 386 m² and average food self-sufficiency months increased to 10.22 from 8.11. Seven to eleven fruit species are maintained in the home gardens. An average number of vegetable species grown increased to 15.85 from 9.86. It has resulted in an increase in vegetables self-sufficient month to 8.74 from 4.74 and a huge increase in cash income NPR 6142.8 (USD 59.6) from NPR 385.7 (USD 3.9) from the sale of surplus vegetables. Coaching and mentoring including nutrition sensitization by the project staff at the beginning, inputs and technical support during the project implementation phase and projects effort on the institutional building of disadvantaged farmers were the key drivers of home garden sustainability and expansion. Specifically, package of home garden management trainings provided by the project staff, availability of group funds for buying inputs even after the project, uniting home garden group members in a cooperative, resource leveraging by local institutions through group lobbying, farmers innovations for maintaining home garden diversity and continuous backstopping support by few active members as local resource persons to other members are some additional factors contributing to sustain and/or improve the home garden status by the resource-poor and disadvantaged group.

Keywords: food-based nutrition, home garden, resource-poor and disadvantaged group, sustained impact

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity-related health conditions impose a substantial economic burden on payers due to increased healthcare use. Estimates of healthcare resource use and costs associated with obesity-related comorbidities are needed to inform policies and interventions targeting these conditions. Methods: Adults living with obesity were identified (a procedure-related body mass index code for class 2/3 obesity between 2012 and 2019 in Alberta, Canada; excluding those with bariatric surgery), and outcomes were compared over 1-year (2019/2020) between those who had and did not have specific obesity-related comorbidities. The probability of using a healthcare service (based on the odds ratio of a zero [OR-zero] cost) was compared; 95% confidence intervals (CI) were reported. Logistic regression and a generalized linear model with log link and gamma distribution were used for total healthcare cost comparisons ($CDN); cost ratios and estimated cost differences (95% CI) were reported. Potential socio-demographic and clinical confounders were adjusted for, and incremental cost differences were representative of a referent case. Results: A total of 220,190 adults living with obesity were included; 44% had hypertension, 25% had osteoarthritis, 24% had type-2 diabetes, 17% had cardiovascular disease, 12% had insulin resistance, 9% had chronic back pain, and 4% of females had polycystic ovarian syndrome (PCOS). The probability of hospitalization, ED visit, and ambulatory care was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (hospitalization: 1.8-times [OR-zero: 0.57 [0.55/0.59]] / ED visit: 1.9-times [OR-zero: 0.54 [0.53/0.56]] / ambulatory care visit: 2.4-times [OR-zero: 0.41 [0.40/0.43]]), cardiovascular disease (2.7-times [OR-zero: 0.37 [0.36/0.38]] / 1.9-times [OR-zero: 0.52 [0.51/0.53]] / 2.8-times [OR-zero: 0.36 [0.35/0.36]]), osteoarthritis (2.0-times [OR-zero: 0.51 [0.50/0.53]] / 1.4-times [OR-zero: 0.74 [0.73/0.76]] / 2.5-times [OR-zero: 0.40 [0.40/0.41]]), type-2 diabetes (1.9-times [OR-zero: 0.54 [0.52/0.55]] / 1.4-times [OR-zero: 0.72 [0.70/0.73]] / 2.1-times [OR-zero: 0.47 [0.46/0.47]]), hypertension (1.8-times [OR-zero: 0.56 [0.54/0.57]] / 1.3-times [OR-zero: 0.79 [0.77/0.80]] / 2.2-times [OR-zero: 0.46 [0.45/0.47]]), PCOS (not significant / 1.2-times [OR-zero: 0.83 [0.79/0.88]] / not significant), and insulin resistance (1.1-times [OR-zero: 0.88 [0.84/0.91]] / 1.1-times [OR-zero: 0.92 [0.89/0.94]] / 1.8-times [OR-zero: 0.56 [0.54/0.57]]). After fully adjusting for potential confounders, the total healthcare cost ratio was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (1.54-times [1.51/1.56]), cardiovascular disease (1.45-times [1.43/1.47]), osteoarthritis (1.36-times [1.35/1.38]), type-2 diabetes (1.30-times [1.28/1.31]), hypertension (1.27-times [1.26/1.28]), PCOS (1.08-times [1.05/1.11]), and insulin resistance (1.03-times [1.01/1.04]). Conclusions: Adults with obesity who have specific disease-related health conditions have a higher probability of healthcare use and incur greater costs than those without specific comorbidities; incremental costs are larger when other obesity-related health conditions are not adjusted for. In a specific referent case, hypertension was costliest (44% had this condition with an additional annual cost of $715 [$678/$753]). If these findings hold for the Canadian population, hypertension in persons with obesity represents an estimated additional annual healthcare cost of $2.5 billion among adults living with obesity (based on an adult obesity rate of 26%). Results of this study can inform decision making on investment in interventions that are effective in treating obesity and its complications.

Keywords: administrative data, healthcare cost, obesity-related comorbidities, real world evidence

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Authors: Noorh Albadi, Salha Khayyat

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People's moods and well-being are affected by their environment. The built environment impacts one's level of activity and health. In order to enhance users' physical health, sustainable design strategies have been developed for the physical environment to improve users' health. This study aimed to determine whether adult resorts in Saudi Arabia meet standards that ensure physical wellness to identify the needed requirements. It will be significant to the Ministry of Tourism, Sports, developers, and designers. Physical activity affects human health physically and mentally. In Saudi Arabia, the percentage of people who practiced sports in the Kingdom in 2019 was 20.04% - males and females older than 15. On the other hand, there is a lack of physical activity in Saudi Arabia; 90% of the Kingdom's population spends more than two hours sitting down without moving, which puts them at risk of contracting a non-communicable disease. The lack of physical activity and movement led to an increase in the rate of obesity among Saudis by 59% in 2020 and consequently could cause chronic diseases or death. The literature generally endorses that leading an active lifestyle improves physical health and affects mental health. Therefore, the United Nations has set 17 sustainable development goals (SDGs) to ensure healthy lives and promote well-being for all ages. One of SDG3's targets is reducing mortality, which can be achieved by raising physical activity. In order to support sustainable design, many rating systems and strategies have been developed, such as WELL building, Leadership in Energy and Environmental Design, (LEED), Active design strategies, and RIPA plan of work. The survey was used to gather qualitative and quantitative information. It was designed based on the Active Design and WELL building theories targeting beach resorts visitors, professional and beginner athletes, and non-athletics to ask them about the beach resorts they visited in the Kingdom and whether they met the criteria of sports resorts and healthy and active design theories, in addition to gathering information about the preferences of physical activities in the Saudi society in terms of the type of activities that young people prefer, where they prefer to engage in and under any thermal and light conditions. The final section asks about the design of residential units in beach sports resorts, the data collected from 127 participants. Findings revealed that participants prefer outdoor activities in moderate weather and sunlight or the evening with moderate and sufficient lighting and that no beach sports resorts in the country are constructed to support sustainable design criteria for physical activity. Participants agreed that several measures that lessen tension at beach resorts and enhance movement and activity are needed by Saudi society. The study recommends designing resorts that meet the sustainable design criteria regarding physical activity in Saudi Arabia to increase physical activity to achieve psychological and physical benefits and avoid psychological and physical diseases related to physical inactivity.

Keywords: sustainable design, SDGs, active design strategies, well building, beach resort design

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Authors: David Dolbow, Daniel Credeur, Mujtaba Rahimi, Dobrivoje Stokic, Jennifer Lemacks, Andrew Courtner

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Introduction: Obesity is at epidemic proportions in the spinal cord injury (SCI) population (66-75%), as individuals who suffer from paralysis undergo a dramatic decrease in muscle mass and a dramatic increase in adipose deposition. Obesity is a major public health concern which includes a doubling of the risk of heart disease, stroke and type II diabetes mellitus. It has been demonstrated that physical activity, and especially HIIT, can promote a healthy body composition and decrease the risk cardiometabolic disease in the able-bodied population. However, SCI typically limits voluntary exercise to the arms, but a high prevalence of shoulder pain in persons with chronic SCI (60-90%) can cause increased arm exercise to be problematic. Functional electrical stimulation (FES) cycling has proven to be a safe and effective way to exercise paralyzed leg muscles in clinical and home settings, saving the often overworked arms. Yet, HIIT-FES cycling had not been investigated prior to the current study. The purpose of this study was to investigate the body composition changes with combined HIIT-FES cycling and nutritional counseling on individuals with SCI. Design: A matched (level of injury, time since injury, body mass index) and controlled trail. Setting: University exercise performance laboratory. Subjects: Ten individuals with chronic SCI (C5-T9) ASIA impairment classification (A & B) were divided into the treatment group (n=5) for 30 minutes of HIIT-FES cycling 3 times per week for 8 weeks and nutritional counseling over the phone for 30 minutes once per week for 8 weeks and the control group (n=5) who received nutritional counseling only. Results: There was a statistically significant difference between the HIIT-FES group and the control group in mean body fat percentage change (-1.14 to +0.24) respectively, p = .030). There was also a statistically significant difference between the HIIT-FES and control groups in mean change in legs lean mass (+0.78 kg to -1.5 kg) respectively, p = 0.004. There was a nominal decrease in weight, BMI, total fat mass and a nominal increase in total lean mass for the HIIT-FES group over the control group. However, these changes were not found to be statistically significant. Additionally, there was a nominal decrease in the mean blood glucose levels for both groups 101.8 to 97.8 mg/dl for the HIIT-FES group and 94.6 to 93 mg/dl for the Nutrition only group, however, neither were found to be statistically significant. Conclusion: HIIT-FES cycling combined with nutritional counseling can provide healthful body composition changes including decreased body fat percentage in just 8 weeks. Future study recommendations include a greater number of participants, a primer electrical stimulation exercise program to better ready participants for HIIT-FES cycling and a greater volume of training above 30 minutes, 3 times per week for 8 weeks.

Keywords: body composition, functional electrical stimulation cycling, high-intensity interval training, spinal cord injury

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Authors: Abubakar Bello Usman, Alhassan Muhammad Gani, Kolo Ibrahim

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The use of botanical raw materials to produce pharmaceuticals, herbal remedies, teas, spirits, cosmetics, sweets, dietary supplements, special industrial compounds and crude materials constitute an important global resource in terms of healthcare and economy. In Nigeria and other developing countries, the indigenous knowledge on the uses of plants lies with the older generation and the traditional healers. However, these custodians are decreasing in number due to death and other unforeseen occurrences. An Ethno-botanical survey was carried out to obtain information on the ethno medical values of wide range of plants used by the people of Gombe State, North-Eastern Nigeria, in the practice of healing and cure of typhoid (enteric) fever. Oral interviews were conducted so as to consider those with low literacy level who are involved in the practice of traditional medicine and thirty four (34) informants availed themselves for the interview and were consulted. All relevant information obtained from the respondents was recorded. A recent and valid nomenclature, along with local names, family names, part of the plant(s) used, methods of preparation and administration and fifty four (54) plant species belonging to 27 families as well as 7 unidentified species that are commonly used by the people of the state in ethnomedical treatment of the ailment were tabulated. Those interviewed included traditional practitioners, local herb sellers, traditional rulers, hunters, farmers and patients. Specific questions were asked and information supplied by informants was promptly documented. Results showed that the people of Gombe State are knowledgeable on herbal medicine in the treatment of diseases and ailments. Furthermore, the aqueous leaf extracts of Senna siamea, the plant species with the highest PPK (percentage of people who have knowledge about the use of a species for treating typhoid fever) in this ethnobotanical survey, was tested for its activity against clinical isolates of Salmonella typhi using the agar well diffusion method. The aqueous extracts showed some activity (zones of inhibition 11, 9, 7.5, 3.5, 1.3 mm) at 2000, 1800, 1600, 1400, 1200 µg/ml concentrations respectively. Preliminary phytochemical studies of the aqueous leaf extracts of the plant revealed the presence of secondary metabolites such as alkaloids, saponins, tannins, flavonoids and cardiac glycosides. Though a large number of traditionally used plants for the treatment of enteric fever were identified, further scientific validation of the traditional claims of anti-typhoid properties is imperative. This would establish their candidature for any possible future research for active principles and the possible development of new cheaper and more effective anti-typhoid drugs, as well as in the conservation of this rich diversity of medicinal plants.

Keywords: antimicrobial activities, ethnobotany, gombe state, north-eastern Nigeria, phytochemical screening, senna siamea, typhoid fever

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Authors: Richard Mababu Mukiur

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

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

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Authors: Brian J. Biroscak

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In the United States (US), “sex trafficking” is defined at the federal level in the Trafficking Victims Protection Act of 2000 as encompassing a number of processes such as recruitment, transportation, and provision of a person for the purpose of a commercial sex act. It involves the use of force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age. Accumulating evidence suggests that sex trafficking is exacerbated by social and environmental stressors (e.g., pandemics). Given that “provision” is a key part of the definition, “provisioning systems” may offer a useful lens through which to study sex trafficking dynamics. Provisioning systems are the social systems connecting individuals, small groups, entities, and embedded communities as they seek to satisfy their needs and wants for goods, services, experiences and ideas through value-based exchange in communities. This project presents a conceptual framework for understanding sex trafficking dynamics in the context of the COVID pandemic. The framework is developed as a system dynamics simulation model based on published evidence, social and behavioral science theory, and key informant interviews with stakeholders from the Protection, Prevention, Prosecution, and Partnership sectors in one US state. This “4 P Paradigm” has been described as fundamental to the US government’s anti-trafficking strategy. The present research question is: “How do sex trafficking systems (e.g., supply, demand and price) interact with other provisioning systems (e.g., networks of organizations that help sexually exploited persons) to influence trafficking over time vis-à-vis the COVID pandemic?” Semi-structured interviews with stakeholders (n = 19) were analyzed based on grounded theory and combined for computer simulation. The first step (Problem Definition) was completed by open coding video-recorded interviews, supplemented by a literature review. The model depicts provision of sex trafficking services for victims and survivors as declining in March 2020, coincidental with COVID, but eventually rebounding. The second modeling step (Dynamic Hypothesis Formulation) was completed by open- and axial coding of interview segments, as well as consulting peer-reviewed literature. Part of the hypothesized explanation for changes over time is that the sex trafficking system behaves somewhat like a commodities market, with each of the other subsystems exhibiting delayed responses but collectively keeping trafficking levels below what they would be otherwise. Next steps (Model Building & Testing) led to a ‘proof of concept’ model that can be used to conduct simulation experiments and test various action ideas, by taking model users outside the entire system and seeing it whole. If sex trafficking dynamics unfold as hypothesized, e.g., oscillated post-COVID, then one potential leverage point is to address the lack of information feedback loops between the actual occurrence and consequences of sex trafficking and those who seek to prevent its occurrence, prosecute the traffickers, protect the victims and survivors, and partner with the other anti-trafficking advocates. Implications for researchers, administrators, and other stakeholders are discussed.

Keywords: pandemics, provisioning systems, sex trafficking, system dynamics modeling

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Authors: Hirseland Andreas, Kerschbaumer Lukas

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In the case of Germany, there are about one million long-term unemployed – a figure that did not vary much during the past years. These long-term unemployed did not benefit from the prospering labor market while most short-term unemployed did. Instead, they are continuously dependent on welfare and sometimes precarious short-term employment, experiencing work poverty. Long-term unemployment thus turns into a main obstacle to become employed again, especially if it is accompanied by other impediments such as low-level education (school/vocational), poor health (especially chronical illness), advanced age (older than fifty), immigrant status, motherhood or engagement in care for other relatives. As can be shown by this current research project, in these cases the chance to regain employment decreases to near nil. Almost two-thirds of all welfare recipients have multiple impediments which hinder a successful transition from welfare back to sustainable and sufficient employment. Prospective employers are unlikely to hire long-term unemployed with additional impediments because they evaluate potential employees on their negative signaling (e.g. low-level education) and the implicit assumption of unproductiveness (e.g. poor health, age). Some findings of the panel survey “Labor market and social security” (PASS) carried out by the Institute of Employment Research (the research institute of the German Federal Labor Agency) spread a ray of hope, showing that unlikely does not necessarily mean impossible. The presentation reports on current research on these very scarce “success stories” of unlikely transitions from long-term unemployment to work and how these cases were able to perform this switch against all odds. The study is based on a mixed-method design. Within the panel survey (~15,000 respondents in ~10,000 households), only 66 cases of such unlikely transitions were observed. These cases have been explored by qualitative inquiry – in depth-interviews and qualitative network techniques. There is strong evidence that sustainable transitions are influenced by certain biographical resources like habits of network use, a set of informal skills and particularly a resilient way of dealing with obstacles, combined with contextual factors rather than by job-placement procedures promoted by Job-Centers according to activation rules or by following formal paths of application. On the employer’s side small and medium-sized enterprises are often found to give job opportunities to a wider variety of applicants, often based on a slow but steadily increasing relationship leading to employment. According to these results it is possible to show and discuss some limitations of (German) activation policies targeting the labor market and their impact on welfare dependency and long-term unemployment. Based on these findings, indications for more supportive small-scale measures in the field of labor-market policies are suggested to help long-term unemployed with multiple impediments to overcome their situation (e.g. organizing small-scale-structures and low-threshold services to encounter possible employers on a more informal basis like “meet and greet”).

Keywords: against-all-odds, mixed-methods, Welfare State, long-term unemployment

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