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Introduction In this work, we propose a new paradigm for studying the well-known TARGET SET SELECTION problem (TSS for short) of Kempe, Kleinberg, and Tardos (2015), which is a fundamental problem in the area of viral marketing and the spread of opinion on social networks. Nevertheless, applications in medicine, social and life sciences, distributed computing, and other areas were found. The TARGET SET SELECTION problem can be, following the threshold formulation of Kempe, Kleinberg, and Tardos (2015), described as follows. We are given a social network modelled as a simple undirected graph G = (V, E), where V is a set of agents, a threshold function f : V → N that represents the resistance of an agent v ∈ V to be influenced by our marketing, and a budget k ∈ N. An agent v ∈ V is willing to buy our product if at least f (v) of his neighbours already have this product. Our goal is to select at most k agents that initially receive the marketed product (e.g., for free) to ensure that, in the end, all agents are influenced and own the product. We observe that the static graph as a model of a social network is perforce simplistic. Real-life networks are seldom static; they change quite often over time -new connections appear and some old ones disappear again; they are sort of dynamic or time-varying. This forces us to initiate the study of the TARGET SET SELECTION problem in more dynamic environments, which, according to us, captures the real-life behaviour of agents and social networks more realistically. G 1 : G 2 : G ↓ : 1 1 2 1, 2 1 , 2 2 It is worth mentioning that the generalisation of fundamental problems from AI, ML, and computer science to more dynamic settings have occupied the attention of both theorists and practitioners in the last years; to name at least a few, see, e.g., recent works of Hamm et al. (2022); Deligkas and Potapov (2020); Mertzios, Molter, and Zamaraev (2019) and the references therein. --- Temporal Graphs We model time-varying networks as temporal graphs. Roughly speaking, a temporal graph is a graph that is subject to discrete changes over time. Temporal graphs have also been studied under different names, such as dynamic, evolving, or time-varying graphs. Formally, the temporal graph is a pair G = (G ↓ , λ), where G ↓ = (V, E) is a simple undirected underlying graph and λ : E → 2 N is a time labelling function that assigns to each edge a set of discrete time-labels in which the edge is active. In this paper, both the underlying graph and the sets of time labels are finite. It follows that there exists ℓ = max{t ∈ λ(e) | e ∈ E} called a lifetime of G. We call the graph G i (G) = (V, E i ), where E i = {e | i ∈ λ(e)}, the i-th layer of the graph G. We omit (G) if the temporal graph is clear from the context. For an illustration of a temporal graph, we refer the reader to Figure 1. G 1 : v G 2 : v G 3 : Figure 2: A running example of the TEMP-TSS influence process. All agents have threshold 2 and the budget is set to k = 2. Influenced agents are filled and the agents in T are depicted as square boxes. In the first round, the bottom left agent becomes influenced as two of his neighbours are already influenced. In the second round, there is no additionally influenced agent since v has only one neighbour in this time-step. In the last round, the agent v becomes finally influenced. --- The Model We formally capture a notation of TARGET SET SELECTION in temporal graphs using the TEMPORAL TARGET SET SE-LECTION problem (TEMP-TSS for short) which is defined as follows. The input of the problem is a temporal graph G = (G ↓ = (V, E), λ), a threshold function f : V → N, and a budget k ∈ N. Our goal is to decide whether there is a targetset T ⊆ V of size at most k such that the following dynamic process: P 0 = T and P i = P i-1 ∪ {v | f (v) ≤ |N Gi (v) ∩ P i-1 |}, where N Gi (v) represents a set of neighbours of agent v in the graph G i , influences all the vertices in V , that is, P ℓ = V . For a running example of the process, we refer the reader to Figure 2. --- Our Results We mainly study the problem from a computational complexity perspective. Since the static TSS problem is notoriously hard both from the computational complexity and approximation algorithms' perspective, it is not surprising that the TEMP-TSS problem is also computationally hard. In particular, we are able to show that the TEMP-TSS problem is NP-complete. To show the hardness, we reduce from the original TSS problem. It is known that every spreading process in static TSS ends in at most n rounds. Therefore, we can reduce the static case to TEMP-TSS by creating n-layer temporal graph such that all layers are equal to the static social network of the TSS problem instance. It follows from the reduction that all lower-bounds known for the TSS problem directly carry over to our problem. However, this is not the case for algorithmic upper-bounds. Therefore, we mainly focus on studying the computational complexity of restrictions, where static TSS is solvable in polynomial time. The first way to tackle the complexity of the TSS problem is to restrict the threshold function. If the thresholds of all agents are equal to 1, then the static variant is trivially solvable by adding one agent from every connected component to the target-set. For the temporal case with the same setting, we have the following result. Theorem 1 It is NP-complete to solve TEMP-TSS even if all thresholds are equal to 1 and the lifetime of the temporal graph is 2. To show this lower-bound, we give a reduction from the SET COVER problem. Assuming the SETH, we also obtain, as a corollary of Theorem 1, that for all ϵ < 1 TEMP-TSS cannot be solved in time 2 ϵk n O(1) . Next, we turn our attention to cases where the underlying graph is restricted. For example, there is a trivial polynomial-time algorithm for TSS on complete graphs.For TEMP-TSS, we show that a polynomial-time algorithm is unlikely. Theorem 2 It is NP-complete to solve TEMP-TSS even if all thresholds are at most 2 and the underlying graph is a complete graph. --- Conclusions and Future Work In this paper, we initiated the study of the TEMPORAL TAR-GET SET SELECTION problem, which is an analogy of TSS in dynamic social networks. We provide intractability results from the computational complexity perspective for fairly limited settings. As our results are mostly negative, it follows that a different perspective is needed in order to obtain some tractability results. In particular, as a natural next step, we would like to investigate the problem deeply from the viewpoint of parameterised complexity and approximations. Last but not least, our variant of the problem is arguably the simplest generalisation of static TSS to dynamic networks. One of the versions that researchers should not overlook is a variant in which even the preferences of the agents may vary over time. In many real-world scenarios, the launch of a new product is accompanied by an advertising campaign designed to convince people to buy. However, this purchase conviction declines over time. Sellers can raise interest again, for example, by providing a discount.

Modern social networks are dynamic in their nature; new connections are appearing and old connections are disappearing all the time. However, in our algorithmic and complexity studies, we usually model social networks as static graphs. In this paper, we propose a new paradigm for the study of the well-known TARGET SET SELECTION problem, which is a fundamental problem in viral marketing and the spread of opinion through social networks. In particular, we use temporal graphs to capture the dynamic nature of social networks. We show that the temporal interpretation is, unsurprisingly, NP-complete in general. Then, we study computational complexity of this problem for multiple restrictions of both the threshold function and the underlying graph structure and provide multiple hardness lower-bounds.

INTRODUCTION Poverty remains a stubborn fact of life. Across the globe, rural populations are overwhelmingly poor. In developing countries, living in rural households increases the odds of being poor as opposed to urban counterparts. Statistically, Malaysia successfully reduced the poverty rate to 0.6% in 2014, and hardcore poverty is nearly eradicated. However, there still exists a small community of poor households that are still far from development and modernisation, especially in the less developed states such as Perlis, Kedah, Kelantan, Terengganu, Pahang, Sabah, and Sarawak. Pahang is one of the states in Malaysia based on agriculture, industry, and tourism activities. It should provide more opportunities to the communities to help poor households exit poverty. Based on the statistics provided by the Pahang Economic Planning Unit (EPU) in 2019, the poverty rate in Pahang was 4.3%. --- Incidence of Poverty in Malaysia Poverty refers to a state of deprivation faced by an individual or family to cope with the survival of daily life. According to the global definition, poverty is a difficult situation faced by an individual or family to meet the needs of human rights. Poverty is a phenomenon of deprivation, inadequacy, or instability experienced by every household (Siti Hadijah, 2012). Poverty in Malaysia is measured in absolute and relative terms. Absolute poverty is measured in terms of income level, which is the Poverty Line Income (PLI). Under absolute poverty, there are two types of PLI. They are the food PLI and non-food PLI. According to the Department of Statistic's 2019 new methodology, the value of food PLI was RM1,169, and non-food PLI was RM1,038. Thus, the total PLI was RM2,208 (DOSM, 2020). On the other hand, relative poverty is measured as a proportion of households earning income less than half the mean or median income. However, poverty should be a relative concept and not just constricted to income levels. When we discuss the poor, they should be considerably worse off than the majority of the population -a level of deprivation heavily out of line with the general living standards enjoyed by the majority of the population. That being said, the issue of poverty has yet to be fully addressed either globally or at the local level despite various efforts and strategies to eliminate it. Hence, poverty in Malaysia should also be defined by the prevalence of social exclusion. The lack of regular access to basic services such as education, healthcare, nutrition, housing, water supply and sanitation is an important dimension of poverty (Jayasooria, 2016, Nor Faraini et al., 2016). This is especially predominant in rural communities, particularly Sabah, Sarawak, Pahang, Kedah, Kelantan, and Terengganu. Therefore, this study aims to examine the factors that cause poverty in rural communities and investigate the socio-economic position and level of educational achievement of parents and children in Bera District, Pahang, Malaysia. --- LITERATURE REVIEW The definition of poverty is deprivation, lack of basic necessities, and very poor conditions. Meanwhile, education is a process of educating, guiding, forming, and nurturing. The income level received by households increases in tandem with the achievement of human capital. This is because the amount of income the household receives in rural areas is defined as what is received from the production of farming and agriculture. Nor Diana et al. (2010) argued that households with a low socio-economic status could be described as having low levels of educational attainment, employment status, and small land holdings. Asan et al. (1999) stated that most household heads in the FELDA area have children who work outside the agricultural sector and provide monthly financial assistance to the head of the household. This is because most rural communities primarily focus on income from the agricultural sector they work in. Marwan et al. (2012) stated that rural communities' education has become the focus of the government in the implementation of the Education Development Plan 2013-2025. Their study found that rural education is still lagging in quality due to factors such as lack of infrastructure, awareness of parents and students, information technology and telecommunications skills, socio-economic conditions, poverty, and quality of rural areas' educators. According to Zalika, Faridah, and Mohamad (2009), rural economic activities such as traditional agriculture offer low value to income. This contributes to low development and reduces competitive and high-level employment opportunities, decreasing household income. According to Narimah S. et al. ( 2018), the issue of poverty can lead to low educational attainment and cause poverty to be passed on from parents to their children. This is because low parental education makes their children more likely to get a low level of education. The cause of poverty due to lack of education or having a low level of education has made it harder for the poor to escape the shackles of poverty and get better job opportunities in the agricultural sector (Aini Samani & Suriati Ghazali, 2018). According to Zurina et al. (2018), the lack of education and low standard of education is the cause of the economic downturn of the household as well as a lack of permanent employment. A study by Siti Masayu (2009) found that poor families could not afford to provide adequate education to their children, causing a low level and low quality of education in the rural community. When families could not afford to send their children to school, the latter had to work to help earn additional income for their parents, affecting the children's education. The study found a correlation between a person's level of education and the income earned where the community in rural areas has a low socio-economic level, thus affecting the level of education and income earned by these poor rural households. Based on the above facts, the focus of this study is to identify the socio-economic background and the factors of poverty in rural communities in Bera District, Pahang. Through this study, the researchers sought to understand the reality of rural poverty by identifying the factors causing poverty in Bera District, Pahang. --- METHODOLOGY This study used primary data obtained from a questionnaire using a random sampling technique with the selected respondents in Bera District, Pahang. One hundred respondents were selected from the List of Poor Families in the Bera district area. The method of analysis included descriptive statistics on the poverty, education, and income variables. Chi-square tests were conducted to examine the relationship between education level and income earned. Figure 1 shows the conceptual framework of this study. --- RESULT AND DISCUSSION --- Demographic Profile Table 2 summarises the demographic profile of the respondents. It shows that 61 respondents are between 20 and 30 years old, 20 respondents are between 31 and 40 years old, 10 respondents are between 41 and 50 years old, and 9 respondents are between 51 and 60 years. Regarding academic qualification, 22% had completed tertiary education, 37% had secondary education, 31% had primary education, and 4% had no formal education. Table 2 also shows that 33 respondents work in the agriculture sector, 25 respondents are students, 21 work in the private sector, 8 respondents are factory operators, 8 respondents are hawkers, and 8 are housewives. Only 2 respondents work in the public sector. Meanwhile, 2 respondents do not work nor re looking for a job. The table also indicates that 41% of the respondents have a household size of 6 or more, 30% have a total of 5 family members, and 14% have a total of 4 family members. Meanwhile, 8, 5, and 2 have a household size of 3, 2, and 1, respectively. As for household income, 58% earned between RM1000 and RM2000 per month, while 28% earned between RM2001 and RM3001 per month. Nine percent had an income of between RM3001 and RM4000 per month, and 5% had an income of RM4000 and above. These findings indicate that based on the sample of rural communities in Bera District, almost 95% were in the B40 income group. --- Relationship between Education and Income Level Table 3 shows a significant difference between education level and income distribution. The finding of this study is in line with a study conducted by Narimah et al. (2018), who found that poverty could lead to low educational attainment and cause poverty to be passed on from parents to their children. Zurina et al. (2018) also found that the absence of education and low standard of education cause an economic downturn in the household as well as poverty due to the absence of a permanent job. Therefore, the finding obtained clearly shows that the low education of the household affects the poverty of rural communities. Table 3 Result of the chi-square analysis for the relationship between education and income level Chi-Square df Asymp. Sig. 36.260a 2 0.000 --- CONCLUSION This study examines the socio-economic background, the level of education, and factors that drive poverty in rural communities in Bera District, Pahang. The authors propose that the government emphasise education, income, and employment opportunities, particularly in rural areas, to develop the communities in rural areas and improve their standard of living. By reducing poverty, the well-being of rural communities will be indirectly improved, and they will not be left behind in national development.

Low levels of education and low income are often associated with communities located in rural areas. This is because rural communities have many constraints in obtaining education, employment opportunities, and earning a high income. This study aims to examine the factors that cause poverty in rural communities and investigate the socio-economic position and level of educational achievement of parents and children in rural communities in Bera District, Pahang, Malaysia. This study used a quantitative method for data collection. Questionnaires were administered to 100 respondents from the community living in the Bera district. Data obtained from respondents were analysed using Microsoft Excel and SPSS software through the Chi-square method. The study found that almost 51 percent of respondents agreed that the factors that drive poverty in rural families are the low education of household heads and the income earned by household heads based on their education level. In addition, a total of 59 respondents agreed with the issue of low education standards affecting the low level of income; 74 respondents agreed with the lack of employment opportunities in rural areas; and 59 respondents agreed that the education of the household heads makes it difficult for the children to get a good and higher education. As a result, the emphasis and opportunities on education, income, and employment opportunities, particularly in rural areas, must be increased more precisely.

INTRODUCTION COVID-19 which was first emerged in Wuhan city of China was a distinct clade from the beta coronaviruses related to human severe acute respiratory syndrome (SARS). 1,2 Covid-19 has more powerful pathogenicity and transmissibility than SARS. 3,4 The main transmission methods were droplets and contact which can be confirmed within a very short exposure time in the absence of personal protective equipment (PPE) like masks. 4,5,6 The World Health Organization (WHO) recognized COVID-19 outbreak as a Public Health Emergency of International globe raced to develop safe and effective vaccines. According to WHO: "vaccine must provide a highly favorable benefit-risk contour; with high efficacy, only mild or transient adverse effects and no serious ailments." The vaccine must be suitable for all ages, pregnant and lactating women, and should provide a rapid onset of protection with a single dose and confer safety for at least up to one year of administration. 13 The fight against COVID-19 has seen vaccine development move at record speed, compared to traditional vaccines. Many people understand the complexity of vaccine development and concerned that the vaccine was rushed. Therefore, it is natural to have some vaccine hesitancy and apprehension over the effectiveness and safety of the vaccine. Starting from March 2021, Iraqi people have the opportunity to receive the vaccine (Sinopharm, AstraZeneca, Pfizer). Therefore, this study aimed to investigate community perceptions towards COVID-19 vaccinations in Iraq and to explore factors associated with the hesitation in the receiving of the vaccine. --- MATERIALS AND METHODS A cross-sectional study was conducted in Iraq from March 2021 to June 2021, enrolling 9,620 participants of which 3,160 men and 6,460 women adults aged 18 years-old or older living in Iraq during the period of study conduct. The participants responded to an online survey on COVID-19 vaccination uploaded via the web-based Survey Monkey platform distributed all over the Iraqi governorates. A link to an online survey was sent via social media platforms (WhatsApp, Facebook). The questionnaire was administered in Arabic, and non-citizens who do not understand the Arabic language showed no response. The questionnaire was pretested in a pilot study involving 50 participants. The questionnaire consisted of three sections, section A on demographic characteristics of respondents included age, gender, occupation, level of education, and residency, section B on the respondent's perception toward COVID-19 vaccine, with nine inquiries (the vaccine is not effective, doesn't provide long-term immunity, not safe, at risk of COVID-19 after vaccination, cause death, may cause infertility, can alter genes, may cause congenital infection and anomalies, women at reproductive age should postpone pregnancy after vaccination). A "yes' and 'no' questions to assess the participants' perception towards COVID-19 vaccine. In section C, participants were asked about the type of vaccine they prefer to receive, once it's available. The analysis of data was performed using SPSS Statistic 22.0. Data were expressed in numbers and percentages; Chi-square was used and a p-value of <0.05 was considered significant. Ethical approval was obtained from the Scientific Committee at Al-Zahraa Medical College, University of Basrah. --- RESULTS A total of 9,620 Iraqi adults had responded to the survey. Majority of the respondents were female (67.16%), aged between 18 to 30 years-old (59.66%), graduated from college or above (88.97%), government employees (42.80%), and lived at Southern governorates (83.78%). Table 1 displayed the demographic characteristics of respondents. Out of 9,620 respondents, 70.68% (6,800 respondents) were not keen for COVID-19 vaccination. Table 2 presented the demographic characteristics of respondents who were not willing to get the covid-19 vaccination. Out of 3,160 male respondents and 6,460 female respondents, 2,180 male respondents (68.98%) and 4,620 female respondents (71.51%) were not keen for covid-19 vaccination. Thus, there was no statistically significance in different gender for covid-19 vaccination receptiveness (P-value=0.608). Out of 1,440 healthcare worker respondents and 8,180 public respondents, 820 of healthcare (56.94%) and 5980 of public respondents (73.1%) not keen for vaccination . Thus, the result shown that the unwillingness for covid-19 vaccination was high in both healthcare workers group and public group. However, it was statistically different (p-value <0.05). The survey also shown that the healthcare workers who keen for covid-19 vaccination preferred and trusted Pfizer vaccine than Sinopharm and AstraZeneca (29.16% vs 18.05% vs 9.72 %) respectively, whereas the public trusted Sinopharm than Pfizer and Astra Zeneca (14.91% vs 11.49% vs 6.84%). The results are displayed in Figure 1. --- DISCUSSION The emergence of covid-19 vaccination gives hope to the world in mitigating the covid-19 pandemic, However, many people were hesitant and had no intentions to be vaccinated. Our online survey observed that nearly three -quarters of the respondents had no willingness to be vaccinated and only 29.32% were keen for vaccination. There were several studies conducted to determine the intention of the public for COVID-19 vaccination had demonstrated high acceptance rates compared to our study. 14,15,16 The high acceptance rates in those studies were associated with better knowledge regarding the severity of COVID-19 and high trust in the vaccines by the respondents. In our study, majority of the respondents were women (67.16%) which is similar to a study conducted in Malaysia (65.9%) but slightly higher than those conducted in United States by Paul et al (56%) and Malik et al (57%). 9.15,16 In our study, majority of our respondents were aged between 18 to 30 years (59.66 %). A similar result was shown in a study by Hassan et al where more than 75% of respondents were in the age group of 18-29. 17 Healthcare workers accounted for 15% of our study respondents. Our study result demonstrated that 56.94% of the healthcare workers were not willing for vaccination in which the result was higher than reported result of a study conducted in Egypt (21%) and in Turkey (20.7%). 16,18 Our study result also demonstrated that majority of healthcare workers and public were not convinced that the vaccine is effective to prevent the covid-19 infection (55.55% vs 69.43%), provide long-term immunity (75.00% vs 80.68%), or safe (59.72% vs 74.59) respectively . In comparison to our finding, a study by Sandooja et al showed that 75% of the participants believed in the vaccine's efficacy, 75% thought people can be protected from COVID-19 by vaccination and 87.9% considered the COVID-19 vaccine to be safe. 19 In our study, 70.83% of healthcare workers and 66.92% of public were worried of being infected with covid-19. Our study results were consistent with a study conducted by Parikh PA. et al in which 80% of healthcare professional and 82% of the general public worried of being infected with the covid-19 post vaccination. 20 In our study also, 34.72% of healthcare workers and 64.05% of public were feared of death. Our study shown that 16.66% of healthcare workers and 38.38% of the public believed that the vaccine may cause infertility. In a study in Germany, 21.9% of participants concerned about impact of vaccines on own fertility. 21 Our results showed 5.55% of healthcare workers and 12.95% of public believed that it could alter their genes. A similar study conducted in Nigeria demonstrated that 15% of their respondents worried that the vaccine could alter their genes or genetic makeup. 22 Our study revealed that the healthcare workers and the general public believed that the covid-19 vaccine may cause congenital infection and anomalies (29.16% vs 25 . A study in Poland demonstrated 20% of participants believed that the vaccine causes defects in the fetus. 23 Our study also revealed that the healthcare workers and the general public believed that women at reproductive age should postpone pregnancy after vaccination (47.22% vs 17.23 %). Our study demonstrated that the healthcare workers trusted Pfizer vaccine than Sinopharm and AstraZeneca (29.16% vs 18.05% vs 9.72 %) respectively whereas the public trusted Sinopharm over Pfizer and Astra Zeneca (14.91% vs 11.49% vs 6.84 %). A previous study in Iraqi Kurdistan region reported that AstraZeneca and Pfizer vaccines frightened the most people (39.9% and 34.01%, respectively). 24 WHO and the Ministry of Health in Iraq raised the challenge to vaccinate the maximum number of people possible to control the COVID19 Pandemic as soon as possible. Iraq prioritizes the high-risk populations through a multi-phase roll-out plan and it is mandatory for all government employees to receive at least two doses of the vaccine. One study limitation was the use of social media in collecting the information, the sample was not generalized, may not represent the population, as this might affect people who have limited access to the internet made them unable to take part in this study. Other limitation is that the questionnaire was in google forms and using Arabic language , non-citizens who do not understand the Arabic language showed no response. These limitations could be addressed in future research. --- CONCLUSION AND RECOMMENDATION Hesitancy for vaccination is a major threat to vaccination success. A rapid development of a new vaccine contributes to the hesitancy, fear, and doubt of COVID-19 vaccine. An increase numbers of people being vaccinated should increase the belief that the vaccines are safe and decrease the fear and hesitancy among the general population. The Ministry of Health needs to address this public health challenge and ensure public confidence in COVID-19 vaccines. Various strategies are recommended to overcome vaccine hesitancy. The healthcare providers and community leaders should play a key role in increasing awareness and knowledge by providing an effective education on the vaccine and clear communication approaches to address vaccine hesitancy. --- FUNDING INFORMATION There was no specific grant or funding received for the study. --- DECLARATION OF COMPETING INTEREST There are no conflicts of interest.

Concern (PHEIC) that endangers international public health with cases ranging from individuals who are asymptomatic to those who experience severe respiratory distress, pneumonia, and death. 7,8,9 The global efforts to lessen the effects of the pandemic, and to reduce its health and socio-economic impact rely to a large extent on the preventive efforts. 10,11,12 Many efforts have been directed toward the development of the vaccines against COVID-19 and several prophylactic vaccines against COVID-19 are currently in development phase researchers across the

Objective In 2012, an estimated 41 million US households paid more than 30% of their pre-tax income for housing (1). High housing costs make it difficult to afford other necessities, including food, transportation, and medical care. Housing affordability is associated with housing insecurity or stress related to affording rent or mortgage (2,3). Studies have reported associations between housing insecurity and mental health problems or avoiding medical care, but questions remain about the association with health risk behaviors and outcomes (4)(5)(6). This study characterizes adults who report housing insecurity and the relationship of housing insecurity to selected unhealthy behaviors and outcomes. --- Methods We analyzed data from the 2011 Washington State Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is a randomdigit-dialed telephone survey conducted annually in all 50 states, DC, and US territories. The Washington State BRFSS response rate for 2011 was about 47%. Data from 8,415 respondents responding to the state-added Social Context Module were used to assess the frequency of housing insecurity, which was defined as respondents answering "always," "usually," or "sometimes" to "How often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage?" (6), and the associations between housing insecurity and health risk behaviors and outcomes. We calculated unadjusted prevalence estimates with 95% confidence intervals (CIs) for housing insecurity, stratified by socioeconomic measures and demographics. Categorical variables representing socioeconomic and demographic measures were educational level, income (when available), home ownership, sex, health insurance coverage, Hispanic ethnicity, age, marital status, veteran status, presence of children in the home, and self-report of experiencing 3 or more adverse childhood experiences (ACEs) (eg, physical abuse) from 11 questions included in the state-added ACE module. Unadjusted prevalence ratios (PRs), PRs adjusted for socioeconomic measures and demographics (aPRs), and 95% CIs using predicted marginals were estimated to assess the relationship between housing insecurity and the following measures: current smoking, binge drinking during the past 30 days (defined as consuming 5 or more drinks on an occasion for men and 4 or more drinks on an occasion for women), delaying doctor visits because of costs in the last year, poor or fair self-reported health status, as well as 14 days or more in the past 30 days of poor physical health, poor mental health, or poor health limiting daily activity. These health risk behaviors and outcomes were chosen as a sample of quality of life indicators that are associated with different types of stressful events. All estimates used Washington State-specific raked and trimmed weights and were performed using SUDAAN version 11 (RTI International) to account for sampling weights and to adjust variance estimates for the complex sampling design. --- Results Among all Washington respondents, 29.4% reported housing insecurity. Respondents with the following characteristics reported a prevalence of housing insecurity higher than the state prevalence: high school education or less, annual household income less than $50,000, women, Hispanic ethnicity, aged 25 to 44 years, unmarried, living in households with children, or 3 or more ACEs (Table 1). The groups with the highest frequency of always being worried or stressed about having enough money to pay their rent or mortgage were respondents with incomes less than $25,000, people without health insurance at the time of survey, renters, and people with a self-reported history of 3 or more adverse childhood experiences. We categorized the frequency of housing insecurity into those who were housing insecure (reported being always, usually, or sometimes worried about making housing payments) and those who were housing secure (reported never or rarely worried). Among people reporting housing insecurity, 33.3% also reported delaying doctor visits because of costs, 26.9% were current smokers, and 26.3% had poor or fair health (Table 2). People who were housing insecure were more likely to be current smokers than people who were not insecure (aPR = 1.4). Binge drinking in the past 30 days was not significantly associated with housing insecurity. Those who were housing insecure were nearly 6 times as likely as those who were not insecure to delay doctor visits because of costs (PR = 5.7). This association was attenuated but still significant after adjusting for socioeconomic measures and demographics (aPR = 2.6). Compared with people who were not housing insecure, respondents who were insecure were about twice as likely to report poor or fair health status (aPR = 1.9), 14 days or more of poor mental health (aPR = 2.3), or poor health limiting daily activity in the past 30 days (aPR = 2.0). A weaker association was found between housing insecurity and 14 days or more in the past 30 of poor physical health (aPR = 1.5). --- Discussion We found that respondents who were housing insecure were more likely than those who were not to report the following even after adjusting for demographics and socioeconomic measures: delaying doctors' visits, poor or fair health, and 14 days or more of poor health or mental health limiting daily activity in the past 30 days. This is not the first study to show an association between housing insecurity and health (2)(3)(4), but to our knowledge, it is the first to show that such associations exist even after controlling for various socioeconomic and demographic measures. This study also shows the value of using data from both the ACE and Social Context state-added BRFSS modules. The findings in this report are subject to at least 4 limitations. First, because the BRFSS is a cross-sectional survey, it is not possible to determine if housing insecurity and health outcomes are causally related. Second, the BRFSS excludes participants who are homeless. People who experienced housing insecurity and then became homeless would not be included, perhaps leading to an underestimation of the association between housing insecurity and poorer health. Third, even though possible confounders were controlled for in the model, residual confounding from using categorical variables could still exist, and not all possible confounders could be controlled. Finally, BRFSS data are self-reported and subject to recall and social desirability bias. This analysis supports a call to action among public health practitioners addressing disparities to focus on social determinants of health risk behaviors and outcomes as barriers for people to achieve optimal health (7,8). The National Prevention Council's Action Plan, for example, emphasizes that affordable housing can help make healthy lifestyle choices easier (8). Such engagement represents an expansion of public health's traditional housing-related efforts that focused on environmental health and safety (9,10) and encourages multisector collaboration as well as nuanced approaches toward health equity. (continued) --- Author Information Corresponding Author: Mandy Stahre, PhD, Chronic Disease Epidemiology Supervisor, Epidemic Intelligence Service Officer (Class 2012), Washington State Department of Health, PO Box 47835, Olympia, WA 98504-7835. Telephone: 360-236-4247. Email: mandy.stahre@doh.wa.gov. --- PREVENTING CHRONIC DISEASE

Few studies of associations between housing and health have focused on housing insecurity and health risk behaviors and outcomes. We measured the association between housing insecurity and selected health risk behaviors and outcomes, adjusted for socioeconomic measures, among 8,415 respondents to the 2011 Washington State Behavioral Risk Factor Surveillance System. Housing insecure respondents were about twice as likely as those who were not housing insecure to report poor or fair health status or delay doctor visits because of costs. This analysis supports a call to action among public health practitioners who address disparities to focus on social determinants of health risk behaviors and outcomes.

Physicians' Consideration of Race in the Clinical Context A straightforward understanding of how physicians employ race in medicine is complicated by the fact that they are exposed to highly varied and often competing narratives about the role of race in health. Today, many scientific studies aim to highlight genetic differences between racial groups, while an equal volume of literature adamantly criticizes the notion of race as having any biological basis. Epidemiological literature clearly shows that disease prevalence differs between racial groups, although the mechanisms behind these differences are not always clear. Additionally, racial stereotypes and assumptions are a source of unquestioned logics about who belongs to which racial group and how their culture, values, and habits influence health. In our efforts to understand how physicians incorporate or reject these narratives in their own practice, we and others have conducted qualitative and quantitative studies with physicians about the clinical relevance of race (Sellers et al. 2018, Hunt et al. 2013, Snipes et al. 2011, Bonham et al. 2009). In these studies, we see that race frequently becomes a proxy for a variety of unobservable characteristics that may increase the risk of poor health outcomes. For example, physicians in focus-group studies have made connections between race and health behaviors by explaining that certain groups prefer unhealthier foods or larger body sizes, have alternative cultural practices surrounding health, or prioritize health in Disclaimer The opinions expressed in this article are those of the authors. No statement in this article should be construed as an official position of the National Human Genome Research Institute, National Institutes of Health, or Department of Health and Human Services. different ways (Hunt et al. 2013). They also discuss a relationship between race and class, suggesting that certain racial groups may be at higher risk for many conditions because of their low health literacy, lack of quality health care, or limited access to the resources required to live a healthy lifestyle (Hunt et al. 2013, Bonham et al. 2009, Snipes et al. 2011). Finally, physicians have reported that certain racial groups may be genetically predisposed to specific conditions (Bonham et al. 2009, Hunt et al. 2013). In some cases, these narratives about the relationship between race and health differences are codified into race-specific clinical guidelines. Physicians discuss examples of a number of race-specific recommendations (Hunt et al. 2013, Snipes et al. 2011, Bonham et al. 2009), such as those to screen for diabetes at a lower body mass index (BMI) for Asian Americans (American Diabetes Association 2018), adjust for race in measurements of lung function (Braun 2014), and consider the increased risk for prostate cancer in African American men when making decisions about prostate-specific antigen screening (U.S. Preventive Services Task Force 2018). Such guidelines adjust for differential disease risk based upon patients' perceived ancestral background and social characteristics, which are described using the construct of "race." The scientific and clinical basis for some of these guidelines have previously been critiqued through a broader examination of the history of the relationships between race, science, and medicine (Braun 2014). --- Intersectionality and the Role of Race in Clinical Medicine We recognize that race and other social identities can be important to consider in the clinical context, but the improper use of race lends itself to imprecise and inadequate care. Many contemporary critiques of the use of race in medicine have centered around the complex relationship between racial categories and genetic variation. Race is fluid, contextual, and does not map neatly onto genetic variation, and assuming that it does risks missing diagnoses, giving inappropriate treatment recommendations, and reinforcing the debunked notion of discrete biological races. In this context, intersectionality adds another lens through which to challenge the uncritical consideration of race in the clinic. Underlying physicians' manifold explanations for the medical relevance of race, or the "adjustment" for race in clinical guidelines, can be the assumption that members of a racial group share the experience of race and its associated burdens, risks, and contexts in similar ways. However, intersectionality posits, and intersectional research has shown, that this is not the case. At its core, intersectionality theorizes that multiple social identities interact to create wholly unique experiences of marginalization and privilege. Therefore, even individuals who share in an axis of identity such as race will have diverse experiences based on their unique social positions along other axes (Crenshaw 1989). In the biomedical realm, we see these ideas play out in the differential risks for diseases that are revealed through intersectional analyses of epidemiological data. For example, the relationship between hypertension and race is well established and is one that physicians frequently raise in discussions about race and medical treatment (Hunt et al. 2013, Bonham et al. 2009, Snipes et al. 2011). However, the prevalence of hypertension has been reported to be even higher in women of color than their male counterparts, and in line with the intersectional reality of these women's lives, this effect is multiplicative rather than additive (Richardson and Brown 2016). For physicians, these findings and intersectional thinking more broadly do not mean that they should simply use more complicated sets of heuristics or reference values that involve multiple social identities. As Wilson and colleagues write, "attention to intersectionality does not necessarily demand finer and finer grained distinctions in order to create new analytic categories of similarity…Rather, intersectionality requires a shift in thinking from dominant frameworks to frameworks that are mindful of how one's social identity contributes to one's experience of the world" (Wilson et al. 2019). We concur, and add that this "shift in thinking" for physicians can involve a revisiting of how they conceptualize race. Under an intersectional framework, race is not a constellation of social contexts, behaviors, or genomic information that can be packaged into a proxy or reference value. Rather, it is one of many identities that determine patients' unique location within interlocking societal structures, and it is the whole experience of this social position that shapes health. What follows from this reconceptualization is that physicians, when they consider race, would consider it in conjunction with the entirety of a patient's identity and social context. They would be open to working through the many ways in which race, together with other social identities and structures, might make a patient more vulnerable in the healthcare system, susceptible to an illness, or suited for a treatment plan. We recognize that intersectionality is ambiguous in methodology and application -it certainly does not spell out the precise health consequences of specific combinations of identities. However, like Wilson and colleagues, we do not see this ambiguity as a weakness. To the contrary, it simply leaves room for health care providers to be open-minded, expansive, and even creative in how they consider the relationship between a patient's social context and health. Our vision for the role of intersectionality in clinical decision making mirrors that of Wilson and colleagues in many ways. However, thinking through the implications of their proposal specifically for physicians' consideration of race highlights the ways in which intersectionality can address at least some of the tensions surrounding the relationship between race and medicine. First, the use of race in medicine is criticized for seeking the rationale for differences in health in biology, which can distract from efforts to address social health inequities. However, an intersectional framework unequivocally foregrounds the role of race in structural social inequities. Second, the use of race as a proxy or heuristic has been criticized for leading to inappropriate care when the assumptions underlying the heuristic are not necessarily true. An intersectional framework is not based upon assumptions about the relationship between a patient's race and disease risk, as it recognizes that social identities and structures can converge in unique and unexpected ways. In this way, intersectionality can foster a truly expansive and thoughtful consideration of a patient's social context in clinical decision making. This research is supported in part by the Intramural Research Program of the National Human Genome Research Institute.

propose intersectionality as a framework that can make clinical medicine more attentive to the complexity of patients' and health care providers' social identities. We agree that "intersectionality acknowledges how multifaceted differences shape the patient-clinician interaction and forces a re-framing that can lead to improved outcomes" (Wilson et al. 2019, 8). In this commentary, we extend Wilson and colleagues (2019) by highlighting the significant influence of one social identity in medicine and the clinical encounter: race. In the midst of deliberations about the appropriate role of race in science and medicine, intersectionality can challenge an uncritical use of race and foster a more expansive consideration of social identities in clinical decision making.

the harmful side effects. Anger that I would adjust or change their treatment regimen to include non-opioid therapies. These patient encounters felt like a negotiation in futility. Within 3 months, I was facing burnout, feeling disillusioned as I combated an inner war between best practice and trying to meet the wants of my patients. These intensifying feelings of self-doubt and frustration climaxed in a distinct moment of weakness. I was standing outside of a patient's room mentally preparing for the upcoming discussion of her pain medication regimen after an inconsistent drug screen. I was 40 minutes behind in the middle of a 12-hour clinic shift and I knew this was going to be an intense and time-consuming clinic visit. There was a sick feeling in the pit of my stomach, a feeling that had been occurring more frequently on a daily basis, and I wondered how I had gotten to this point. Difficult discussions are common in medicine, but not discussions in which the physician is made to consistently feel the villain. I started questioning whether the inevitable confrontation and conflict was worth it. Should I just sign another prescription? There would be no denial, no anger, no questioning of clinical judgement, and no conflict if I just said yes. I realized, however, that acquiescing would create 2 problems: it would potentiate the denial that this patient had an addiction, and would eventually place the prescribing burden on another physician. I suddenly saw the source of my frustration and self-doubt: I lacked the experience and tools to treat this overwhelming and dangerous health condition. A colleague of mine noted my despair and invited me to a meeting at the Substance Abuse Treatment Unit of Central Iowa (SATUCI). The director of SATUCI expressed a need for a physician in our community to offer medication-assisted treatment (MAT), in particular buprenorphine and naltrexone for those addicted to opioids. I realized I could learn how to treat opioid addiction through MAT and at that moment felt the sick feeling in my stomach dissipate for the first time in months. Opioid addiction treatment with the combination of MAT and therapy has a 60% success rate and a 12% success rate with therapy alone. In our rural community, we had very limited resources and there were no MAT providers within a 60-mile radius. Without access to medication assisted treatment, patients had little incentive to self-identify as having an opioid use disorder. The fear and discomfort of withdrawal in addition to the social stigma associated with addiction was a barrier that could not be overcome without changing the way we as a clinic approached this disorder. I realized we could provide a treatment option to help stabilize those who were found to have addiction through our chronic pain program or self-identified as being addicted to opioids while they undergo addiction counseling and therapy. Following MAT training and initiation of our program, my role transformed from villain to coach as we became a key component to our patients' treatment of addiction. As we developed our program and began enrolling patients for treatment, we began to heal our patients and our community. Mrs Smith's story was not unique; a significant amount of the opioid addiction in our community began following a prolonged prescription of opioids. Patients within our clinic began coming forward expressing their desire to be free of the destruction that follows the wake of addiction. Following the demand we had in our clinic, we wanted to expand the program to all patients in the community. We received a federal Health Resources and Services Administration (HRSA) MAT community expansion grant; however, acceptance by the local medical community proved difficult. Some providers denied opioid addiction as a problem and declined information on the program. One clinic manager stated their clinic had had 1 patient in the past 20 years with an opioid addiction. I was in shock and disbelief. After discussion with community leaders, we came to 2 possible scenarios: either patients were not being screened for addiction or there was a lack of awareness by clinicians. Many clinics have a low addiction-screening rate due to the pressure on physicians to increase productivity and patient satisfaction. Responsible opioid prescribing with random urine drug screens and pain agreements opens a door to conflict that practices may choose not to undertake. Lastly, that moment of weakness where I had contemplated avoiding the discussion and signing a script is a daily struggle for many physicians. Whether the reasons are productivity, patient satisfaction, avoidance of confrontation or lack of resources, this professional and community self-denial is as dangerous as the epidemic itself. As family physicians, if we are not recognizing addiction and recommending appropriate treatment, we will not be doing our part to curtail the opioid and heroin crisis, and, even worse, we will contribute to the opioid epidemic. On our path toward change, it is imperative that we acknowledge many of the barriers that affect our fellow physicians. What support do we have for our solo or small practice physicians who rely on patient interaction and feedback for the survival of their practice and their own professional satisfaction? Who coaches these physicians and supports them before and after an aggressive patient encounter? Who exposes primary care physicians to the prospect and feasibility of becoming a medication-assisted treatment provider? Chronic opioid dependence and addiction has permeated all socioeconomic and geographical levels of our society. Despite the statistics, public health announcements, and litany of celebrities who die of an overdose-denial is still the predominant response. Denial is the single largest threat in addressing the opioid epidemic-denial by patients, denial by physicians, denial by families, denial by communities, and denial through lack of access to MAT treatment. I chose not to deny the opioid epidemic, and the lack of resources and training led to burnout. The decision to provide my patients and community access to MAT led to my professional healing. In the community, our clinic created a culture of recognition of opioid addiction, openness to challenge current prescribing habits and encouragement of treatment of opioid addiction. I implore our profession to develop a similar culture and network of support for physicians to engage in when they are compared with "my old doctor." To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/15/4/372. Key words: substance-related disorders; opioids; opiate substitution treatment; addiction Submitted June 3, 2016;submitted, revised, December 5, 2016;accepted December 13, 2016.

Why can't you be like my old doctor?" This essay explores my experiences as a new family physician in a rural town endemic with liberal opioid prescribing practices and opioid addiction. I detail my inner turmoil while overcoming resistance to change, the influence of these experiences on my professional growth, and my decision to offer medication-assisted treatment.

INTRODUCTION Online dating is a way for people to meet and form romantic relationships over the internet. It typically involves the use of a dating website or app where users can create a profile and search for potential matches. With the introduction of smartphones and tablets, people can now connect with potential partners from anywhere in the world. Online dating apps such as Tinder, Bumble, and OkCupid have made it easier than ever to find a match. Technology has also enabled users to filter potential matches based on their interests, location, and other criteria. Additionally, online dating sites have implemented safety measures such as background checks and photo verification to ensure that users are who they say they are. Although recent studies and media reports indicate that it may also be a good environment for deceit, online dating is a well-liked new method for starting love relationships. The current study in a contrast to other ones that only used self report data, establishes ground truth for 8-online daters height, weight and age and contrasts it with information given in dating profiles. The findings imply that although dishonesty is regularly notices, it typically occurs at a low level. It was revealed that more people are engaging in dating online as indicated by a 7 month rise in the percentage of conventional traditional daters which increased from 41% to 1 69% . The fact of portraying oneself as attractive might encompass from the way dating software works, it includes a set of photographs that is swiped through in order to find a suitable dating partner which catches the individual's eye thereby physical appearance becomes a key factor in choosing dating 2 partner . Some of the factors that would be looked into is social desirability and self-image, here social desirability means one can quantify desirability by the number of messages a user receives and specifically the number of initial messages, since it is the first contact between a pair of individuals that most reliably indicates who finds whom 3 attractive . It was estimated that the mate preferences used information by utilizing the Gale-Shapley algorithm to forecast stable pairings using data on user traits and interactions from an online dating service. The real matches are roughly as efficient as the anticipated matches, which are close to the actual matches the dating service has been made. Out-ofsample forecasts of offline matches, or marriages, show assortative mating patterns that are consistent with those seen in real marriages. As a result, sorting in marriages might be caused be mate preferences without the need of search frictions. However, the correlation patterns; search frictions 4 could be a factor in this discrepancy's explanation . --- METHOD Sample distribution The sample size was 206 which is based on whether the individuals are using online dating apps currently Inclusion Criteria: Individuals who are in the age range of 18 to 30 and who are currently using online dating apps. --- Exclusion Criteria: Individuals who haven't used dating sites and who used dating sites previously. --- Procedure The questionnaire approach was employed as the primary source of primary data. The standard scales that were used are Marlowe-Crowne Social Desirability scale -short form and Body Self-Image Questionnaire-short form Tools used for the study 1. Marlow -Crowne Social Desirability scale -short form. --- Body self-image questionnaire by David Rowe (2005, June) --- Statistical Analysis The statistical Package for Social Sciences (SPSS) version 26.0 was used to evaluate the hypotheses using Pearson Correlations and Regression Analysis. --- RESULTS AND DISCUSSION --- Table 3: Correlation Between Social Desirability And Body Self-image The Pearson Correlation was done to analyze the correlation between social desirability and Overall Appearance Evaluation and correlation coefficient r was found to be 0.188 which is statistically significant at 0.01 level, since there is a low positive correlation and the p value obtained is 0.007 (p<0.05), indicating that the null hypothesis which states that there is no significant relationship between social desirability and overall appearance evaluation is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Influence. The correlation coefficient r was found to be 0.123 which is statistically insignificant at 0.01 and 0.05 levels, since there is a low positive correlation and the p value obtained is 0.078 (p>0.05), thus indicating that the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and Investment in Ideals. The correlation coefficient r was found to be -0.38 which is statistically insignificant at both 0.01 and 0.05 levels. Since there is a low negative correlation and the p value obtained is 0.585 (p>0.05), thus the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Evaluation. The correlation coefficient r was found to be 0.075 which is statistically insignificant at both 0.01 and 0.05 levels. Since there is no significant correlation and the p value obtained is 0.285 (p>0.05), thus the null hypothesis which states that there is no significant correlation between social desirability and height fitness evaluation is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and social dependence. The correlation coefficient r was found to be -0.184 which is statistically significant at both 0.01 and 0.05 levels. Since there is a low negative correlation and the p value obtained is 0.008 (p<0.05), thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Height Fitness Evaluation. The correlation coefficient r was found to be -0.152 which is statistically significant at 0.05 level. Since there is a low negative cor relation and the p value obtained is 0.029(p<0.05), thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and Attention to Grooming. The correlation coefficient r was found to be -0.188 which is statistically not significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0.91, thus the null hypothesis is accepted. The Pearson Correlation was done to analyze the correlation between social desirability and negative affect. The correlation coefficient r was found to be -0.398 which is statistically significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0, thus the null hypothesis is rejected. The Pearson Correlation was done to analyze the correlation between social desirability and negative affect. The correlation coefficient r was found to be -0.320 which is statistically significant at both 0.01 and 0.05 level. Since there is a low negative correlation and the p value obtained is 0, thus the null hypothesis is rejected. --- Table 4: Linear Regression To Assess The Impact Of Social Desirability On Aspects Of Body Self-image Table 4 shows the regression analysis of social desirability on overall appearance evaluation with Beta value of 0.188, t value 2 of 2.727. The model summary indicates that the r value is 0.035, F is 4.831 and the result was found to be significant with p<0.05. This indicates that there is a significant impact of social desirability on overall appearance evaluation among 2 young adults on online dating. The r value indicates that 3.5% change in overall appearance evaluation is predicted by social desirability. Thus, rejecting the hypothesis. The regression analysis of social desirability on height dissatisfaction with Beta value of -0.232, t value of -2.198. The 2 model summary indicates that the r value is 0.023, F is 4.831 and the result was found to be significant with p<0.05. This indicates that there is a significant impact of social desirability on height dissatisfaction among young adults on 2 online dating. The r value indicates that 2.3% change in height dissatisfaction is predicted by social desirability. Thus, accepting the hypothesis. --- Variables --- CONCLUSION With the use of descriptive and inferential statistics, it was shown that social desirability had positive correlation with overall appearance and negative affect in terms of body selfimage, but a negative correlation with height dissatisfaction, fatness evaluation and social dependence. Regarding the impact of social desirability on the variables of overall appearance, fatness evaluation, negative affect, and social dependence in the area of body self-image, it was seen that there was an impact on the aforementioned variables. --- REFERENCES:

The current study "social desirability and body self-image among young adults using online dating apps" looks into the relationship between social desirability and body self-image and how social desirability influences body self-image. A total of 206 participants from both male and female genders belonging to the age group of 18-30. The tools used were Marlowe-Crowne Social Desirability -Short Form(CMSDS) and Body self-image questionnaire -Short Form(BSIQ-SF). The statistical technique for correlation was used to identify the association between social desirability and body selfimage, in which the body self-image consists of 9 subscales. The findings of the study indicate there is a negative relationship between social desirability and fatness evaluation, height dissatisfaction and social dependence with respect to body self-image and a positive relationship between social desirability and overall appearance evaluation and negative affect in body self-image. Lastly, there is a significant impact of social desirability on negative affect and fatness evaluation with minimal impact on overall appearance evaluation, social dependence and height dissatisfaction in relation to body self-image.

Introduction In September 2022, 45 Clinical Psychologists (in training) and scientistpractitioners paid a working-visit to colleagues in Lisbon, Portugal as part of their post academic education program. Public, private medical and psychiatric hospitals, public mental healthcare facilities, the university, start-ups and innovation centers were visited. During this working-visit, Prof. Dr. D. Neto, lecturer and researcher in ISPA (the first school of Psychology in Portugal, a private University, https://www.ispa.pt/) provided a global view of the presence of clinical psychologists and psychotherapists in health care contexts. He substantiated the need for the integration of an increasing number of professionals in hospitals and primary care. In Portugal some rural regions have very little support with respect to other regions. The differences in the organization of the healthcare system between the Netherlands and Portugal were explained. These (cultural) differences inspired the trainees. At the end of the working-visit there was clear agreement on future international cooperation and exchanges of knowledge [1]. Both the Portuguese and Dutch colleagues agreed that several topics require constant attention to promote the relevance of psychology in different domains such as (public) healthcare and scientific research. In addition, the importance of uniformity in education and training, examination and implementation of the profession of psychologists in a European context was supported. --- Continuing the collaboration To perpetuate the interconnection and new cooperation, collaboration between the Dutch and Portuguese Clinical Psychologists continued digitally in 2023 to prepare a live working-visit in the autumn of 2024 with a new group of Clinical Psychologists (in training). A first part of the collaboration involved a masterclass on EMDR treatment on trauma in June 2023 which was organized together with the Psychiatric Hospital Júlio de Matos. The Portuguese colleagues N. Canudo and P. Diegues., both Clinical Psychologists, arranged a two-day conference on several topics (Jornadasdo Serviçode Psicologia Clínica: Um Serviço, várias especialidades (min-saude. pt), including trauma therapy. As part of this conference, a Dutch delegation organized an online lecture on EMDR offered by a Dutch expert, Clinical Psychologist Drs. R. van Diest. According to Kaats and Opheij (2012), 5 impactful indicators are important for the effectiveness of cooperation, which they integrate into the so-called Lens Model: Ambition, Interests, Relationship, Process and Organization [2]. In the preparation of the masterclass, we used this model as a frame to optimize the results of the collaboration. A small workgroup was formed and a close contact with colleagues from Psychiatric Hospital Júlio de Matos was attained online, to discuss ambitions and organizational details of the masterclass and the precise content of the program involving EMDR practice in general. were considered and ensured by a pre-conference meeting. Intercultural cooperation requires effort from both parties to get to know each other's habits and self-evidence, allowing mutual trust to grow. --- The process and the technical conditions EMDR therapy is being practiced in the Netherlands extensively, and is also rising within the Portuguese health care system. The main goal of this masterclass was to inform the Portuguese colleagues about the applicability and current scientific status of EMDR in the treatment of trauma and other psychiatric disorders. The Portuguese colleagues were expected to be enthused about the possibilities of EMDR and referred to the national professional association to become EMDR therapists. The masterclass was well visited by approximately 70 Portuguese professionals; both live present in the Portuguese lecture-hall as well as online. The attendants appeared to be well engaged and multiple questions about the treatment technique were asked after the lecture. The digital form of the lecture did not seem to limit interactive communication and engagement. In return, the Portuguese colleagues inspired the Dutch delegation in the advisory function they built up on national level and in their experience with for example community based care [3]. In the autumn of 2023 more innovative events will take place. In collaboration with Hospital CUF Tejo, Lisbon city, an exchange of scientific research will take place during a conference. Further, the Ordem dos Psicólogos Lisboa will exchange experiences with the Dutch Institute of Psychologists (NIP). At the end of the year an event will be organized in collaboration with Manicómio art outsider studio with respect to Experiential Expertise. Both the Dutch and Portuguese delegation stimulate young professionals to join the events and prepare them to be the key figures that contribute to the fusion of psychologists and use the power of community on a global scale [4]. --- Young professionals and mental healthcare challenges over the world The digital opportunities to discuss and exchange knowledge create positive implications for cooperation between countries, which can lead to innovation and creative solutions. Advantages of digital exchange include for example time efficiency, especially compared to live communication. The digital possibilities have grown extensively over the last several years. Especially since the COVID-19 pandemic, advanced technology supports the expansion of digital health entrepeneurship [5]. Maintaining digital collaboration also creates new opportunities and pathways for future work and helps to be flexible in rapidly changing environments [6]. Moreover, young professionals are more used to working with digital resources and may prefer this method of working over face-to-face communication. Also, and importantly, digital cooperation provides the benefit of sustainability. Innovation and creative solutions that are expected to be created through these developments are urgently needed to address larger, global issues within mental health care. Mental health systems around the world are under pressure due to different factors such as aging and an increasing workload [7]. Young professionals have to deal with big global challenges on different levels, as well as maintaining their own mental health. Research shows that mental health professionals report more sick leave and frequent absences post-pandemic, which highlights the importance of the focus on their resilience [8]. This may be particularly challenging for them considering the current global issues that may affect their work on direct or indirect level, including climate change, war, and staff shortages due to aging. International collaboration provides chances to unite on a larger level, to learn from each other, and to exchange evidence based, uniform knowledge. To conclude, it can be interesting to expand international cooperation on mental health. --- Conclusion and clinical relevance In order to expand the new cooperation between clinical psychologists (in training) in The Netherlands and Portugal, an online EMDR masterclass was provided by Dutch psychologists as part of a two-day conference at the Portuguese psychiatric hospital Júlio de Matos. The main goal of the masterclass seems to be achieved; colleagues have been enthused, relevant and evidence-based information about EMDR has been exchanged, and the cooperation has been continued to prepare for a new working-visit in 2024. These achievements would have been far less feasible without the use of current digital opportunities, in a time when international collaboration seems to be increasingly important given the rising global issues that affect mental health care. By all means the collaboration between the Dutch and the Portuguese Clinical Psychologists will be continued in the future. There is a common hope for a long-term cooperation and exchange of knowledge which can be inspiring for intercontinental collaboration as well. As we stated before [1] and in accordance with our expectation, a lot of lessons in mental healthcare are to be learned abroad. It's work in progress. --- Conflicts of Interest All authors declare that they have no conflicts of interest.

Background: The international working visit of a Dutch delegation of 45 clinical psychologists (in training) and science-practitioners in September 2022 to their colleagues in Lisbon, Portugal as part of their post academic education program inspired young psychologists to realize a masterclass. Purpose: Exchanging information on specific treatment between the Dutch psychologists and the colleagues from the Portuguese Psychiatric Hospital Júlio de Matos. Method: A digital masterclass on EMDR treatment. Results: A mutual ambition for a long-term cooperation over the borders and exchange of knowledge which provides more uniformity and positive solutions for future challenges. Conclusion: Digital opportunities create positive implications for cooperation between countries which can lead to innovation and creative solutions.

importance of corporeal attributes and the embodied dispositions of workers during service encounters. However, the theory is also challenged for its dominating feminist scope and the one-sided accentuation of the dysfunctions of society. A growing volume of research has diverted the attention on the experiences of male workers in aesthetic labor, and some, at the same time, are attempting to justify the prevalence of aesthetic labor by examining the agency of workers during the labor process. Comparative case studies, as well as the scope of cultural approach, are considered two promising research methodologies for aesthetic labor studies. Although the pursuit of beauty has always accompanied human development, the value of a "good look" has never been more prominent in our age. The booming of beauty industries such as make-up, modeling, and fashion has witnessed how a desirable physical appearance helps countless men and women ascend the social ladder from almost the bottom to the top. An increasing volume of literature focuses on the phenomenon, among which the term "aesthetic labor" stands out as one of the most influential theories that capture the characteristic of occupations based on the never-ending polishment of physical appearance. After two decades of development, the theory of aesthetic labor has stimulated volumes of research examining the role of the body and physical beauty in interactive service work. The review essay aims to sketch the breakthroughs that the theory have made, the debates centered on the theory and the future directions that might fill the gap. --- Keywords: Aesthetic Labor; Economy; Strathclyde Group; Sociology of Work --- Aesthetic Labor in the Millennium Aesthetic labor is introduced alongside the discussion of the "new economy" at the advent of the millennium. In their book "Looking good, sounding right: Style counselling in the new economy", Warhurst C, et al. [1] contend that it is not the "thinking" and technical skills in the IT industry, but the "aesthetic skills" possessed by front-line workers in service sectors, hold the key to employability and the key to economic success during the industrial transformation of UK at the dawning of the 21st century. Using the successful shift of Glasgow as an example, they illustrate how the recruitment of employees with stunning looks and consonant dispositions vitalizes the service market and the city's economy. Generally, aesthetics refers to the sensual components of people's daily encounters. Aesthetic labor is "the mobilization, development, and commodification of embodied dispositions" [2]. By accentuating the corporal attributes and a set of embodied dispositions of workers that arouse the visceral sensibilities and aesthetic experiences of customers, Warhurst C, et al. [3], who are later known as the "Strathclyde group", discover the "aesthetic" dimension of service work and its influence on re-defining the service interaction. Later on, the "Strathclyde group" subsequently initiate a series of research surrounding the theory of "aesthetic labor", with the ambition to re-conceptualize the work and employment structure of service organizations [3]. The theory shines out its greater empirical competence nowadays, given the omnipresent beauty images enhanced by the well-developed visual technologies and the lucrative beauty economies [4]. Apart from its empirical significance, the theory has its theoretical stick points to emotional labor. By foregrounding the body and bodily presentations in service encounters, the "Strathclyde group" challenges the theoretical and even the epistemological basis of emotional labor, which has been generally accepted as the dominant research paradigm in studies of interactive service work for decades. --- Beyond Emotions: The "Aesthetic Turn" In the Study of Service Work In her pioneering work "The managed heart: Commercialization of human feeling", Arlie Russell Hochschild AR [5] states that besides the physical and mental labor, a flight attendant is also required to "induce or suppress feeling to sustain the outward countenance that produces the state of mind in others" [5]. This requirement is termed as emotional labor by her and has been widely acknowledged by the academia. The empirical applications spread out to different disciplines from organization and management to the sociology of work, and the core interest of the discussion centers around the dynamic power relations in service encounters and the consequences of the commercialization of emotions [6][7][8][9]. After three decades of development, scholars' attention has returned from empirical explorations to theoretical reflections of emotional labor. One of the most often-heard critics among emotional labor theorists is that the empirical research has been theoretically fragmented and case-specific, lacking the potency to provide coherent theoretical guidance for academia [10]. Recent studies are trying to compensate for the inadequacy by providing an integrative framework to conceptualize and operationalize emotional labor [11]. More than the lack of theoretical coherence, critics from the literature stream of aesthetic labor make a breakthrough by pointing out the theory's analytical drawbacks. In their article "The labour of aesthetics and the aesthetics of organization", Witz A, et al. [2] address the deficiencies of the analytic frame of emotional labor and theorize aesthetic labor. The first one lies in the overlook of corporeality. By theorizing the labor in service work as "the war of smiles", Hochschild AR [5] dives into the inner struggle in the course of labouring while "analytically abandoning" the precise status of the flesh and blood that makes the acting possible. Moreover, the inheritance of the Goffmanian tradition, which leads to the surface-deep acting analysis, adds to the dichotomy of body-soul in the analysis. As a result, the surface "becomes synonymous with the body that is devoid of authenticity, where depth becomes synonymous with the soul as the authentic, feeling core of the self" [2]. Drawing from the "embodied disposition" that Bourdieu brings about in his practice theory, aesthetic labor is capable of resolving the body-soul dichotomy while foregrounding bodily presentation in service encounters. The re-conceptualization further prompted the "aesthetic turn" in service work studies [12]. From 2000 to the present, a series of studies have been carried out successively, led by "the Strachy Group". Case studies in retail and hospitality sectors, along with statistical analysis, are the primary research approach in their thread of research. Their research investigates how organizations perpetuate and institutionalize the importance of appearance not only through the recruitment and selection of "stylish" employees, but also through the cultivation of aesthetic skills underpinned by the training and supervision process [13,14]. The consequences of which are also scrutinized. Employees possessing a sense of "middle classness" gives rise to a new labor aristocracy and the prevalence of "lookism" [15], making physical appearance another important social category in employment discrimination. In their latest book, Warhurst C, et al. [16] gives a systematic theorization and application of aesthetic labor by dialoguing with theories from the sociology of work and body. --- Debates and what's Next Apart from focusing on the general routine interactive service jobs, a growing number of researchers have diverted their attention to professions where the management and commercialization of the body lie at the heart of the work process. The study of the modelling industry is amongst the most typical. Drawing from the fashion industries of New York and London, Entwistle J, et al. [17] argue that aesthetic labor entails the ongoing production of body/self. Besides staying physically attractive, freelancer fashion models must also invent distinctive "personalities" to survive in the industry. In "Pricing beauty: The making of a fashion model", Mears A [18] incorporates her own experiences of being a model to unpack the seemingly glamorous while precarious work conditions of fashion models. The edited work of Elias AS, et al. [4] are worth mentioning for its global vision in providing readers with worldwide empirical studies of aesthetic labor regarding various occupations encompassing the beauty industry from cosmetics, beauty make-up to wellness, social media entertainment. The collection mainly discusses how the ideology of neoliberalism facilitates the association between aesthetic labor and "entrepreneurial labor" and helps female workers re-interpret gender relations, femininity, and the relationship between work and self-transformation. As the majority stance of aesthetic labor, the previously mentioned research takes beauty as a feminist issue. It is not only because "looking good" has been intuitively reckoned as the mission for women [19], but also due to the fact that the politics of appearance has long been an ineluctable topic in feminist studies. Facing the concentration on female workers in aesthetic labor studies, a group of scholars starts to argue that it is essential for researchers to recognize that "gender is not just about women" [20]. It is not the first reminder. Researchers have proposed that "while there are indeed gendered and sexualized dimensions in aesthetic labour, it is by no means only female labour that is subject to commodification via aestheticization" [2]. --- By examining the work experiences of men who cross into what is conventionally defined as "women's work", Cross S, et al. [21] uncover men's struggle with their gender identity when masculinity is challenged. Drawing from ethnographic observations and interviews of two men's hair salons, Barber K [22] examines how organizations strategically habituate their employees with heterosexual masculine aesthetics that cater to their male clients. Elfving Hwang JK [23] interviews middle-aged urban men in South Korea and discovers that rather than emulating the hegemonic masculinity, men's aesthetic practices in the workplace are subject to the "homosocial gaze" of other male workers. Besides the feminist perspective dominance of the theory, there are also oppositions towards the dysfunction of what aesthetic labor poses on the selfhood of workers. For example, using the case of fashion modeling, Holla S [24] argues that the modification and commercialization of the body do not always lead to the separation of the body and the soul. Instead, models make efforts to justify their bodily practices by using moral repertoires that motivate themselves to be "natural" and "healthy". The debates above reveal the necessity to bring new analytical perspectives to unearth more nuanced explorations in aesthetic labor. Mears A [19] suggests that introducing comparative scope to examine the similarities and differences in different workplaces can help offer variable experiences that might be included in aesthetic labor. Another contribution may come from the perspectives of cultural sociology. Most of the contemporary analyses that emphasize the destruction of the commodification of the body in service work can be summarized, according to what Alexander JC [25] calls, as the materialist point of view that presupposes "human beings would be unable to experience their subjectivity in human-made objects until commodity exchange were overcome" [25,26]. This anti-commodification model has hindered a deeper understanding of how meaning is made by actors during the labor process. Instead of holding a material-positivist viewpoint, a hermeneutical approach that allows for a thick description of the meaning-making process of actors might be a refreshing scope for scholars to discover the dynamics underneath bodily performances.

Aesthetic labor refers to the process in which workers' appearances make the core of employability. After two decades of development, the theory has yielded outstanding theoretical and empirical achievements. The review briefly investigates the trajectory of the construction, the debates, and the unfinished agenda of aesthetic labor. Introduced at the dawn of the 21st century, aesthetic labor ambitiously re-conceptualizes the emotional labor paradigm by accentuating the role "looking good and sounding right" plays in the new economy. It challenges the analytic frame of emotional labor by foregrounding the Copyright© Wan R.

One or two kinds of social glue? As an anthropologist who studies religion, I am always an outsider looking inalbeit sympathetically. And that is often how I feel when trying to untangle the intricacies of the social identity perspective on group psychology, which appears (again, from the outside) to be forcibly reminiscent of a religious organization. Although the social identity perspective has two branches -Social Identity Theory (SIT) and Self-Categorization Theory (SCT) -all followers subscribe to a mainstream orthodoxy with varying degrees of piety and commitment. Core beliefs include that everything in group psychology, including the phenomenon of identity fusion discussed in my target article, falls within the ambit of the social identity perspective. As such, fusion appears to be just one more sect under the infinitely extendable umbrella of the mother church and her encompassing doctrines. Of course, outsider impressions can be misleading and I cannot claim to have conducted long-term ethnographic research among social identity theorists. So my comments on this topic will be as tentative as they are curious and well intentioned -and no doubt shaped to a degree by my having been trained to recognize the trappings of religious fervour no matter how subtly it is expressed. Field notebook in hand, I have spent the last few days tracking down informants. Let's begin by giving some space to their voices (it's standard practice in ethnographic research to disguise sources): "A while back, advocates of SIT and SCT (self-categorization theory) realized that many of their own workers didn't believe in the main tenets of one or more cardinal doctrines, e.g. functional antagonism (that activation of personal self reduces salience of social self and viceversa) and depersonalization (that groups members are categorically interchangeable when the group is salient)." Another informant described what happened next: "Instead of providing a formal revision to the theory, some researchers simply endorsed arguments that were in direct opposition to the original tenets. The result was that the informally revised 'theory' now embraced both the original theoretical ideas (e.g. functional antagonism and collective ties) and their opposites (e.g. identity synergy and relational ties). The resulting 'social identity perspective' was immune to falsification." Unfalsifiable? This sounds like a set of beliefs that can't be resolved on empirical grounds. Like a religious system perhaps? Let's explore this in more detail… According to Ingram and Prochownik identity fusion is probably just an "extreme form of social identification." Reeve and Johnson agreed with this take on things, arguing that the notion of identity fusion merely "expands the SIT paradigm." But as Kavanagh and Buhrmester carefully argued in a series of posts, the empirical evidence points to systematic differences between fusion and identification. Kavanagh cited a body of empirical evidence showing that existing measures of social identification simply cannot subsume identity fusion. If, for example, personal and social identities are hydraulically related, what is one to make of evidence that activating a personal identity enhances the tendency for fused individuals to enact pro-group behaviour? Building on this, Buhrmester pointed out that fusion theory focuses on the causal role of relational ties to other group members as well as collective ties to the group whereas the social identity perspective is only concerned with the latter. The two kinds of social glue predict different psychological and behavioural outcomes. What motivates efforts to make identity fusion part of the social identity perspective rather than, as the evidence suggests, an alternative theory of how groups are glued together? The motivation doesn't appear to stem from either empirical or logical considerations but from a desire to maintain the sovereignty of a tradition. It is easy to underestimate the extent to which academics (including good scientists) can form distinctive cultural traditions that, just like any other traditions, can glue adherents to each other and to a set of values and beliefs. And this makes the study of social glue all the more complicated. If we think of the social identity perspective as a kind of church it is a relatively new one. There is of course a much bigger and older church, called 'social science'. As Michael E. Smith reminded us, in an informative post entitled somewhat indignantly "You Folks Should Pay Attention To Social Science", there is a grand tradition out there, one that has a more illustrious history than the social identity perspective and a greater plethora of special terms for things, ways of talking about them, and other special customs and beliefs. When I started to read Smith's commentary, I thought at first he was going to say that we'd made a basic error that could have been avoided if only we'd known about some previous research on the topic. But as I read on it became clear that his main point was something quite different -that there is another academic tradition over the hills that has lots of doctrines about social glue, including what to call it and how to think about it. To my mind, however, the most thought-provoking response of all, from a bigpicture perspective, was the one written by Lanman. He reminded us that when we're asking questions about human psychology we should ask about both mechanism and function. To put this in the language of the evolutionary sciences, we should address both proximate and ultimate causation. The social identity perspective has taught us much of importance about the proximate level but when we broaden the focus of groups research to consider issues of ultimate causation we begin to understand social glue rather differently. To appreciate why fusion and identification may be different it could help to unpack their evolutionary histories. Lanman and I hypothesize that the categorical ties studied by social identity theorists evolved to bind together tribes and ethnic groups whereas identity fusion emerged to hold kin groups together: two functions, two psychological mechanisms, and two kinds of social glue. Kin psychology (on this view) regulates behavior among genetically related individuals, facilitating exceptionally high levels of altruism towards the group, rooted in the fusion of personal and social selves. Ethnic psychology, by contrast, solves collective action problems using categorical ties based on identification with groups. As Lanman succinctly put it: "Whitehouse's account of identity fusion as 'psychological kinship'… which lies at the heart of the imagistic mode of cohesion… utilizes the findings of both evolutionary psychology and socio-cultural anthropology and can serve as a reminder of the insights we can reach when we move past the more exclusionist rhetoric sometimes used by scholars in these fields." --- How important is social glue? Several contributors to this discussion pointed out that a range of factors contributes to altruistic behavior and that 'social glue' is only one of them. Bill Swann, for example, mentioned shared interests, top down incentives and deterrents, and ideologies that appeal to our capacities for empathy or right and wrong. Arguably, however, social glue has a special role in motivating altruism. You and I might share similar concerns about social problems, discover common vested interests, and even agree on the best courses of collective action, but I doubt whether any of this would motivate most of us to make big sacrifices for the greater good. Not everyone shares my hunch. Some prominent activists insist, for example, that morality rather than social glue is the best way to address the major collective action problems faced by our species. One of my three wishes for the world was to eliminate extreme poverty. The moral philosopher Peter Singer famously gives away a third of his income to the charity OXFAM and he urges everyone else to do the same. I vividly remember a lecture given by Singer in Oxford, at which he pointed out the wrongness of allowing extreme poverty to persist in the world and the fact that we could eliminate the problem overnight if we all set our minds to it. But that's the problem. We won't all do it. And since we know that other people won't all do it, we typically decide not to do it ourselves. After the lecture, I sat next to Singer at lunch and I put it to him that the moral argument wasn't going to change things. His response? It simply had to -there was no other way. But as Swann points out there are indeed other ways. Aside from moralizing we've seen many efforts to solve world problems using a diversity of strategies. For example, over several decades concerted effort has been made via high level international initiatives to redistribute wealth from the world's wealthiest countries to help the poorest and there has long been broad agreement that 0.7% of GNP is a realistic target for provision of aid. But apart from some outliers like Scandinavia, we have fallen woefully short in achieving these kinds of targets. Swann mentions various mechanisms of regulation in modern states that can be used to solve collective action problems without relying directly on social glue -we can incentivize, legislate, tax, subsidize, and do other things in a top-down fashion to tackle poverty. But I would argue that none of these approaches works very well without the right kinds and quantities of social glue. Social glue plays a vital role in solving collective action problems in a sustainable fashion. Without it, other mechanisms deteriorate and fail. Examples are legion but to take just one from my own country: social glue was essential to setting up the welfare state in the UK but it is now eroding because of a culture of sponging and entitlement symptomatic of a progressive weakening of national cohesion. Whereas the social sciences have traditionally provided quite sophisticated ways of understanding systems of regulation -in economics, law, governance, politics, and so on -a more basic aspect of coordination in societysocial glue -has not been understood so well, and figures less prominently in the thinking of policy makers and advisors. I think it's time to rectify the neglect. --- Closing remarks After much debate on points of detail, Gordon Ingram concluded an informative thread in this debate by taking issue with my suggestion that "when we fight back against injustice it's because we believe that its victims share our suffering. The victims are, in an important sense, one with us." Ingram retorted: "This, I think, is quite wrong: I predict that it is not necessary to feel fused with someone in order to feel a duty of care towards them… it comes down to the need for more empirical research: these are two testable predictions and I hope that someone will test them soon. Until then, Harvey is not really justified in making this sort of claim." Ingram's call for more data is well taken. And I should have been careful to emphasize repeatedly that my fusion-based explanation for altruism (including parochial altruism) is no more than a working hypothesis rather than an established fact. But by the same token Gordon is offering a counter-prediction rather than demonstrating the wrongness of mine. Although we do need more evidence, the idea that empathizing and moral reasoning are sufficient to motivate extreme sacrifice for the group warrants skepticism. By contrast, there is already quite compelling evidence that when compassion and morality are bolstered by a visceral belief that the group is me, self-sacrificial commitment markedly increases

The discussions in this forum have raised some big issues, ranging from the implications of two types of social glue for the evolution of groups (e.g. Waring; Smith) to the practical and ethical challenges of seeking public policy interventions based on our scientific theories and findings (e.g. Lanman; Waring). I agree with most of the comments that have been posted and as everybody points out we need more evidence before much more can be said. But there are two issues I'd like to pick up. The first is a very basic question about whether there really are two kinds of social glue (Kavanagh; Buhrmester) or just one with varying degrees of 'stickiness' (Ingram and Prochownik; Reeve and Johnson). The second is about whether social glue is really the most important issue in addressing my three wishes for the world or if other sources of altruistic behaviour should receive equal or greater priority (e.g. Swann; Smith). Altruism has many sources but in my view social glue plays an especially important role in solving collective actions problems that carry high individual costs.

INTRODUCTION The emergency committee has stated that the spread of COVID-19 can be stopped if protection, early detection, isolation, and rapid treatment are carried out to stop the spread of COVID-19. In view of this, as an effort to protect against COVID-19, various countries from all over the world have committed together by involving governments, biotechnology companies, scientists, and academics to be able to create a Covid-19 vaccine. So far, many vaccine candidates have been launched against the SARS-CoV-2 virus, the cause of Covid-19. 1 On October 6, 2020, the president signed and issued a Presidential Regulation regarding the procurement of vaccines and the implementation of the vaccination program to tackle the COVID-19 pandemic. 2 The National Immunization Expert Advisory Committee (Indonesian Technical Advisory Group on Immunization/ITAGI) has evaluated the situation related to COVID-19 vaccination and provides a number of recommendations regarding After a survey was conducted on the acceptance of the Covid-19 vaccine in Indonesia, which took place from 19 to 30 September 2020. Around 65% of respondents said they were willing to accept the COVID-19 vaccine if provided by the government, while eight percent of them refused. The remaining 27% expressed doubts about the Government's plan to distribute the COVID-19 vaccine. This situation needs to be understood carefully; the public may have different levels of confidence in the COVID-19 vaccine due to limited information about the type of vaccine, when the vaccine will be available and its safety profile. 4 Factors that influence people's behavior in participating in Covid-19 vaccination are influenced by predisposing factors related to individual characteristics, vaccine service providers, and reinforcing factors that are realized with the support of family or community leaders. Individual factors include knowledge of the Covid 19 disease, economic status, religion and belief, age, working in the health sector, income level, education, fear of vaccines, the thought that there is a lot of hoax news about the covid 19 vaccine, thoughts on vaccine safety, and thoughts of danger. vaccine. 5 This study was conducted to find risk factors based on individual characteristics on the behavior of receiving the Covid-19 vaccine. By knowing the risk factors for receiving the Covid 19 vaccine, it can be used as information in providing education, especially to people who have not decided to take part in the Covid-19 vaccination so that they can follow the vaccinations as recommended by the government to break the chain of disease transmission. --- METHOD This research is an analytic descriptive study with cross sectional design. This research was conducted by distributing surveys via google form to all respondents covering all regions of Indonesia. Data collection was carried out in January 2021. The number of samples was 411. The sample inclusion criteria were Indonesian people aged more than 17 years and were able to access and fill out google forms independently. The sampling technique was purposive sampling. The independent variables include age, gender, history of working in the health sector, education, family history of being affected by Covid, feeling afraid of vaccines, thinking that there are a lot of hoax news about the COVID-19 vaccine, thoughts on vaccine safety, and thoughts of dangerous vaccines. The dependent variable is public acceptance of the Covid-19 vaccine. The questionnaire uses the Public Perception Survey questionnaire for the Covid-19 Vaccine in Indonesia published by WHO and the Ministry of Health of the Republic of Indonesia. Analysis using Chi Square test. --- RESULTS The results showed that the majority of respondents were in the age range of 18-24 years (62.8%). Likewise, the group of respondents who decide, refuse, or have not decided to implement the vaccine are the majority of respondents in the 18 --- DISCUSSION The results of this study indicate that most of the respondents received and will carry out the Covid-19 vaccine (53,7%). This is similar to the results of studies in other countries such as China, Sudan, Europe and America which state thet most received the Covid-19 vaccine. 6 There is a relationship between age, gender, history of working in the health sector, education level, family history affected by Covid-19, feelings of fear Hema Dewi Anggraheny / Factors Affecting Public Acceptance of the Covid-19 Vaccine in Indonesia of vaccines, the thought that there are many hoax news regarding the Covid-19 vaccine, thoughts on vaccine safety, and the thought that vaccines are dangerous to the behavior of receiving the Covid-19 vaccine. The above factors are included in the predisposing factors in Lawrence Green's theory. Despite the support from the government and even provisions for the Indonesian people to be obligated to vaccinate against Covid-19, there are still quite a number of respondents who choose not to vaccinate. The results of this study are in line with several other studies related to the acceptance of the Covid-19 vaccine which state that the idea of vaccines is dangerous, fear of vaccines, the idea of vaccine safety, and the protective effect of the vaccine on the acceptance of the Covid-19 vaccine. [7][8][9][10] Similar things emerged from this study and other similar studies in Indonesia and other countries, namely that most felt that the Covid-19 vaccine was important to do as protection for themselves and others against Covid-19. Most of them already believe that to break the chain of transmission of Covid-19 and to create herd immunity is by vaccination. 11,12 Most respondents who have a history of contact with Covid-19, either their family or themselves who are infected with Covid-19 tend to receive the Covid-19 vaccine. The experience of himself or his family being exposed to Covid-19 will be a strong enough reason for him to take the Covid-19 vaccine. This is in contrast to respondents who did not have contact with Covid-19, who stated that they had not received the Covid-19 vaccine (46.8%). Similar results were obtained in other studies. 11,13 Most of the respondents who refused vaccination were respondents who did not work in the health sector. These results reflect that people who do not work in the health sector need to get information or education about the importance of the covid 19 vaccine. These results are not directly proportional to the respondents' education. Although quite many respondents graduated from high school and university (more than 95%), there were also quite a large number of respondents who refused or had doubts about the Covid 19 vaccination. also respondents who reject vaccines who do not work in the health sector, and are highly educated. 14 This proves that information regarding the importance of Covid-19 has not spread widely in Indonesian territory in January 2021. The majority of respondents who refused vaccines in this study stated that the COVID-19 vaccine was not safe. Similar results were obtained in other studies both in Indonesia and abroad. 11,13,[15][16][17][18][19] . These results appear probably because the data collection was carried out before the vaccine was widely circulated in the community. So that people need information in the form of real proof of how the effects that arise from vaccines after being injected in most people in the world. If most are not problematic, people will tend to believe in and comply with the vaccine's obligations. It is proven that after most of the community took the vaccine in mid-2021 and the conditions were proven safe, people flocked to vaccinate and many even waited for the vaccine stock to be ready because health facilities providing vaccines often ran out of vaccine stock. --- CONCLUSION Public acceptance of the Covid-19 vaccine is related to several factors, including age, gender, education level, history of being exposed to Covid-19, perceptions of vaccine safety, and working in the health sector. Acceptance of the Covid-19 vaccine is gradually increasing after the public ensures that the vaccine is safe enough for most people in the world, and the pandemic conditions improve.

One of the efforts to protect the community against Covid-19 cases is vaccination. However, in the preparation of vaccination, there are several negative issues related to vaccines, which make people doubt and even reject the effort. Predisposing factors include age, gender, occupation, income, education level, history of contact with people with COVID, and knowledge of vaccines, which can affect acceptance of vaccines. The purpose of this activity is to find out what factors affect public acceptance of the Covid-19 vaccine. The research was conducted by distributing questionnaires via google form to the general public in January 2021. The total respondents were 411 respondents. The questionnaire uses the Public Perception Survey questionnaire for the Covid-19 Vaccine in Indonesia published by WHO and the Ministry of Health of the Republic of Indonesia. Analysis using Chi-Square test. The survey results showed that 46.2% of respondents had not decided on and refused the vaccine, and 94.2% wanted to get information about the vaccine. Factors related to vaccine acceptance include age, work in the health sector, income level, education, fear of vaccines, the thought that there are many hoaxes regarding the COVID-19 vaccine, thoughts on vaccine safety, and thoughts on the dangers of vaccines. Accurate and scientific information, accompanied by easy access to receive the Covid-19 vaccine, is needed so that people with self-awareness carry out vaccinations to reduce the morbidity and mortality of COVID-19 in Indonesia.

Introduction Covid-19 has globally caused 12,964,809 death cases, including 570,288 confirmed deaths report-ed by WHO [1]. The number of cases and the death toll proceeded to grow, with India also contributing majorly to this increase. India, the second most popular country globally, with high rising cases due to Covid-19, is worrisome. There are approximately 0.9 million confirmed cases and 24915 deaths in India on 16 July 2020 [2]. There could be invisible numbers due to asymptomatic cases and other factors like non-reporting symptoms due to fear [3] and stigma related to the disease. --- Fear and Stigma In Covid-19 The psyche of Individual fear As per [3] , the study says that the individuals fear getting admitted to Isolation centers. Their family members will be sent to quarantine centers, discrimination, and Ill-treatment at these centers. They will fear dying alone and not being cremated as per rituals. A study conducted on suicides in India shows that the most common causes were fear of infection, loneliness, social boycott, the pressure to be a quarantine, and inability to return home post lockdown. A proportionate increase in fear and stigma is pragmatic with increasing cases. --- The Psyche of Mass Fear Many experts and non-experts give their opinions in news media for self-image building to add to scientific knowledge. Multiple mathematical prediction models presented across the world are confusing the masses. The latest MIT study says, 'India may come across 2.87 lakhs COVID-19 cases per day within the time of winter 2021 [4] , which mainly flashes on the Internet on the news media. Data presented by media flashing it as 'Breaking news' in negative comportment adds to the fear. Also, frequent changes in the guideline of prevention and scientific knowledge are creating bewilderment amongst the masses. --- Literature Survey Besides, the transmission of medical knowledge to en masses through social media and its use for circulating saddening and negative news are increasing fear and stigma related to the disease. "Is this a Pandemic of Covid-19 or a Pandemic of Panic and fear?" [5]. Thus, the first step is to throttle the fear and stigma related to Covid-19. Covid-19 has perplexing epidemiology; varied pathophysiology; unknown natural history being a novel disease; diagnostic tool with low sensitivity; [6] and cautiously evolving treatment protocols. The general reasons of subconscious tension throughout the Covid-19 pandemic include the fear of falling ill or spread of infection and mortality, dodging wellness support because of the dread of infection in support, job loss and economical backwardness based on the dread of loss of livelihood, fear of living in social exclusion, the dread of quarantine, feeling powerlessness in guarding themselves and their family and relatives [16]. The dread of being isolated from custodians, the dread of helplessness, loss of pride to do things in their day-to-day life [7] , isolation, and despair because of staying lonely and re-experiencing a previous pandemic [8]. In addition to the above difficulties, coronavirus disease-19 can create subconscious answers like the threat of being afflicted during the spreading phase of the disease is never fully cleared, general indications of additional wellness issues increased the concern of the kids staying at residence due to lockdown and online classes as the school closed. However, the parents need to be at work. So the physical and mental health problems for children due to vulnerable gadgets and care reduction leads to a high risk of health issues [9]. The untrained non-medicos, volunteers, affiliated with political parties across cities, towns, and villages have certainly restricted using the science of prevention, which has led to the baffling use of scientific terms of isolation and quarantine. It has also created poor and chaotic dissemination of medical knowledge. Every small medical trial became public before the experts established it. The greatest examples are the use of Hydroxy-chloroquine and arrivals of the vaccine [11]. The SGTM prediction of people who suffered and died of COVID-19 is measured and supervised using a neural-like structure [10]. The prediction of the covid-19 transmission behavior in Indonesian countries utilizes various parameters like the distribution of a virus, mortality rate, cure rate, movement, and communication rate. Compared with other countries to Indonesia, the appropriate parameters are measured by WHO [12]. "Do not get carried away by social media news unless there is scientific evidence. " Let us embrace the science of prevention. " The ongoing COVID-19, with many deaths, forced the experimental populations to increase the Research and Development (R&D) projectson the undergoing pandemic situation [13]. To guide the scientists in the comprehensive research, the committees, regulators, policymakers, andfunders are in the deliberate studies regarding the SARS-CoVid-2 challenges [14]. --- Results and Discussions Embracing the science of prevention • Embracing the science of prevention based on current knowledge of the disease [7] • Physical distancing -Minimum 3 feet distance [15] • Avoid Gatherings, crowded places, and unnecessary travels and meetings. • Appropriate use of Mask • Hand Hygiene • Good Respiratory Hygiene • Avoid touching eyes, nose, and mouth • Seek medical attention • Self -Isolation • Get information from trusted sources. Total alignment to the above advisory and acknowledgment of a pandemic's social game may help control ituntil the vaccine is available. --- Specific Measures • Training and deployment of social volunteers to stringently implement prevention strategy in the field • Restricted use of social news media spreading unscientific knowledge, negative news. • Governments and healthcare [2] --- Conclusions Increased GDP allocation to the health sector for the robust public health system; Population Control; Improved Literacy rates; Stronger economic reforms to accommodate the Covid-19 like situation; Improved Lifestyle and Mental Health says restricting medical knowledge to the medical fraternity is a key intervention required to reduce confusion and fear among the population. An over the dissemination of medical knowledge not authenticated through scientific research, news, and social media adds fuel to fear and stigma. The spread of COVID-19 disease Prevention in the common space is suggested with an AIbased smart system of gate and website alliance can be established. However, there is a lack of systematic dissemination of scientific knowledge to the medical fraternity. Circulation of multiple prevention and treatment methods on social media, news media without scientific published data is a heinous crime in this pandemic. --- Conflict of Interest Not applicable Funding Self-funded --- Ethical approval Taken from Symbiosis Medical College for Women (SMCW) Symbiosis International (Deemed University) (SIU), Pune

Covid-19 is creating a flurry of fear and stigma across the globe. The individual fear is of discrimination at isolation centers, fears of dying alone with no funeral as per rituals. The mass fear is fueled by social and news media through negative news, disseminating medical knowledge, and confusing multiple mathematical projection models. Hence, firstly need to impede this pandemic of fear and stigma. Equally vital is to embrace the science of prevention by stringently following WHOguidelines. The general population should not fall prey to non-scientific news on social media. There should be restricted, systematic, and timely dissemination of medical knowledge to the medical fraternity. Identify limited expert spokesperson to present factual positive data and strategies of prevention. Disengaging politics and conflicts of commercial interests and educating the population for social changes and norms are required to control the pandemic. Increased GDP allocation to the health sector; Population Control, Improved Literacy rates are other long-term measures.

Introduction --- D espite efforts to reduce health inequalities within Europe, since the beginning of the 1990s regional inequalities in life expectancies have remained broadly stable, and increased among males within Eastern Europe. 1 Migration could be one factor contributing to spatial differences in mortality within Europe [2][3][4] as more and less healthy populations may have distinct migration patterns and substantial population growth or decline could effect determinants of population health. This possibility is supported by analysis of net population change over 10 years in municipalities and districts in Spain, 5 20 years in local authority districts in the UK 6,7 and municipalities in Sweden, 8 and 40 years in communes and cantons in France. 9 These studies found an ecological association between death rates and population change, with higher death rates in areas with shrinking populations. The relationship between population change and death rates has, however, not been assessed across Europe as a whole. 2 Migration could be of growing significance to health inequalities in Europe because the substantial expansion of the European Union (EU) has increased rights to free movement within the continent. 10 The largest single expansion of EU population took place in May 2004 when the EU grew from 15 to 25 member states with the accession of seven former Eastern Bloc countries (Estonia, Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia), plus Cyprus, Malta and Slovenia. Furthermore, since 2007 some European countries have experienced significant new migration trends following the global financial crisis. 10 While in 2015 the EU experienced a 'migrant crisis' with a large increase in refugees arriving from conflict-ridden countries. This short report considers 'migratory population change' or net migration balance-net change in population size resulting from migration-across the regions of Europe. It assesses if there is an association between migratory population change and death rates, whether any relationship is independent of area socioeconomic status, and compares Eastern and Western European regions. --- Methods 'Nomenclature of Statistical Territorial Units' geography level 2 (NUTS2 2010) areas were used for the analysis. All NUTS2 regions for which data could be obtained were included, with the exception of regions that were not situated in the European mainland or had very small populations (A ˚land, Ceuta, Melilla, the Canary Islands, Madeira, the Azores and the French overseas territories). In total, 250 NUTS2 regions in 26 countries were analysed (regional population in millions, annual average 2008-2010: minimum = 0.13; maximum = 11.72; mean =1.90; standard deviation = 1.56). The analyses included 196 regions in 16 'Western' countries (Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Norway, Portugal, Spain, Sweden and UK, excluding Scotland) and 54 regions in 10 'Eastern' countries (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia). All regional data were obtained from Eurostat. Age-and sexstandardised death rates per 100 000 were accessed for the most recently available 3-year average period, 2008-2010. Proportional net change in population resulting from migration was calculated for 2000-2010 using total population in 2000 and 2010 (at 1 January) and annual data for births and deaths. Population change was considered over 10 years as this was sufficient to capture a significant period of migration while short enough to ensure that data were available for most European regions. Socio-economic status was represented by primary income of private households in 2005 (mid-way through the migratory period). This was estimated using Purchasing Power Consumption Standard units per capita to allow for comparison between countries. Up to 2 years of missing data for births, deaths, population and income were imputed using straight line estimates. The relationships between death rates and migration were first described by Pearson's correlations and then assessed with linear regression models which were adjusted for income. Analyses were weighted using average population, 2008-2010. --- Results The regions with the highest death rates in 2008-2010, were concentrated in Eastern countries, in particular Bulgaria and Romania (Figure 1). The highest rates of population loss due to migratory change, 2000-2010, were also found in regions of Bulgaria and Romania and in the former German Democratic Republic regions of Sachsen-Anhalt, Mecklenburg-Vorpommern and Thu ¨ringia, and Northern French regions of Nord-Pas-de-Calais and Champagne-Ardenne. In contrast, regions that had experienced large gains in population though migration were more likely to have low death rates. Death rates and migratory change were significantly negatively correlated (P < 0.001), with Pearson's r of À0.487, À0.530 and À0.346 for all, East and West regions respectively. The linear regression model, containing migratory change and household income, for all European regions combined, suggested that across European regions there was a significant and independent association between migration and standardised death rates (P < 0.001), with a coefficient of À0.258. This indicated that for every 1% migratory loss of population there were 11.4 more deaths per 100 000. The coefficient for migration was, however, much smaller than the À0.707 found for income. In the Western regions' model the migration and income variables had similar significant coefficients of À0.354 and À0.333, respectively. In contrast, among the Eastern regions the association between migration and death rates was not statistically significant (coefficient = 0.045), but there was a strongly significant coefficient for income of À0.726. Migration and mortality patterns among European regions --- Discussion Across regions of Europe after adjustment for income, there was a strong association between migratory population change (2000-2010) and death rates (2008-2010) which suggests that migration could contribute to the well-established regional health inequalities. 1 These findings were consistent when Europe was considered as a whole and also 'within' the group of Western European regions. Hence, the association between mortality and migration is not driven solely by East-West differences in these variables. This relationship between migration and mortality may result from health selective patterns of migration. It could also indicate that population loss has contextual effects upon health, damaging social relationships and services that support well-being. 4,6,7 Eastern regions account for most of the areas of Europe with the highest death rates, lowest incomes and greatest population loss. An independent association between population change and death rates was not found among these regions but income was strongly associated with mortality. This suggests that while the recent expansion of the EU has increased population decline in some East European regions 10 it is low income 4 which continues to drive their poor health. Among these regions low income may also underlie population loss, which in turn could have important socioeconomic consequences. It is notable, however, that while immigration has long been prominent within international political debates regarding EU policy the problems of European sender countries, experiencing the combined effects of low income, high rates of emigration and poor health, have received less attention. The analyses were limited by the availability of European-wide regional data. While NUTS2 regions are intended to contain approximately similar populations significant variation remains. As migratory change was considered only over 10 years the full impacts of migration upon population health will not have been captured. In particular, some East European countries, such as Romania and Bulgaria, have experienced major population decline since the end of communism in the early 1990s. 10 Population data error are likely to be significant in regions with substantial migration. The 'independent' associations found between migration and death rates after adjustment for income are likely to reflect residual socio-demographic confounding. The relationship between migration and mortality may also vary by age group and with geographical scale. More detailed European data describing the health characteristics of in-and out-migrants and the impacts of population change upon the social determinants of health would aid understanding of these relationships. Analysis of more recent data could assess whether new associations between migration and mortality have emerged from the 'migrant crisis' in Europe. This short report is the first to describe the association between migratory population change and death rates across the regions of Europe. It suggests migration could contribute to inequalities in mortality within Europe, and highlights the acute problems of Eastern regions with the worst health, lowest incomes and declining populations. --- Conflicts of interest: None declared. --- Key points Among 250 European regions population loss 2000-2010 was correlated with higher death rates in 2008-2010. The association between migration and mortality was independent of household income among all European regions and Western regions but not among Eastern areas. In Eastern Europe low income may drive both high mortality and migration patterns. Migration patterns could contribute to the persistent inequalities in death rates within Europe. Policies to reduce health inequalities within Europe should address the potential impacts of population loss upon health.

Geographical inequalities in mortality across Europe may be influenced by migration between regions. The relationship between age-and sex-standardised death rates, 2008-2010, and population change resulting from migration 2000-2010, was analysed in 250 'Nomenclature of Statistical Territorial Units' (NUTS) level 2 regions in 26 European countries. Across Europe death rates were significantly higher in regions experiencing population loss. This association continued after adjustment for 2005 household income among all regions and Western regions but not among Eastern areas. This analysis suggests migration could contribute to Europe's persistent inequalities in mortality, and highlights the problems of Eastern regions with the highest death rates, lowest incomes and declining populations.

Public health must necessarily be concerned with social conditions at the root of many inequities (Braveman, 2006). Public policy that seeks to achieve sustainable improvements in the social determinants of health-income, education, housing, food security and neighborhood conditions, can contribute to positive health outcomes (Anderson, Scrimshaw, Fulilove, & Fielding, 2003). One approach lies in building capacity for communities to increase their participation and effectiveness in civic engagement, to generate collective action, and to engage private and public institutions to create systems that protect health (Wallack, 2003). Community health workers (CHWs) are members of the communities they serve, have intimate knowledge of community needs and resources, and are considered leaders among their peers (Rosenthal, Wiggins, Ingram, Mayfield-Johnson, & De Zapien, 2011). While recognized for their role in impacting health downstream (Viswanathan et al., 2009), there is evidence that CHWs can also successfully facilitate community efforts to impact social and structural issues related to health (Eng & Young, 1992;Kent & Smith, 1967;Perez & Martinez, 2008) In fact, advocating for individual and community needs is a core competency of CHWs in the U.S. (Rosenthal et al., 2011). This report describes preliminary results from Acción Para La Salud (Action for Health) an intervention that relied upon CHWs to engage community members in three Arizona border communities in pursuing public policy contributing to sustainable health improvements. The Arizona border population is much poorer, attends fewer years of school, and suffers a higher rate of unemployment than the population of any State. Not surprisingly, these conditions translate into greater health risks, which are exacerbated by the lack of insurance and health care resources (U. S.-Mexico Border Health Commission, 2003). --- Theoretical Background Two theories guide Acción. The first centers on the importance of community engagement in addressing relevant and meaningful policy change. The second postulates an avenue through which CHWs can engage communities in the policy process. --- Community engagement: Gaventa and Barrett (2010) presented the results of an international meta-case study that surveys types of citizen engagement (Gaventa & Barrett, 2010). Analysis of 100 studies from 20 countries found that people engaged civically through local associations, social movements/campaigns, and as members of formal participatory spaces such as advisory committees. Outcomes with implications for public policy development include: 1) construction of citizenship; 2) strengthening practices of participation and capacity for collective action; 3) strengthening responsiveness and accountability of states and institutions; and 4) development of inclusive and cohesive societies. Acción used this framework to describe ways CHWs engage their communities as precursors of changes in social determinants of health. --- Policy development: Kingdon's conceptual framework for policy change (2003) envisions three streams, problem, policy, and political, which operate independently (Kingdon, 2003). In the problem stream, issues are identified and defined based on various indicators or events. The policy stream represents solutions generated about an issue. The political stream describes factors that bring a particular problem into focus or favor a specific policy solution, such as national mood. Policy change most likely to occurs when conditions in all three streams are interconnected. Kingdon calls this alignment a policy window. Change agents can act to open policy windows and/or take advantage of those that have opened. In Acción, CHWs serve as catalysts for change on a local level in all three streams. In the problem stream they interact with community members to identify salient issues. In the policy/solution stream they engage them in creating ideas to improve their community. In the political stream they develop relationships and advance the community's policy agenda with such entities as school districts, health care delivery system(s), or municipalities. Thus, CHWs both create and seek to capitalize on policy windows in diverse systems. (Figure 1) --- Methods Members of an academic-community partnership Community Action Board (CAB) developed Acción through a community-based participatory research process. The five partnering organizations, which have CHWs as core to their health efforts, included two community health centers, a county health department, a grassroots clinic and a grassroots organization. Each agency identified experienced CHWs on their staff to work on Acción. The eleven Acción CHWs had at least five years of experience. --- Intervention: The CAB training committee developed the Acción community advocacy curricula guide using strategies from existing advocacy and leadership tools. The 18-month training consisted of four participatory and reflective workshops with the Acción CHWs and their supervisors (http://azprc.arizona.edu/resources/curricula). The CHW supervisors were strategically included to ensure that the CHWs had organizational support for advocacy activities. Activities to foster community advocacy were initiated during the training in which Acción CHWs were asked to talk to community members about issues and identify existing power structures within their communities. After the first year, the CHWs began to identify community advocacy projects based on needs they identified in their contact with clinic patients and participants in CHW prevention activities, during outreach efforts, and in community conversations and meetings. In ongoing technical assistance, CHWs were then assisted in using strategy maps to identify steps to their desired policy outcome (Zacoks, Dobson, Kabel, & Briggs, 2010). Acción CHWs met regularly with their supervisors and engaged in monthly peer network conference calls to share challenges and successes with their colleagues. --- Data Collection: Acción data collection instruments were determined through a participatory process with partners (Israel, Schulz, Parker, Becker, & Health, 2001). The data were primarily qualitative and collected systematically across all five intervention sites to capture the span of their activities. Acción CHWs used encounter forms to document conversations and meetings with community members, groups, and local officials. On the forms they described the issue being discussed, their next step(s) in addressing it, and which of Kingdon's streams they were working in. The strategy maps identified the advocacy outcome and corresponding strategies. Corroborating data sources included quarterly program narratives and technical assistance notes. --- Analysis: Three members of the research team were responsible for analysis. Information on the forms was validated using program narratives and technical assistance notes. The description of the encounter was used to verify whether the CHWs had categorized it in the correct stream(s). Among the 211 encounter forms, approximately 29% was re-categorized as individual advocacy, community programming or education, leaving 150 forms for analysis. Content from the encounter forms and strategy maps was coded to types of community engagement. --- Results The remaining 150 encounter forms across the five partner agencies were analyzed to ascertain the extent to which CHW advocacy activities were related to Kingdon's theory. The number of forms per agency was 17-55. CHWs most often reported working only in the problem stream (61% of total encounters) reflecting the first step of engaging community members in identifying issues of importance. Many of these encounters were conversations between the CHWs and community members during normal job activities in clinic visits, health education classes, and support groups, and reflected concern over a broad range of issues such as the adequacy of public services, community safety and cleanliness, and activities for youth. Over time, the encounter forms documented a shift from individual to group encounters in the problem stream; e.g., CHWs brought community members together in house meetings or community forums to discuss a problem. Encounters in the problem stream were coupled with the policy stream in 20% of total encounters reflecting activities in which CHWs began identifying and working on solutions to a previously identified problem. A small percentage of policy encounters were activities (10%) not connected to a problem identified through Acción (attending an anti-tobacco coalition). The policy stream and political stream overlapped in 3% of encounters, all of which occurred in one organization in which CHWs had the opportunities to discuss organizational policy change not directly connected to a previously identified problem. In 3% of encounters CHWs began engaging in all three streams, taking their community-generated solution to decision-makers in their agency or town. The remaining 3% of total encounters were political, in which CHWs in one agency held informational meetings with political or organizational leaders (Table 1). Critical to the Acción intervention is community engagement to address the power relationships that underlie disparities in the social determinants of health. To describe strategies CHWs used to involve community members in the policy development process, we also analyzed encounters by type of engagement. Most often, CHWs used local associations to strengthen practices of participation (70%), typically by engaging their clients in conversations about the wellbeing of their community and what might be done to improve it. The CHWs also involved community members in efforts to increase access to services and to make systems more accountable to community needs (27%), for example through petitions and group meetings with public officials. In two instances (3%), CHWs engaged in activities related to the construction of citizenship, one informing community members of their rights under immigration law, and the other discussing the potential impact of proposed state redistricting on community members. Finally, the strategy maps further documented advocacy strategies and desired outcomes including plans to address transportation infrastructure, clinic hours, safe routes to schools, the safety net for domestic violence victims and sales of energy drinks to minors. --- Discussion Using theories of community engagement and policy change, Acción sought to empower CHWs and their communities to advocate for sustainable change targeting underlying social determinants. To varying degrees across organizations, Acción CHWs encouraged community members to think ecologically about their health and identify advocacy-oriented solutions to improve neighborhood conditions, enhance community opportunities, and increase access to services. In three organizations, Acción CHWs initiated activities in the political stream, in several cases directly involving community members. In looking at types of community engagement, CHW advocacy activities most often focused on strengthening practices of participation, and the majority of these took place within the problem stream. Our findings indicate the value of long-term testing of effectiveness of Acción in identifying specific advocacy activities leading to policy development, and potential policy and environmental changes impacting community health. In the future, it will be important to investigate organizational factors that facilitate or discourage CHW advocacy and determine optimal conditions for successful CHW public health advocacy activities. CHWs community advocacy activities in the Kingdon (2003)

Objectives: Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive, sustainable health impacts. This paper describes preliminary results of Acción Para la Salud, a public health intervention in which Community Health Workers (CHWs) from five health agencies engage their community in the process of making positive systems and environmental changes. Methods: Acción CHWs were trained in community advocacy and received ongoing technical assistance in developing strategic advocacy plans. Acción CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Results: Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environmental-related factors that impact health, and identified solutions that improve neighborhood conditions, create community opportunities, and increase access to services.

Introduction The unique combination of computer-mediated and face-to-face communication gives rise to significant risk of harm against youth and young adults. Examples from popular media include doxing (the unwanted release of one's personal information, which can lead to online harassment and physical safety risks [17]) and swatting (pranks against Twitch live streamers and online gamers that involve calling the police with false reports in hopes of triggering a SWAT team dispatchat least one case has resulted in a fatality [2]). A context of online-to-offline risk to youth and young adults that we focus on in this position paper is mobile social matching apps [18], such as Tinder, Bumble, and Grindr. As of 2020, 48% of adults under the age of 30 have used a social matching app [1]. These apps enable users to discover strangers in their geographic vicinity, interact with them online, and then meet faceto-face. While once known predominantly for dating and sex, their use and design have expanded to all aspects of social interaction including friendship, activity partners, and even employment [9,13,19,20], making them a predominant avenue for young people to construct their social lives. Research has repeatedly connected social matching app-use with online and offline harms, including sexual harassment through online messaging, and sexual assault during subsequent face-to-face meetings [1,5,7,8,[14][15][16]22]. Safety has seldom been a motivating force behind social matching app design, however. AI serves as an valuable material for detecting and mitigating risk, and it has long served as a core component of social matching apps in the form of user-matching algorithms. Yet the use of AI for user safety, rather than user discovery, is rare. Our work looks into how AI can be incorporated into social matching apps for user safety across online and in-person interaction. In this position paper we review some of our ongoing participatory AI design efforts with young women, a demographic at disproportionate risk of harm during social matching app-use. Our co-designers conceptualize roles that AI can play pursuant to risk detection in social matching apps, and build directly explainable models for how AI can detect risk in this context. We use this review to promote participatory AI design as a way to directly involve stakeholders in AI interventions for safety, and also to highlight challenges to the method. We are committed to supporting MOSafely in any capacity that is most meaningful. --- Author Bios --- Douglas Zytko is an Assistant Professor in Oakland University's Department of Computer Science and Engineering, and director of the Oakland HCI Lab. Hanan Aljasim is a PhD student researcher in the lab. As a woman of color she utilizes methods that involve direct interaction with women and other at-risk demographics to empower them in articulating their visions of safety and design trajectories that can fulfill those visions. The lab's research broadly focuses on computer-mediated risk of harm against marginalized identities. Recent work from the lab has studied computer-mediated consent to sex to understand how application design perpetuates sexual violence online and offline [23], prototypes to support women in mitigating harm in social matching contexts [24], and participatory design with woman-and LGBTQidentifying young adults to understand their conceptualizations of safety and ideas for safetyconscious social matching apps of the future [4,6]. We typically collaborate with public health experts in the academic and non-profit sectors to inform our research. --- Participatory AI Design for Safety in Social Matching Systems With the use and design of social matching apps expanding to ever-myriad social interaction goals, more users are likely to be exposed to harms historically perpetuated through matching app-use such as harassment, rape, and bodily harm. We are in the midst of conducting participatory design studies with young women to explore how they envision AI intervening in the matching app user experience to support their safety. Women under the age of 30 are our target demographic because they are disproportionately the victims of matching appfacilitated harm (most of our participants have been in their late teens and early 20s). --- Risk detection models: In one such study we are supporting women in crafting directly explainable models, with supporting activities similar to those in [11], for how AI can predict the risk associated with a discovered social opportunity in a user's geographic vicinity, whether that opportunity be an individual person with a matching interest, an emergent activity, or an organized group event. See Figure 1 for an example social opportunity shown to participants to prompt their reflection on possible features in a risk detection model. The example social opportunities are tailored to the participant based on answers to a screening survey. Participants have proposed drastically different models that reflect their varying conceptualizations of what constitutes risk. Some example factors in participants' models include crime rate at the proposed meeting location, gender of the discovered person, the number of people attending the social opportunity, and reviews from other women who have interacted with people involved in the social opportunity. Variation in participants' models suggests that social matching systems should craft user-specific models of risk detection that take into account how the user conceptualizes risk and which factors in the model they may trust more than others. --- Risk has been identified…now what?: The notion of a risk detection AI for social matching apps was borne out of a preceding participatory design study, with woman-identifying college students in their early 20s, in which participants conceptualized different roles that AI could play in the social matching app experience pursuant to safety. In addition to risk detection, two other roles pertained to what the AI should do once a social risk is detected. One idea, dubbed the "cloaking device," refers to the AI altering a woman's visibility on the app depending on the general risk of their geographic location, and the presence of specific users in the area deemed high risk. When a woman's "cloaking device" is enabled other users would not be able to discover or interact with her on the app. This idea reflected a desire for the AI to not only detect risk, but attempt to mitigate potential harm on behalf of the user. The other idea was dubbed a "human support network" and refers to the AI proactively alerting trusted contacts about a risky interaction (either online or offline). Trusted contacts could include friends, family members, and in some cases police. This is reminiscent to "panic button" designs discussed in prior literature [10,21], but with two key differences: the AI autonomously responds to a risky situation without the user needing to deliberately click a button, and the barrier for AI intervention is must lower. Rather than requiring that harm already have occurred, the AI would reach out to a woman's support network when the likelihood of harm occurring in an interaction reaches a threshold set by the user. --- Challenges to Participatory AI Design Participatory design has long been heralded in its capacity to involve stakeholders in technology design [12]. Yet AI incurs unique challenges on the participatory design process, as became evident to us in our ongoing research. One issue involves background knowledge of AI (also discussed in [3]). Most of our participants have had little to no familiarity with AI, and so we have to incorporate activities to prime them on AI possibilities such as Powerpoint presentations and interactive exercises. In addition to this taking vital time away from participants expressing their own designs, it risks biasing participants since this priming often involves us providing examples of AI and models. Relatedly, time itself is another limitation. We divided our first participatory design study into four recurrent sessions so as not to rush participants. Yet we were still unable to proceed to model building in that time frame and needed a separate study, with mostly new participants. The capacity for participants to remain consistently involved in each stage of the design process (e.g., articulating a new AI use case > creating a model > designing an interface) is severely limited because of the time each step takes and other life responsibilities that participants have. As a result, a certain level of "translation" is needed to apply participant ideas to a subsequent design activity that they are not directly involved in.

In this position paper we draw attention to safety risks against youth and young adults that originate through the combination of online and in-person interaction, and opportunities for AI to address these risks. Our context of study is social matching systems (e.g., Tinder, Bumble), which are used by young adults for online-to-offline interaction with strangers, and which are correlated with sexual violence both online and inperson. The paper presents early insights from an ongoing participatory AI design study in which young women build directly explainable models for detecting risk associated with discovered social opportunities, and articulate what AI should do once risk has been detected. We seek to advocate for participatory AI design as a way to directly incorporate youth and young adults into the design of a safer Internet. We also draw attention to challenges with the method.

The aim of this study was to identify predictors of longevity using retrospectively coded autobiographical stories written and recorded from N = 1,858 deceased centenarians (M = 102.79 years; SD = 2.25 years) from the state of Oklahoma. Using the Developmental Adaptation Model as a conceptual framework, total number of years lived, the developmental outcome was regressed on socio-demographic characteristics including sex, race, and education, as well as retrospectively coded variables reflecting parental occupation, total years married, age at retirement, engagement in international travel, and self-attributions of longevity. Results confirmed three key predictors of living to 100 years and beyond. First, race was confirmed as a strong predictor of longevity (β = -.65, p < .001). Fatherhood agricultural occupation emerged as second key predictor of living 100 years and longer (β = .42, p < .10). Finally, total years spent in a marriage represented a third predictor of longevity (β = .47, p < .01). Results suggest being a person of color, being raised by a father who made a livelihood working in the agricultural industry, and remaining within a long-term marital union are contributing variables linked to living 100 years and longer. Further detail regarding descriptive and methodological evaluation of retrospectively coded centenarian biographies will be highlighted. Results have implications relative to how gerontological researchers and aging service professionals may evaluate and link autobiographical information of long-lived adults to developmental outcomes such as longevity. Abstract citation ID: igad104.3021 --- EXTREME WEATHER PREPAREDNESS AND CLIMATE ACTIVISM AT AGE 85+ Taylor Patskanick, Sophia Ashebir, Lisa D'Ambrosio, and Joseph Coughlin, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States Current projected shifts in climate suggest extreme weather events and disasters will become increasingly common and severe. Older adults are a population vulnerable to the impact of extreme weather due to complex mobility, health, and financial situations in later life, affecting their ability to prepare for and respond to extreme weather emergencies. These compound vulnerabilities demonstrate the importance of adequate emergency preparedness among older adults, particularly among the oldest of older adults or the age 85+ demographic. This paper shares findings from a mixed methods study with the MIT AgeLab 85+ Lifestyle Leaders panel, a research panel of U.S. octogenarians and nonagenarians, on climate change, including their perceptions of generational contributions to climate change, extreme weather preparedness, and engagement in climate justice. Utilizing a survey (n=23) and five virtual focus groups (n=19) conducted in July 2022, findings underscore differences in themes related to weather-event-related emergency preparedness among Lifestyle Leaders living in senior housing versus those community-dwelling. Additional themes note a perceived lack of individual agency and control around impacting climate change locally (including a potential life stage effect) and the urgency of climate change as a societal-level and voting issue. The implications of these findings for effective engagement with the over-85 age demographic in conversations about climate change and emergency preparedness will be highlighted.

we conducted both an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Our EFA identified three interpretable factors, including a 3-item sexual abuse factor (α = .80), a 3-item physical/emotional abuse factor (α = .69) and a 5-item household dysfunction factor (α = .64). Results of our CFA supported the 3-factor solution, X2 (DF = 11) = 14.289, p < .001. A series of 1-way ANOVAS examined age differences in childhood adversity, where middle aged adults reported experiencing more sexual abuse relative to younger and older adults, and younger adults reported experiencing more physical/emotional abuse and household dysfunction compared to middle-aged who reported more than older adults. Additional analyses examined the influence of adverse childhood experiences on physical and mental health outcomes, including depression. Our analyses highlight the persistent effect of ACEs across the lifespan and identify a need for intervention resources for younger and middle-aged adults in order to mitigate effects of ACEs at late life.

of sense of belonging on campus" and experience "marginalization and alienation" (p. 127). In the concluding chapter, the editors summed up that "Indigenous research is imperative to healing our communities and fostering our overall well-being" (p. 210). They noted also the importance of "honoring our collective voices" and entering "our writing space with good thoughts and intentions." They remarked on the "fluid" nature of "Indigenous methodologies" and say that there is "not a singular approach to Indigenous methodologies" (pp. 207-208). This collection of essays is important for anyone with an interest in current Indigenous perspectives on higher education and research. In chapter 13, Pearl Brower, president of Iḷisaġvik College, the only tribal college in Alaska, provided a list of traditional Inupiaq values to live by, including when doing research, that include sharing, knowledge of language, cooperation, humility, and respect. Similar lists can be found for many other groups of Indigenous peoples, and I would argue that these values should be central to any scholarly pursuit.

The contributors emphasized researchers' responsibility to the group versus research being just an individual quest, and they emphasized the need for getting beyond a deficit perspective and acknowledging the need for reciprocity, responsibility, and relationships. As Adrienne Keene wrote in chapter 4, "In many ways, Indigenous methods are 'just good research,' but they also constitute a level of responsibility, accountability, and commitment that many non-Native researchers may not be able to understand" (p. 51). Citing Wilson, Natalie Youngbull wrote in chapter 9, "Through an Indigenous paradigm, knowledge is not created or owned; rather, it is relational and shared" (p. 128). In the lead chapter entitled "The Need for Indigenizing Research in Higher Education Scholarship," Charlotte Davidson, Heather Shotton, Robin Minthorn, and Stephanie Waterman noted that they and other "Indigenous scholars do not ignore or dismiss Western epistemologies," however, they interpret them through their own lenses (p. 16). Adrienne Keene wrote in chapter 4 how "[r]esearch has often been the tool of colonialism, offering justifications for polices of assimilation and cultural eradication" (p. 50), and Sweeney Windchief commented in chapter 6 on the incidental and passive assimilation faced by Indigenous students in academia today. Theresa Stewart remarked in chapter 7 on the "dehumanizing nature of education" (p. 88) and she was echoed in chapter 9 by Natalie Youngbull who examined the support Indigenous students need as they face "feelings of invisibility and/or isolation and a lack

Introduction Cinema, a visual storytelling medium, has a rich history of enthralling, enlightening, and inspiring viewers. Among the several cinema genres, documentaries stand out and have a significant impact on society since they aim to do more than just amuse. a thorough investigation of how documentary filming is interactive and how it impacts social activism. This article explores the ways in which films impact the contemporary activism landscape by expressing societal issues and motivating audiences to act. Documentaries are one subgenre of filmmaking that has made a name for itself in recent years. They provide marginalised communities a platform to speak out, expose injustice, and demand change by combining the art of storytelling with the analytical rigour of social commentary. In this article, we delve into the various ways documentaries influence the discourse around social change, highlighting their capacity to inform viewers, rally communities, and influence policymakers. historical progression of activism as depicted in documentaries. From the innovative films of early nonfiction filmmakers to the age of immediate internet access and global distribution, we trace the development of documentary styles and methodologies. As a result of adapting to new technology and audience engagement, documentaries have continued to serve their original mission of illuminating societal issues. Throughout our voyage, we cover a diverse array of documentary topics and themes, each offering a fresh insight on how these things have influenced activism. Whether the topic is cultural awareness, political reform, human rights, or environmental preservation, documentaries have the ability to evoke strong emotions, stimulate critical thinking, and motivate viewers to take action. We look at cases that demonstrate how movies have affected legislative policy choices and inspired grassroots initiatives. We also delve deeply into the complicated relationship that exists between documentary filmmakers and the subjects they show. We explore the weight of duty and the moral dilemmas that arise when we record authentic stories and stand up for social causes. the power of documentary storytelling to elevate the voiceless and the importance of telling tales with integrity. We also become aware of the challenges faced by documentaries as they attempt to influence society as we make our way through this complex terrain. Concerns about public reaction, a lack of funding, and ethical dilemmas are just a few of the challenges that the documentary faces as a weapon for change, so it's crucial to understand its strengths and weaknesses in detail. cinema's ability to motivate viewers to take part in social change. It recognises their function as channels through which society tackles important problems by raising consciousness, evoking empathy, and mobilising people. It praises the ability of movies, particularly documentaries, to do more than just entertain; it may motivate positive social change. --- Evolution of Documentary Filmmaking as Activism Documentary filmmaking has gone a long way from being only a storytelling and entertainment medium; it is now a potent instrument for social change. In this fascinating journey through time, we trace the evolution of documentary filmmaking as a tool for societal transformation, education, and action. In Hollywood, documentaries hold a unique status as a subgenre of cinema. They skillfully blend the compelling stories of storytelling with the ethical imperative to address pressing societal issues. Our understanding of society and politics, as well as technological advancements, have all contributed to the evolution of documentary filmmaking. a journey through the pioneers of documentary cinema... The media that aimed to portray the world as it actually was was born with the "Actualités" by the Lumière brothers and continued with Robert Flaherty and Dziga Vertov. These early documentaries gave audiences a glimpse into other cultures and countries via the use of the observational technique. Furthermore, we traverse the tumultuous 1900s, a time marked by major social and political upheavals. During this time, documentary filmmakers started getting more involved in political movements. Two filmmakers who used cinema to advocate for social change and environmental conservation, Leni Riefenstahl and Pare Lorentz, respectively, used quite different methods. the '60s and '70s, when documentaries were most popular. The term "cinéma vérité" was used to characterise the increase of politically tinged documentaries during this period. By capturing the essence of social movements, political protests, and cultural revolutions, filmmakers such as D.A. Pennebaker and Frederick Wiseman cemented the documentary's place as a lens through which to see the processes of social change. --- Documentaries as Catalysts for Awareness In the realm of visual storytelling, documentaries have emerged as powerful catalysts for change, capable of awakening consciousness, inspiring introspection, and quickening collective understanding. documentary films have an essential role in drawing public awareness to pressing social issues. It delves at how documentaries may shed light on hidden corners of our world and motivate viewers to make a difference. Documentaries offer an unfiltered picture of the world as it truly is, which is a major benefit when compared to other narrative filmmaking styles. By utilising these tools, filmmakers have the opportunity to step into the shoes of storyteller, activist, and human condition observer. One of documentaries' greatest strengths is the way it boldly tackles taboo themes, making viewers confront uncomfortable truths. offering viewers a glimpse into the complexities of the globe via the film. These films may open people's eyes to other cultures, shed light on environmental problems, and call attention to injustices that deserve our attention. Using compelling narratives and striking visuals, documentaries transport viewers to the heart of situations and shed light on perspectives they would have missed otherwise. We also get into the emotional depths that people may go to watch documentaries. The foundation of many of their works are true stories, detailed recollections, and anecdotes. As a result of the profound connection established by the authenticity, the viewer is able to sympathise and have compassion towards the subject matter. Documentaries have the power to evoke strong emotions, provoke profound contemplation, and prompt viewers to question their place in the grand scheme of things. We also look at how documentaries may be platforms for marginalised voices; these films offer a platform to marginalised people, activists, and communities who have been historically disadvantaged. Documentaries provide a forum for diverse perspectives, which in turn encourage viewers to relate to tales that challenge and broaden their worldview. the power of documentaries to tackle systemic issues. They serve as mirrors, reflecting both the successes and failures of society. Documentaries have shed attention on political corruption, violations of human rights, and global issues such as climate change and healthcare disparities. They want to see problems resolved, not only identified. --- Conclusion Documentaries have consistently demonstrated the power of artistic filmmaking to inspire social transformation throughout human history. How have documentaries influenced audiences to become activists? That is the central question of this research report. In bringing attention to injustice, inspiring action, and planting the seeds of a new consciousness, it proves that film can do more than just show us the world; it can also change it. Documentaries, as a form of film, have several uses outside of the entertainment sector. They are more than simply narratives; they mirror society's triumphs and tragedies, demand fairness, and elicit compassion. Our research has shown the many ways in which films may be utilised to organise people, bring about change, and increase awareness. Documentaries have come a long way, baby, from the daring early adopters of factual filmmaking who wanted to show the world as it actually is to the ubiquitous digital technology that has democratised the filmmaking process. Documentaries have evolved in tandem with societal shifts, reflecting a heightened awareness of diversity, social justice, and the urgent need for swift action. Our study has shown that documentaries have the potential to be a powerful tool for raising awareness. They offer a platform to marginalised people, shed light on injustices that often go unnoticed, and teach us about different cultures. Watching a documentary may bring viewers to tears, prompt profound reflection, and motivate them to take action on meaningful issues. Considerations of ethics in documentary storytelling serve as invitations to empathy, drawing the audience into the stories

When it comes to activist stories and social change, documentaries are powerful tools in the visual storytelling toolbox. an in-depth exploration of the intricate connection between films, particularly documentaries, and their influence on activism. By doing so, it delves into the ways in which films are influencing contemporary activism via bringing attention to important issues, motivating viewers to take action, and fostering societal transformation. In its ability to give a platform to marginalised communities, expose injustices, and demand societal change, films bridge the gap between art and activism. The multifaceted role of documentaries as agents of social transformation, illuminating their far-reaching impacts on issues as varied as cultural awareness, political shifts, and human rights.

Introduction The term socioeconomic status (SES) refers to the position that a person or family has in relation to the community's typical standards for cultural and material goods, income, and involvement in social activities. 1 It is a crucial factor in determining an individual's nutritional status, mortality, and morbidity since it affects the cost, acceptability, accessibility, and use of medical facilities. The disparities between socioeconomic position (SES) and health status follow a gradient, or a step-by-step pattern, between where one sits in an SES hierarchy and most health outcomes. Even though not all health issues are correlated with socioeconomic class (a few diseases are more common in higher SES groups than in lower SES groups), the tendency is persistent throughout time and is evident in both men and women of all ages across countries. However, recent studies have demonstrated that health disparities accumulate over a lifetime and have an impact on health at every stage of life. Poor social and economic circumstances early in life have a long-term effect on health. 2 3 The criteria that are most frequently utilized in these scales are total income, educational achievement, and occupation. In India, the most well-known and extensively used scale for determining the socioeconomic status of an individual or a family in urban areas is the "Modified Kuppuswamy SES Scale". Originally intended to assess an individual's SES, the scale was later modified to assess the SES of a family rather than an individual. Kuppuswamy created the original scale in 1976. It has three index factors viz; education, occupation, and total income. Each parameter has been further divided into subgroups, and each subgroup has been given a score. The Kuppuswamy SES Scale categorizes families into five groups (upper class, upper middle class, lower middle class, upper lower class, and lower class) based on their overall score, which ranges from three to twenty-nine (03-29). 3 Yet, due to the dynamic nature of macroeconomic indices viz; inflation, per capita, etc., the SES is ineffectual in reaching their main objective. To fulfill their objective of determining the SES of an individual or a family, they must undergo consistent changes over time. This work aims to update and provide an "Updated Modified Kuppuswamy SES" scale for the year 2023. --- Revision of Income Parameters in Modified Kuppuswamy Scale The Kuppuswamy socioeconomic survey's parameters, including education and occupation, have remained constant over time. However, the third parameter i.e. income loses its pertinence following the Indian rupee (INR) sensitivity to inflation. 5 The income scale in Kuppuswamy SES is therefore adjusted in accordance with changes in the Consumer Price Index (CPI) for industrial workers as projected by Labour Bureau, Ministry of Labour and Employment Govt. of India 6 and the Central Ministry of Statistics and Programme Implementation 7 on their website. The values of the CPI are explained in reference to a base year. 8 As per the Labour Bureau, Government of India, the current base year to be considered is 2016. Here in this paper, we will use 2016 base year for calculating the income level of families to determine their socioeconomic status. 9 For calculation inflation rate (conversion factor), of February 2023 is 6.16 has been considered. If we multiply the generated income scale values of the year 2016 with the conversion factor of 6.16 that will update the Kuppuswamy SES scale for February 2023. The conversion rate or inflation rate is calculated using the formula. Inflation Rate = b -a a × 100 b is the CPI of the current year & a is the CPI of previous year --- Limitations Although researchers most frequently use it in community, and hospital based investigations, the Kuppuswamy socioeconomic survey has significant limitations that decrease its sensitivity in predicting a family's socioeconomic level. These include determining socioeconomic class by taking into account the employment history and educational background of the family's head, which is wholly inappropriate in the current context. Furthermore, the scale is subject to variations in income levels because it depends on shifting CPI values and needs to be updated frequently. --- Source of Funding None. --- Conflict of Interest None.

Socioeconomic status SES is one of the most important indicators to consider when assessing a family's health and nutritional status. It is a position that any person can achieve within a hierarchical social framework. Academicians and medical researchers have made several attempts in the past to create a collection of composite indices to assess an individual's or a family's socioeconomic status (SES) whether they reside in a rural or urban location. The Hollingshead, Nakao, and Treas, Blishen, Carroll, and Moore, Tiwari, Kumar, and Agarwal, Jalota, and Kuppuswamy scales are a few of the notable scales. The scales have several factors that account for information about a person or a family. Among all the SES, the most widely used scale in India is 'The Modified Kuppuswamy SES'. Based on the total score of the Kuppuswamy scale, which ranges from 3-29, families are categorized into five classes, from upper class to lower class. Owing to constraints, the Kuppuswamy SES requires frequent updates for income levels that are dependent on shifting consumer price index (CPI) values, making the scale susceptible to changes over time. This paper aims to update and provide an "Updated Modified Kuppuswamy SES" for the year 2023.

We are well aware that if we concentrate on STEM alone to the detriment of the humanities and the social sciences, we are likely to miss an essential dimension of human existence. The sciences of human beings through which man can reflect on himself as a human being, on the meaning of his existence and the existence of another world, are absolutely essential to him. This takes us to the following statement by Pascal: In other words, the so-called hard sciences alone cannot capture all the dimensions of a human being. The humanities and the social sciences are also needed capture this plural dimension. They remind us of our past and show us the way forward. This, however, does not imply that the humanities and the social sciences are competing with the so-called hard sciences, in particular STEM. It is the opposite. Scientific and technological progress has so much accelerated for the humanities and the social sciences to ignore that both STEM, the humanities and the social sciences have become closely interlinked. "Digital humanities" is even a term used to mean that the humanities cannot shut itself off from omnipresent digital uses; even thinking has also been instrumented. Besides, issues that were traditionally handled by the humanities and the social sciences are now at the core of research and STEM innovations. This paper purports to show that instead of shying away because they perceive STEM as a threat, both the humanities and the social sciences must stand up to the challenges posed by new themes and issues in view of the tenuous link they have with STEM. Indeed, the humanities was once defined through a number of questionings such as "what's a human being ?", "What's thought ?", or "what's conscience" "what's memory, perception, learning, etc.". Now, these questionings are no longer their exclusive concerns. Cognitive sciences are wondering about the meaning of "knowledge", "having convictions", "to ignore" or "being mistaken". They raise questions about the perception of objects and subjects in the surrounding world, source of knowledge as well as learning, memorising and rationalising mechanisms. They are wondering over differences between individuals when it comes to learning, remembering, etc. What are the impacts of brain damage on memory, speech, thinking... Furthermore, knowledge engineers are wondering about various knowledge materials: what's a shape, an image, a concept, a word? As Howard Gardner1 put it, cognitive sciences, "this new science" dates back to the Greeks because they were desirous of discovering the nature of human knowledge. However, this science is a radically new one because knowledge engineers exclusively use empirical methods to test their theories and hypotheses, relying mainly on the most recent scientific and technological discoveries of various disciplines. Computer science is one major part, with computer emerging as the best model for understanding how the human brain operates. Indeed, computers are not only indispensable for doing all sorts of research but also because computer is modelled on the operation of the human brain. Is computer omnipresence not likely to impact the themes of the humanities and the social sciences? New disciplines like artificial intelligence have emerged and research is stimulated by new questioning like the potential knowledge-acquiring capacity that manbuilt machines may have. Cognitics or knowledge engineering, or the automatic processing of knowledge and relationship between man and information and communication technologies blends the humanities and the social sciences with automation, computer science, ergonomics, cognitive sciences and life sciences. Equally in health matters, cutting-edge technologies are being increasingly widely used sending a message of hope on potential victory over diseases while also posing new challenges. Are questions about life, death, pain and age not assuming new meaning with the emergence of all this technology? So, the point here is not for the humanities and the social sciences to take a defensive attitude and wonder, from the outside so to speak, whether or not STEM constitutes a threat a source of alienation and. Far from being a threat to the humanities and the social sciences, STEM, on the contrary, form a major challenge. If African researchers can raise their awareness of this trend and stand up to the challenge, the humanities and the social sciences which are well rooted in social, technological and scientific realities, can play a decisive role in building a veritable African research space. CODESRIA, which has always upheld a broad social sciences concept, would then be a key agent for this convergence of STEM and the humanities and the social sciences in Africa. --- Note --- The Social Sciences and Humanities in the Age of STEM --- Ramatoulaye Diagne Mbengue Cheikh Anta Diop University Dakar, Senegal

t may sound paradoxical, at a time when the orientation towards Sciences, Technology, Engineering and Mathematics (STEM) has become mainstream for all to also unanimously recognise the importance of the humanities and the social sciences.

PATIENT-CLINICIAN RELATIONSHIPS IN HOME HEALTH CARE Ayomide Bankole 1 , Tyra Girdwood 2 , Dorothy Addo-Mensah 3 , and Mark Toles 1 , 1. Chapel Hill,North Carolina,United States,2. Duke University,Durham,North Carolina,United States,3. University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States Patient-clinician relationships are fundamental attributes of high-quality home health care (HHC); yet little is known about patient-clinician relationships in HHC (where 5 million Medicare beneficiaries receive care annually). The objective of the study was to describe perspectives of HHC patients and HHC clinicians about patient-clinician relationships in HHC. We conducted a secondary qualitative analysis of semistructured interviews (n=34) from a completed qualitative study investigating perspectives of older adult HHC patients (or caregivers as proxy) and their HHC clinicians (17 pairs) on discharge preparedness in a large HHC organization in North-Carolina. A conceptual model of patient-clinician relationships guided content analysis of the interview data. HHC patients identified as White (65%) and black (35%). Most HHC patients reported female sex (53%) and average age was 83 years (range= 69-93). Clinicians were registered nurses and physical therapists. Across the patient-clinician pairs, HHC patients valued relationships with clinicians with shared commonalities and those who provided reciprocal informational exchange and respected their autonomy. HHC clinicians valued relationships in which they felt helpful and respected as a healthcare professional. Relational conflicts arose when there was discordance in expectations of care (e.g., type of HHC services provided). Conflicts also arose when organizational constraints, such as disruptive scheduling, limited HHC visit time, and when limited continuity of care prevented the formation of patient-clinician relationships. Relational conflicts and organizational constraints influence patient-clinician relationships in HHC. Multi-level interventions (targeting modifiable factors at the patient, clinician, and organizational levels) are needed to improve the patient-clinician relationships and the quality of HHC. Abstract citation ID: igad104.1724 --- PERCEIVED FEASIBILITY TO IMPLEMENT A TASK-ORIENTED EXERCISE PROGRAM BY FITNESS STAFF AT SENIOR LIVING COMMUNITIES Chiung-ju Liu 1 , and Lauren Mansuy 2 , 1. University of Florida,Gainesville,Florida,United States,2. University of Central Florida,Orlando,Florida,United States Older adults who relocate to senior living communities have a desire to maintain their independence. The fitness infrastructure within these communities is a great platform to deliver evidence-based exercise programs to support residents' independence, especially for those who have experienced activity limitations. Task-oriented exercise incorporates daily activities into exercise strategies and has been recommended as an approach to reduce late-life disability. The current study used an interview research design to determine the feasibility of implementing 3-Step Workout for Life, a taskoriented program, in senior living communities. The 3-Step Workout for Life program consists of gym-based group resistance exercise and home-based one-on-one activity exercise. Fourteen fitness instructors from different communities, with independent living units, in the state of Florida completed the study. Interviews were transcribed, coded, and underwent thematic analysis. Instructors perceived the screening procedure to select and enroll residents in this program could help match residents to the right fitness program. The gym-based group resistance exercise is compatible with existing instructor-led fitness programs. Although instructors perceived the homebased one-on-one activity exercise positively, such as the potential benefits for frail residents who do not attend the gym, they acknowledged several barriers to implementing this exercise. Major barriers include their job responsibility

were also risk factors. Patient risk factors included prior hospitalization, health conditions such as cancer and renal disease), functional limitations, certain medication classes (e.g., anticoagulants, diuretics), the use of oxygen, and the use of a urinary catheter. This study demonstrates that clinician behaviors and documentation patterns can be incorporated in risk models to yield important insights.

Caregiving; Health Equity; and Community Linkages. Health departments offered input through facilitated listening sessions and an open input period. Their feedback emphasized the importance increased information on health equity and partnerships in the Road Map. The Leadership Committee also advised continued partner engagement through the review process. This translated to review by the Alzheimer's Association, CDC subject matter experts, external health equity experts, the Leadership Committee, workgroup members, the Healthy Brain Initiative Collaborative, the Alzheimer's Association Early Stage Advisory Group and ultimately CDC leadership. This presentation will explore important themes that emerged throughout this process that shaped the design and evolution of the HBI Road Map series to its most recent iteration, as a guiding document with health equity and multi-sector collaboration action at its core. --- SESSION 3060 (SYMPOSIUM) Abstract citation ID: igad104.0854 --- A HISTORICAL-CONTEXTUAL PERSPECTIVE ON GRANDPARENTS' ACTIVITIES WITH GRANDCHILDREN Chair: Jill Juris Discussant: Amy Rauer Grandparenting is one of the most positive roles for many older adults, yet there is limited understanding of what activities grandparents and grandchildren actually engage in together or how these may vary based on both context (e.g., residential grandparenthood, grandparents' marriage) and historical events (e.g., . Drawing from multiple theoretical frameworks and methodological approaches, this symposium begins with Flood providing a broad view of time grandparents and grandchildren spend together using large-scale populationlevel data from IPUMS. Illustrating how such activities may vary based on context, Stephan and Chan provide insights into how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents' perceived roles. Extending this examination of context to consider specific processes, Juris and Zvonkovic will then describe the process of family leisure among grandparent couples by examining how both individuals in a couple experience family leisure with their grandchildren. Providing a historical perspective on these experiences, Fruhauf and colleagues reveal the challenges of raising grandchildren in the context of COVID-19 and the importance of engaging in different and new activities with their grandchildren during this time. Finally, as discussant, Rauer will draw upon Bronfenbrenner's socioecological framework to illustrate how grandparenting is situated within a complex network of interdependent systems and dynamic contexts. Together, this symposium will highlight the implications of grandparenting for catalyzing development and enhancing well-being across multiple generations. Abstract citation ID: igad104.0855 --- LARGE-SCALE POPULATION-LEVEL DATA FOR STUDYING GRANDPARENTING IN THE UNITED STATES Sarah Flood, University of Minnesota, Minneapolis, Minnesota, United States The questions we can answer about grandparenting in the United States are shaped by the availability of data. This presentation will review previous research on trends and sociodemographic variation in grandparenting in the United States based on large-scale population-level data from IPUMS (www.ipums.org). It will highlight the various ways that researchers have measured families that include grandparents (e.g., three-generation families, grandfamilies). It will also discuss the limitations of these data, specifically the focus on coresidence, for studying grandparents. The presentation will then review research on grandparents using the American Time Use Survey, the only data in IPUMS that enables analyses of grandparents time spent with both their resident and non-resident grandchildren. These analyses will focus on the leisure activities that grandparents share with their grandchildren and how this varies by living arrangements and sociodemographic characteristics. Though the grandparent population varies across virtually all sociodemographic characteristics, caregiver status (i.e., whether grandparents are raising grandchildren), may be most salient in how grandparents engage in activities and perceive their roles in relation to their grandchildren. Informed by the bioecological process-person-context-time model, this mixed-methods study explores how activity engagement varies by caregiver status and whether activity engagement with grandchildren is related to grandparents' perceived roles. A convenience sample of 86 mid-life and older adults (Mage=65.12 years, range=42-82) completed an online survey with open-and closed-ended items related to their grandparenting experience. 22% of grandparents selfidentified as grandparent caregivers (GC), or those who have been raising their grandchildren for six months or longer; the remaining 78% self-identified as non-caregiving grandparents (NCG). Comparative analyses did not yield statistically significant results, revealing GCs and NGCs largely engaged in similar activities with their grandchildren. However, activity engagement intervals differed by group (i.e., daily basis for GCs vs. weekly or monthly basis for NGCs), and a greater proportion of NCGs reported digital activity engagement with their grandchildren. Both GCs and NGCs identified their roles as emotional supporters to their grandchildren, though GCs also identified with instrumental roles (e.g., surrogate parent, anchor, financial supporter). These findings shed light on the connection between self-reported activity engagement and subjective role perceptions across just one sociodemographic characteristic-caregiver status-and suggest both groups share a similar grandparenting foundation, with an additional, "dual-roles" component for GCs. Implications for future research and practice will be discussed. Abstract citation ID: igad104.0857 --- HOW GRANDPARENT COUPLES ENGAGE IN FAMILY LEISURE WITH GRANDCHILDREN Jill Juris 1 , and Anisa Zvonkovic 2 , 1. Appalachian State University, Boone, North Carolina, United States, 2. --- University of Georgia, Athens, Georgia, United States There is limited understanding of how grandparent couples negotiate time with grandchildren. Family leisure is often purposive by being planned, facilitated, and executed by parents or grandparents to achieve goals such as improved interaction, communication, and family cohesion. Moving beyond studies of counting time in leisure, few studies of family leisure have included how people experience leisure as couples. Guided by a life course approach, this qualitative study provides insight to an understanding of the process of family leisure among grandparent couples by examining how both individuals in a couple experience family leisure with their grandchildren. Grandparent couples (n=10) ranged in age from 60 to 75 years old (M=66.8, SD=5.01). The grandparents interviewed were not providing custodial care to their grandchildren. Participants completed individual interviews that were then analyzed at the couple level. Through constructivist grounded theory, this study developed a process model of grandparents' decision-making that unfolded into four options for engaging in family leisure with grandchildren. The four options included: wanting a grandparent fix, going with the flow when invited by children, hosting grandchildren in their homes, and meeting expectations for family gatherings. Grandparent couples often described more than one option of family leisure based on their life course dimensions (i.e., individual, family, and sociohistorical). Implications for application in the fields of recreation and family sciences will be discussed. Managing COVID-19 demands may exacerbate caregiving responsibilities of custodial grandparents raising grandchildren. This presentation aims to discuss qualitative data obtained from 14 custodial grandmothers who participated in virtual focus groups to understand their parenting experiences in conjunction with meeting COVID-19 demands. Participants were recruited from a larger sample (N=145, age range 30-79 years, Mage = 61.4 years, SD = 8.5) of custodial grandparents who completed a quantitative survey on COVID-19 stressors. Guided by McCubbins and Patterson's Family Stress and Adaptation model, three researchers conducted open coding of the focus group data. The analysis revealed distinguishing patterns related to managing challenges of grandchild caregiving brought on by COVID-19. Some grandparents discussed the demands of COVID-19 as difficult, but not as challenging as the day-to-day experiences of raising grandchildren. This was reflected when grandparents discussed raising grandchildren with special needs in the pandemic environment, advocating with schools to adjust virtual learning expectations, managing custody cases and

has near nationwide uptake, and, in 2023, a new project, Data for Action, launched in four states to support the use and dissemination of BRFSS and other data. Together, these projects improve assessment, planning and measurement of community health outcomes related to brain health. The 4th edition of the HBI Road Map has an accompanying evaluation tool offering common measures for state and local health departments to track their success as they implement the new actions. This session will explore the past impact of Road Map actions and opportunities for future measurement.

INTRODUCTION Inequality of income distribution is a problem faced by almost every region in Indonesia. Income inequality widens the gap between the poor and the rich in the long run. The Gini ratio is often used as an indicator of income distribution inequality. The Gini ratio ranges from 0 to 1. If the Gini coefficient is 0 it means perfect equality, whereas if the Gini coefficient is 1 it means there is absolutely perfect inequality. Inequality of income distribution of North Sumatra province is moderate. According to Central Statistical Agency for North Sumatra Province, the Gini ratio of North Sumatra province in 2021 is 0.3145. The coefficient value is moderate. Even though inequality is not high, the government should pay attention to this. Equal distribution of income is a goal that must be achieved by the government to realize social justice for all people. The current North Sumatra provincial government must maintain consistency in suppressing inequality of income distribution. This is because, in 2021, as many as 27 or 82 percent of regencies/cities in North Sumatra province have low income inequality. Meanwhile, 6 or 18 percent of other regencies/cities are at a moderate level. However, this achievement was slightly tarnished, because in 2021 the Gini ratio of 7 regencies/cities has increased compared to the previous year. This means that the inequality of income distribution in the area has increased. This is a setback for the province of North Sumatra in the midst of efforts to improve equality and social welfare. Solving the problem of income inequality is a challenge for the government. An indepth introduction to the important factors that affect inequality of income distribution can help the government formulate appropriate policies to accelerate equity. Several previous studies have found many factors that affect inequality of income distribution, including poverty and the Human Development Index (HDI). Poverty was found to have a significant positive impact on inequality of income distribution (Hindun et al., 2019). This means that an increase in the poverty rate will further sharpen the income inequality that occurs. Poverty makes it more difficult for marginalized people to enjoy the benefits of development, and instead become victims of development (Suryanto, 2001). The low-income group of people has a lower speed in enjoying the benefits of successful economic growth (Wibowo, 2016) because the factors of production, the use of resources and their profits are controlled by the capitalists, or the rich (Dewantara, 2020). This causes the rich to get richer, while the poor get poorer. In the end the gap in inequality gets deeper. If poverty is seen as further deepening the inequality gap, the HDI should have the opposite effect. HDI reflects human development achievements from the aspects of education, health and income. A high HDI indicates that people's access to these three aspects is very good. This means that an increase in the HDI should be able to reduce the income inequality that occurs. This is supported by the findings of several previous studies which concluded that HDI has a significant negative effect on income distribution inequality (Samsir & Rahman, 2018;Yanthi & Sutrisna, 2018). This study aims to analyze the effect of poverty and HDI on the inequality of income distribution in districts/cities in North Sumatra province, either partially or simultaneously. This research is expected to contribute to supporting the regency/city government efforts in North Sumatra province to increase the equity of income distribution --- METHOD The research type is quantitative research. The variables tested consisted of inequality of income distribution as the dependent variable, poverty and HDI as the independent variables. Table 2 shows the tolerance value for poverty and HDI variables is greater than 0.1. Likewise, the VIF values of the two variables are smaller than 10. This indicates that there is no multicollinearity problem in the research model. Table 3 shows that the p-value of the poverty variable is 0.098 and HDI is 0.064. Both of these variables have a p-value greater than 0.05. This shows that there is no heteroscedasticity problem in the research model. --- Multiple Linear Regression Analysis Summary of multiple linear regression analysis is presented in Table 4: Based on the results of the analysis presented in Table 4, the research equation is obtained: Y = -0,367 + 0,004X1 + 0,008X2 This equation can be explained as follows: 1. The values of constanta -0.367 indicates that if poverty and HDI are zero, then the inequality of income distribution of regency/city in North Sumatra province is -0.367. --- Coefficient regression of poverty variable 0.004 indicates that if poverty rate increases by 1 percent and the other independent variables remain, then the inequality of income distribution of regency/city in North Sumatra province increases by 0.004. In contrast, a 1 percent decrease in poverty rate will reduce the inequality of income distribution of regency/city in North Sumatra province by 0.004. Poverty has a statistically positive relationship to inequality of income distribution. 3. Coefficient regression of HDI variable 0.008 indicates that if HDI increases 1 percent and the other independent variables remain, then the inequality of income distribution of regency/city in North Sumatra province increases by 0.008. In contrast, a 1 percent decrease in HDI by will reduce the inequality of income distribution of regency/city in North Sumatra province by 0.008. HDI has a statistically positive relationship with inequality of income distribution. --- Testing the Coefficient of Determination The coefficient of determination shows how many independent variables can be in the research model to explain the variation of a dependent variable. The coefficient of determination in this study is shown by the Adjusted R Square value. Summary of coefficient of determination test presented in Table 5: --- Hypothesis test This research examines the impact of poverty and HDI on inequality of income distribution, both partially (t test) and simultaneously (F test). Decision making on hypothesis testing is done based on certain criteria. If the significance probability value of the t test is <0.05, then independent variables are stated partial to affect the dependent variable, and vice versa. If the significance probability value of the F test is <0.05, then independent variables are stated to simultaneously have a significant effect on the dependent variable, and vice versa. This research uses an alpha value of 5%. A summary of the results of the t test and F test is presented in Table 6: The results of the F test presented in Table 6, show the F-test of 14.404. The significance probability value is 0.000, less than 0.05. Thus, it can be concluded that poverty and HDI simultaneously have a significant impact on inequality of income distribution of regency/city in North Sumatra province. Poverty has a positive and significant impact on inequality of income distribution. This can be seen from the significance probability value of poverty which is less than 0.05 (0.016 <0.05). The poverty regression coefficient is positive, indicating the direction of the impact of increasing and decreasing poverty on inequality of income distribution of regency/city in North Sumatra province. The results of this research are consistent with the initial allegations that poverty exacerbates inequality of income distribution. People living below the poverty line have very limited access to the benefits of economic development. This is because the factors of production, resource utilization and profits are controlled by capitalists, or the rich (Dewantara, 2020). Meanwhile, the poor only get the smallest share of the benefits of this development (Itang, 2015). Therefore, in the long run, inequality of income distribution will widen. On the other hand, sharpening inequality will make it more difficult for the poor to get out of the poverty zone. In this case, poverty and inequality of income distribution have a causal relationship (Ahmad & Triani, 2018;Fernando & Amar, 2021;Randa & Sentosa, 2020). The results of this study are in line with the research of Hindun et al. (2019). Inequality of income distribution is also significantly affected by HDI. Table 6 shows that the regression coefficient of HDI is positive. In addition, the HDI probability value is smaller than 0.05 (0.000 <0.05). This means that HDI has a positive and significant impact on inequality of income distribution of regency/city in North Sumatra province. The results of this study are in line with the research of Ariesta et al. (2022) and Farrah & Yuliadi (2020). The findings of this study are different from the initial assumption. The assumption that an increase in HDI will reduce inequality of income distribution is not proven. The research findings reflect the opposite. HDI may positively affect inequality of income distribution. HDI can have a positive effect on income distribution inequality. Farrah and Yuliadi (2020) suggest the reason, namely that the existence of inequality in a region will affect the level of welfare owned by the people in the region itself. The unevenness of the Human Development Index in all regency/city in North Sumatra causes there to be more developed regions because the quality of human resources in the area is better and there are areas that are left behind because the quality of human resources in the area is still low. --- CONCLUSION Based on the results of the analysis that has been conducted, it can be concluded that poverty has a positive and significant impact on inequality of income distribution of regency/city in North Sumatra province. Similarly, HDI has a positive and significant impact on inequality of income distribution of regency/city in North Sumatra province. The simultaneous test results conclude that poverty and HDI simultaneously have a significant impact on inequality of income distribution of regency/city in North Sumatra province. Regency/city governments in North Sumatra province need to prioritize poverty alleviation programs so that the poor can move out of the poverty zone. This research implicates on preparation of poverty alleviation programs and equal of income distribution of regency/city in North Sumatra province.

This research aims to analyze the impact of poverty and the Human Development Index (HDI) on inequality of income distribution of regency/city in North Sumatra province. This research is quantitative descriptive. The research was conducted in 33 regencies/cities in North Sumatra province. The type of data used is secondary data. Data is accessed online on the website of Central Statistical Agency (BPS) for North Sumatra Province. The data used includes poverty rate data, HDI and Gini Ratio. Data analysis used multiple linear regression analysis. The results showed that poverty had a positive and significant impact on inequality of income distribution of regency/city in North Sumatra province. HDI also has a positive and significant impact on inequality of income distribution of regency/city in North Sumatra province. The results of the simultaneous test conclude that poverty and HDI simultaneously have a significant impact on inequality of income distribution of regency/city in North Sumatra province. This research implicates on preparation of poverty alleviation programs and equal of income distribution of regency/city in North Sumatra province.

INTRODUCTION The detriment that emanates from substance misuse are disparaging and often immeasurable, but one keeps wondering, why its prevalence? The economic and human resources being lost to the wasteful hands of substance abuse in our society is alarming. Dug abuse has often led to detrimental social consequences such as road accident, loss of jobs, poor academic and job performances, instability in family set-up, etc. (Sharma, 2009;Aspen Ridge Recovery Centers, 2022). Other scholars have attributed Substance abuse to High-risk sexual behavior, Reckless behavior, and unemployment (Nyaga, Mwaura, Mutundu, Njeru, Juma, & Were, 2021). The level of drug abuse is predominated among Africa girls, and have taken different shapes, the common names given to drugs that youths abuse in northern Nigeria abuse include but not limited to Lalakula, Ice, AZ, Loud, Jimonkawye to mention but few. Alcohol abuse is by far the most widespread form of drug abuse in our society, because it is humanity's oldest and most widely known drug of abuse, such as gin, beer, table wine and palm wine. Albenze (2020) pointed out the effects of alcohol is predominantly seen in the brain, where alcohol restricts a number of brain functions by depressing the central nervous system. (Alhassan, 2021). Physical health also known as medical health is the medical condition of an individual that has to do with their biological health conditions (Albenze, 2020;Alhadi, 2019). Generally, substance abuse has be linked to physical health conditions like changes in coordination, high blood pressure and heart rate changes, feelings of being more awake or sleepy, at chronic stage it could lead to death (John, 2022;Amati, Meggiolaro, Rivellini, & Zaccarin, 2018). Traditionally, physical health has been defined as the absence of disease or serious illness. However, in recent years, modern medicine has changed this viewpoint. World Health Organization (2021) defines health in the sense of the overall well-being of a person, physically, mentally, and socially. These aspects are intricately linked, and the health of an individual encompasses all of them. Physical and mental health have a very close connection. Poor mental health puts a person at a greater risk of chronic physical conditions (Klostermann & O'Farrell, 2013). Additionally, chronic physical conditions are linked with an increased risk of poor mental health. studies have linked poor physical health to substance abuse and illicit drug use both in Nigerian and other countries (Amati, Meggiolaro, Rivellini, & Zaccarin, 2018;Lomas, Waters, Williams, Oades, & Kern, 2020;NIDA, 2022). Other studies have linked substance abuse to poor psychological wellbeing and impaired social functioning (UN Drugs Crime, 2016; Abubakar, Abubakar, Kabiru, Zayyana, Garba, Abubakar, Abubakar, & Mohammed,2021). Data have demonstrated high rates of comorbid substance use disorders and anxiety disorders-which include generalized anxiety disorder, panic disorder, and post-traumatic stress disorder (Wenzel, Liese, Beck, et al., 2012;NIDA, 2003). There is an undeniable link between substance abuse and delinquency. Arrest, adjudication, and intervention by the juvenile justice system are eventual consequences for many youths engaged in alcohol and other drug use. This study focuses on establishing the relationship between substance abuse and the psycho-social and physical wellbeing of Lafiya Youths. --- METHOD A correlational survey method was used for the study; a correlational survey is the type of analysis that tries to find the relationship between two or more variables in survey analysis. Lafia is a town in North Central Nigeria, it is the capital city of Nasarawa State. The study covers the youths of the Lafia Local Government area, who matches the research criteria, which were substance abusers. The study used snowballing to get participants, since it was easier to get people who abuse substance, helping to talk to other substance abusers, so they could respond to the scales used for the study. All ethical guides as regards to this study were duly followed, participants were given the choice to participate and were told they can withdraw at any point. No participant was forced into participating in the research. A total of 246 participants were used for the study, where 128 (52.0%) were males and 118 (48.0%) were females. The age of the respondents ranges from 18-40 years. Educational background of the respondents indicates that 147(59.8%) had SSCE, 47(16.7%) had NCE/ND, 41(16.7%) acquired university degree, and 11(4.5%) have postgraduate certificates. Drug Use Questionnaire (DAST-20) and General Health Questionnaire -28 (GHQ-28) were used to collect data. The data was coded, entered, and cleaned before being analysed using the Statistical Package for Social Sciences (SPSS-V-23). Result s in table 1 showed a negative relationship between substance abuse (r= -11, <.05) and physical health (r = .11, P<.05). this implies that the higher the substance abuse the lower the physical health of Lafia Youths. Result in table 2 showed a negative relationship between substance abuse (r= -09, <.05) and anxiety insomnia and a negative relationship between substance abuse (r = -.11, P<.05). This implies that the higher the substance abuse the lower the psychological health of Lafia Youths. 3 showed a significant negative relationship between substance abuse (r= -16, <.05) and social well-being among the participants. This implies that the higher the substance abuse the lower the social well-being of Lafia Youths. --- RESULTS --- DISCUSSION This study examined the influence of substance abuse on the psycho-social and health wellbeing of the youths in Lafia. A total of 248 youths were participants who participated in the study. Result showed that youths who abuse drugs more were more liable to poor medical health condition. This shows that people who smoke Marijuana, high intake of alcohol and other related substances were liable of suffering from heart failure, heart attacks, and likely severe medical conditions. This is tandem with the studies of Amati, Meggiolaro, Rivellini, & Zaccarin, 2018; Lomas, Waters, Williams, Oades, & Kern, 2020 that discovered that substance abuse significantly affected human physical health. Psychologically, result revealed a negative correlation between substance abuse and psychological health of the participates. This demonstrated that those who abuse substance were more predisposed to psychological conditions like depression, insomnia, anxiety, schizophrenia and delusion. The higher level of substance abusers the more likely the individual will be exposed to this risk psycho health conditions. The result of this hypothesis is in line with the studies of Abubakar, Abubakar, Kabiru, Zayyana, Garba, Abubakar, Abubakar, & Mohammed, (2021) that demonstrated the influence of substance abuse on psychological health of youths. More so, it was revealed that substance abuse has a negative significant relationship with social well-being of youths in Lafia. This shows that youths who abused high substance are liable to poor social life and tend to lead a negative social lifestyle. They are liable to criminal acts like, stealing, burglary, violence, rape, become school dropouts and fail to maintain a health intimacy relationship. On a whole, this result implies that Lafia Youths` psycho-social wellbeing and physical health are affected by their levels of substance abuse. This finding is in line with the findings of (Aknin, Dunn, & Norton, 2012;Adeyeye, 2018) that discovered that social well-being can significantly be affected by substance abuse. --- Summary The present study has shown that substance abuse is a significant factor influencing the psychosocial well-being and physical health of Lafia Youths. It affects it such that the higher the level of substance abuse the higher the risk of having negative health and social conditions. --- CONCLUSION This study concludes that substance abuse has significant influence on the psychological life of Lafia Youths. It also revealed that the social life of Lafia youths is affected negatively by substance abuse. The study further reveled that the physical health of the youths in the general area has a negative correlation with their level of substance abuse, hence the need to track the menace of substance abuse. --- Recommendations The following recommendations if followed will help to fight the menace of substance abuse in Lafia Metropolis 1. There should be a serious sensitization among Lafia youths on the negative effects of substance abuse on their psycho-social and medial health. The youths should be made to understand the dangers and possible effect of substance abuse. --- 2. Psychological tests should be made available to the youths and everyone who wishes to undergo it, free or affordable psychological interventions should be set up by the government. --- 3. At family levels, parents should try to bring up their child in a healthy environment, and monitor the people their children and wards interact with.

The psychological, physical and social effect of substance abuse is enormous and can be detrimental to the productive years of a youth. Researches have demonstrated that substance use often lead to negative psychological, physical and social impairment. This study using correlational survey method, analyzed the research with Pearson moment correlation and discovered that in Lafia, the physical health of youths had a negative correlation (r -.11, p<.05), while, it also affected psychological health negatively (r=-.09, p.<05) and a significant negative relationship between social wellbeing (r= -.16, <.05) and substance abuse. it was concluded that substance use negatively affect the physical, psychological and social wellbeing of Lafiay Youths. The research recommended that there should be a serious sensitization among Lafia youths on the negative effects of substance abuse on their psycho-social wellbeing.

I. Introduction Currently, for community segments with a certain social level in Daerah Istimewa Yogyakarta (D.I.Y.) Province, the eating culture has shifted, and eating out has become a family recreation trend (Wardiyanta et al., 2019). Culinary tourism is one of the three family-favorite tourist activities besides shopping and enjoying natural scenery (Ingkadijaya et al., 2016). Research on 200 families in Sleman, Yogyakarta, shows that people use diners and restaurants as a resource for entertainment, to experience new and fun experiences, to gain social interaction, and to try new foods (Wardiyanta et al., 2019). The prolonged pandemic conditions and online activities have increased people's desire to enjoy leisure time outside. Even so, under limited conditions, recreational activities at crowded tourist sites are considered risky. Consequently, places to eat within proximity (within the same province) are an option for visiting to meet recreational needs. In Yogyakarta, many restaurant developers have responded well to this condition, marked by the emergence of many new thematic restaurants in recent years. When choosing a restaurant, the atmosphere of the restaurant is one of the determinants of preference by customers (Septiyanti et al., 2018), in addition to price, service quality, and image of the restaurant (Abdullah et al., 2011in Erinda et al., 2016). On the other hand, cities need regional identity, which can be obtained from the sustainability of local values. Meanwhile, for cultural values to survive and continue, these values must be by needs and become practical solutions in society. (Oliver, 2006in Hidayat, 2011) including, for example, functions that are in demand by the community such as recreational restaurants. This paper aims to find the role of locality in restaurant preferences as an alternative to family recreational tourism in the Special Region of Yogyakarta. --- II. Method This study is explorative. Data was obtained through a survey via online questionnaire at the end of 2022 with 115 respondents in total. Questionnaires were distributed through proximity to related respondents or convenience sampling. The character of the respondents is limited to the age of 17 and over, lives in D.I.Y. Province and has a track record of eating with family in D.I.Y. Province. The data were then analyzed using the content analysis method and produced qualitative data. The result then attempted to be interpreted based on the context of the respondent's character, additional data related to objects by online observation via video vlogs on Youtube, and related literature. --- III. Results and Discussion --- Characteristics of Respondents The characteristics of the respondents are as follows. The majority of the respondents were women (64%). The age range of the respondents was 18-47 years, with 38% being 18-25 years old, 43% being 26-35 years old, and 19% being 35-47 years. More than half of the respondents are workers (46% employees and 11% self-employed), while the rest are students and university students (31%), domestic workers (11%), and job seekers. The economic level of the respondents varied; 27% income less than IDR 1,000,000.00 per month, 29% income of IDR 1,000,000.00-IDR 2,500,000.00 per month, 34% income of IDR 2,500,000.00-IDR 5,000,000.00 per month, and the remaining 10% earn more than IDR 5,000,000.00 per month. The majority of respondents live in Sleman Regency (45%), followed by Yogyakarta City (32%), Bantul Regency (22%), and one respondent lives in Gunung Kidul Regency. More than half (52%) of respondents have lived in DIY for more than 20 years, the remaining 16% have lived for 11-20 years, 14% have lived for 6-10 years, and 18% have only lived for 1-5 years. --- Locality in Atmosphere Factors Expected by Respondents Based on the question of "the order of things that are considered essential in choosing a recreational restaurant for the family", selected factors are mentioned by the respondents. The essential things in considering restaurant selection (preference) for family recreational tourism, as shown in Figure 1, are related to restaurant management, namely taste of food (most significant) and price. Even so, restaurant's layout and design are also considered significantly as a preference factor. Factors included in these aspects are amenities and comfort; atmosphere/ambience (fourth most significant); cleanliness; conditions that are friendly, fun, and safe for children; spacious place; completeness of facilities, especially ease of parking; the beauty of the space; relief conditions (not crowded); open space with access to a garden or outdoor area; and security. The study also shows that the desired side activities, besides eating, to do in restorants with the family for recreative purpose by the respondents are not related to local traditions matters. The data shows that the desired activities are more informal and casual; the most answers are "chat" and discussion. Based on the results of the questionnaire, it was found that no local value emerged as an important consideration in choosing a restaurant for family recreational tourism, additional activities that one wanted to do in a restaurant with the family apart from eating, as well as the expected facilities at the restaurant. However, the locality factor appears even with a small amount of data on the mood question. Significant factors from the atmosphere of the restaurant that are expected as an alternative to family recreational tourism (see Figure 2) include; have access including views to natural things (49 data); peacefull/quiet, away from the crowd, and not in a rush (39 data); spacious and roomy space, quite apart from other visitors so they can get privacy (26 data); as well as cool temperatures and clean air (21 data). Locality appears even though the amount of data is less than 10% (8 data) with keywords; traditional, rural, Javanese (1 data), and Sundanese (1 data). Apart from that, in a clearer way, locality values can be seen through the physical manifestation of the choice of restaurant by Locality in Restaurant Preferences as an Alternative Family Recreative Tourism in Yogyakarta respondents. --- Recreational Family Restaurant Object Preferences in Yogyakarta The choice of the restaurant by respondents was represented by asking the name of the restaurant in D.I.Y. Province which they felt was suitable for eating with family and had the recreational effect that 1. never been visited but planned to; 2. have been visited and will be recommended; and 3. have been visited and is the family favorite. From these questions, 251 restaurant names emerged as answers. To see the trend of restaurants that respondents are interested in, the assessment process is carried out by summarizing the number of points from the three previous questions. Points are obtained by multiplying the number of data that mentions the name of the restaurant by; 1 poin if the data is obtained from questions (1) never been visited but planned to; 2 poin if the data obtained from question (2) have been visited and will be recommended; and 3 poin if the data is obtained from question (3) have been visited and is the family favorite. From this process, 40 (forty) restaurant names with the most points were obtained with the distribution as shown in Figure 3. Restaurants with the most points include; Mang Engking (Central) Gubug Makan, Warung Kopi Klotok, Waroeng Raminten, Westlake Resto, and Banyumili Resto. --- Locality Aspects of Recreational Family Restaurant Object Preferences in Yogyakarta The application of cultural values can be seen as a sign of locality in building objects, including in this study, restaurants. This value can be traced from its transformation in buildings, for example by the "ATUMICS" method, through several aspects, including traditional objects (Artefact), manufacturing processes (Technique), use/function (Utility), elements of objects (Materials), symbols symbol (Icon), concept (Concept), and shape (Shape) (Nugraha, 2012in Suriastuti et al., 2014). In shape, for example, based on the type of roof, Javanese traditional houses are grouped into five namely joglo, limasan, village, mosque, and tajug or tarub (Ismunandar, 1997in Firlando & Wiyatiningsih, 2018). In terms of materials, the materials that are often used in Javanese houses, especially in rural areas, are organic materials, namely wood, bamboo and leaves (Hardiyati et al., 2013). The shape and material aspects were then checked for existence in 20 (twenty) restaurants for family recreational tourism with the most preference rating points. As a result, as shown in Table 1, the majority of restaurant objects chosen by respondents apply Javanese roof shapes (14/20 data) and use a lot of organic materials (19/20 data) which characterize the locality of buildings with Javanese culture. Some of the restaurants in Table 1 do show roof characteristics and materials that are suitable for roofs and materials that are often used in Javanese buildings (Figure 4). Even so, if you look at restaurants with high scores but not too many Javanese characteristics (Figure 5), a tropical and traditional atmosphere can still be felt as local characteristics at the regional level. Restaurants with a modern style (Figure 6) are also included in the list in Table 1 but with lower points than buildings with characteristics and materials that indicate locality. Of the seven aspects of "ATUMICS", the two aspects that have been examined (Material and Shape) have not shown a deeper application of cultural values. These values cannot be examined because of the limited observation media. Direct observation in the future will facilitate a more comprehensive assessment and analysis of building elements. For a deeper study of locality, it is also necessary to look at intangible aspects because locality is not just a design style but a basic architectural process (Pratiwi et al., 2022). appear in restaurants for family recreational tourism with the most preference rating points, which may also be due to the age range of the families invited to enjoy the restaurant by the respondents. The majority of respondents invited their parents (highest score) and siblings or in-laws to eat at restaurants for alternative tourism (Figure 7). This locality preference is possible because of nostalgia. Nostalgia in the consumer behavior can make consumers choose consumption with stimuli in the form of artifacts, images (visuals), or stories that are positively related to the past (Rahma et al., 2017). It is possible that the respondent's parents or in-laws, as well as the respondent's siblings or inlaws, have positive memories of spaces with regional characteristics of Javanese and Indonesian localities. In this case, locality and tradition might appear as practical solutions in family restaurant design strategy. Therefore, it can sustainably maintain its existence (Oliver, 2016in Hidayat, 2011). --- Proposed further studies Discussion point D: "Locality Aspects of Recreational Family Restaurant Object Preferences in Yogyakarta", shows factors that are happened to be coincidental. There is no significant explicit data from respondents stating that the atmosphere design with local aspects is the basis for choosing a recreational restaurant for families. Therefore, further studies to confirm these findings are needed. --- IV. Conclusion From the above study, it was found that there were respondents who did not directly and explicitly choose a restaurant based on the emergence of locality aspects in the restaurant. Even so, other considerations, including preference factors in the form of the presence of natural elements and openness, tend to direct respondents to choose restaurants which, if viewed in fact, have elements of locality, especially in the Material and Shape aspects. This is possible because the majority of family character factors involved in eating activities at restaurants are in the pre-elderly and elderly age range which are influenced by nostalgia factors in their preferences as consumers.

The location of culinary services (including restaurants) has now become an alternative for recreational tourism that is popular with the community. On the other hand, cities need regional identity, one of which can be obtained from the sustainability of local values. This paper aims to find the role of locality in restaurant preferences as an alternative to family recreational tourism in the Special Region of Yogyakarta (DIY). Data was obtained through a survey via online questionnaire at the end of 2022 with a total of 115 respondents. As a result, it was found that the number of respondents who explicitly chose a restaurant based on the appearance of the locality aspect was not significant. Even so, the data shows that the restaurants that are favorite by respondents to visit with their families in order to achieve recreational goals tend to have elements of locality, especially in the material and shape aspects. This is thought to be influenced by the character of the majority of families who are invited to enjoy the restaurant by respondents, namely the parents of preelderly and elderly respondents who are influenced by nostalgia factors in their preferences as consumers.

Background People with dementia want to be involved in the many decisions they have to make over time in order to adjust care to their values and preferences. Involving informal caregivers in decision-making can promote autonomy for people with dementia by using their extant capacities. However, informal caregivers have their own interests in the decisions made. Our aim was to describe the challenges of shared decisionmaking in dementia care networks. --- Methods Our study involves a multi-perspective qualitative study using face-to-face interviews with 113 respondents in 23 care networks consisting of 23 people with dementia, 44 of their informal caregivers, and 46 of their professional caregivers. The interview guide addressed the decision topics, the decision-making participants, and their contributions to the decision-making. We used content analysis to delineate categories and themes. --- Results The three themes that emerged describe the challenges of shared decision-making for dementia care networks: (1) adapting to a situation of diminishing independence, including shifting roles in the decision-making; (2) tensions in network interactions, resulting from different perspectives and interests and requiring agreement about what constitutes a problem in the situation; and (3) timing decisions well. --- Conclusion The challenges described have consequences for a shared decision-making approach in dementia care networks. Such an approach should (1) be flexible regarding the changing capabilities of the person with dementia to preserve his or her autonomy; (2) work towards a shared view about what constitutes a problem in the situation; and (3) be adjusted to the decision-making pace of the care network. Geriatrics,Memorial Sloan Kettering Cancer Center,New York,New York,2. Weill Cornell Medical College,New York,New York In addition to the ageing of the population, a significant sociodemographic change in the United States is the growth in the number of minorities. Minorities and older adults are particularly vulnerable to receiving suboptimal healthcare. The Health Resources and Services Administration (HRSA), is the primary Federal agency for improving and achieving health equity. Queens County in New York City is the most ethnically diverse urban area in the world. Funded by a grant from HRSA, in collaboration with various local community organizations, the Geriatric Resource Interprofessional Program (GRIP) at Memorial Sloan Kettering Cancer Center (MSKCC) spearheaded a multi-prong educational initiative on geriatric syndromes targeting minority communities in Queens County. To date, 13 sessions were conducted at 7 community centers in Queens. A total of 521 people who spoke 13 different primary languages attended. The mean age of the participants was 63 (27-99, median 67); 53% were women, 8% were born in the USA, 56% were born in Bangladesh, 22% in India. Consecutive interpretation of the lectures was performed to the predominant language of the group; written materials were translated. Pre and post test questionnaires were administered to measure understanding. A focus group was set up to identify the needs of caregivers of older adults, and educational sessions have been offered based on those needs at main Community Centers. Main challenges included differences in literacy, multiple cultures and languages. Successes and barriers faced in implementing the educational initiative, as well as pre and post-test results will be presented. --- INITIATIVE TO PROMOTE KNOWLEDGE OF GERIATRIC SYNDROMES IN MINORITY OLDER COMMUNITIES AND CAREGIVERS K. Alexander 1,2 , J. Nonaillada 1 , N. Gangai 1 , R. Costas Muniz 1 , B. Korc-Grodzicki 1,2 , 1. --- CULTIVATING FAMILY CAREGIVER RESILIENCE AND PREVENTING AVOIDABLE HOSPITALIZATIONS IN DEMENTIA T. Sadak 2 , E. Ishado 1 , B. Gaster 3 , L.N. Gitlin 4 , K.C. Buckwalter 5 , S. Borson 3,1 , 1. University of Washington School of Nursing, Mountlake Terrace, Washington, 2. university of Washington School of Nursing, Seattle, Washington, 3. University of Washington School of Medicine,Seattle,Washington,4. John Hopkins University School of Nursing,Baltimore,Maryland,5. University of Iova School of Nursing,Iowa,Iowa Enhancing and maintaining family caregiver (CG) selfcare is a national priority for long-term societal wellbeing. The National Alzheimer's Plan Act recognizes widespread Innovation in Aging, 2017, Vol. 1, No. S1 1105

IAGG 2017 World Congress 59.9 ± 8.8; male 19%; spouse 17%; parent 60%). Qualitative content analysis revealed rich information about the characteristics of supportive support brokers, and also about support broker characteristics that were not supportive. Support brokers directly influenced many of the challenges caregivers identified. A responsive, imaginative, and involved support broker was identified as a major source of effective support. Conversely, frequent support broker turnover, limited knowledge and involvement, and the perception that the support broker was simply there to "check boxes" became sources of additional stress. Support brokers are uniquely positioned to help caregivers navigate the complexities of the healthcare system, thereby decreasing stress and strain. For example, many of the roadblocks that caregivers identified as difficult could often be negotiated by a support broker. Support brokers can serve as an avenue for caregivers to find out about additional supports within the PD program, as well as organizations outside of PD, such as disease-specific support groups, which caregivers identified as an additional source of support. This research is part of the Family Support Research & Training Center.

2 ) Variables E t (C t -C t-1 ) C t-1 (E t -E t-1 ) E t-1 (C t -C t-1 ) C t (E t -E t-

Unfortunately, after publication of this article [1], it was noticed that Tables 3 and4 were inadvertently swapped during the production process. The tables with their correct table citation can be seen below and the original article has been update to reflect this.

Cancer equity for those impacted by mass incarceration Mass incarceration is a uniquely American consequence of structural racism, ableism, and classism that disproportionately puts people who are poor, Black, Brown, undereducated, underemployed, and sick behind bars (1). Thirteen million people experience incarceration in US carceral settings every year, destabilizing communities, families, and individuals' lives (2). There is a growing focus on cancer disparities and inequity, however, little attention has been paid to the intersection of mass incarceration and cancer inequity. In North America, people with histories of incarceration have 10 times the risk for liver cancer, 5 times the risk for cervical cancer, and 3 times the risk for lung cancer compared with people without incarceration histories (3,4). Cancer is a leading cause of mortality among incarcerated persons and people recently released from incarceration, with cancer-related death rates higher compared with people with no incarceration history (5,6). In the next decade, one-third of the carceral population will be aged 55 years and older, increasing cancer burden in the aging carceral population (7). The denial of medical care to incarcerated persons was deemed cruel and unusual punishment by the US Supreme Court (8), and therefore all prisons and jails have a court-obligated duty to provide care. But the level of care they have to provide is minimal and subject to legal interpretation. The types of screening and care vary across institutions (federal and state-run longerterm prisons and locally administered short-term jails). Accrediting bodies in the United States have set forth minimum standards for health care in prisons and jails but accreditation is voluntary (9,10). Health care in prisons and jails is paid out of correctional budgets, with more than two-thirds of health care contracted out to a handful of third-party corporate vendors as capitated managed care (11). Correctional health companies prioritize treatment for conditions that cannot be ignored (and if an imprisoned person can get the attention of medical staff) and may not deploy evidence-based prevention and screening, including screening for cancer. Annual wellness exams may not always be performed, and intake assessments are not consistent or comprehensive. For health-care professionals, the standard of care provided to incarcerated persons doesn't vary on the basis of the setting in which health care is provided or on an incarcerated person's sentence, crimes, or time served. However, individuals providing care are also motivated by their own biases and commitments, rules of the prisons and jails, resources available, and what services are reimbursable by the entity providing care (12). For example, a liver transplant may be the standard of medical care, but if the department of corrections won't pay for it, the service won't be provided. Depending on the type of criminal legal facility (federal prison, state prison, or locally administered jail), standards and services vary greatly. A lack of transparency about consistency and quality of care across jails and prisons further complicates the ability to assess care-data are woefully lacking and not consistent across jurisdictions. Medical records for incarcerated patients are fragmented across federal and state prisons and more than 3000 local jails, as well as patients' community providers. The coordination challenge of obtaining consistent data on health care behind bars is a monumental task. Most researchers localize data collection based on relationships with prison and jail administrators, who can deny research approval and access to data, or may resort to Freedom of Information Act requests. After a long history of ethical violations in research with incarcerated persons, new movements and regulations that foster collaborative research that protects incarcerated persons' autonomy and benefits from research dominate the field (13). Although the ethical bar has been raised for research, access to rigorous and comprehensive data still remain a challenge. Similar challenges with quality of care, prevention, data, and research ethics have been identified in other countries, even in countries that provide universal health care, where local and federal governments pay for care inside prisons (14). The World Health Organization has recently catalogued the state of health inside prisons in 39 European countries (14). Similar efforts could provide more clear roadmaps for work in US prisons and jails. The United States holds one of the largest share of the world's prisoners. Although the United States makes up 5% of the world's population, it holds one-fifth of its prisoners, making the landscape of care detrimental to many more people (15). Cancer inequities are established and sustained by inequities in health care, income, education, and other factors that are disproportionately present among people with a history of incarceration (16). Although the systemic inequities related to incarceration must be addressed, interaction with the carceral system also provides a public health opportunity to decrease cancer disparities in an aging prisoner population. Individual and structural factors lead to elevated cancer risk factor exposures and suboptimal prevention opportunities. Higher rates of tobacco and alcohol use, human papillomavirus, hepatitis B and C, and HIV may contribute to elevated cancer incidence, more advanced disease at diagnosis, and elevated cancer-related morbidity and mortality (17,18). Prevention tools such as smoking cessation or human papillomavirus and hepatitis B vaccination and treatment for cancer risk factors may be less accessible (19,20), compounded by variable cancer literacy in people with histories of incarceration that limits screening uptake and follow-up (21). The numerous consequences of structural racism, including socioeconomic status, health-care access, discrimination based on carceral status, and access to information and resources, also disproportionately affect incarcerated patients. Incarcerated individuals often have poor access to insurance and primary care and, thus, cancer prevention and screening in the community. When incarcerated, shorter-term correctional facilities (jails) in the United States do not provide routine cancer screening, and there is a lack of robust data regarding whether longer-term prisons do. Given the logistical and security constraints of delivering cancer care that is largely provided at cancer centers outside of correction facilities, incarcerated patients with cancer may have delays in treatment initiation (22). The limited data available demonstrate that incarcerated patients with cancer have worse survival than nonincarcerated counterparts but do not evaluate differences in high-quality treatment. Postincarceration, people struggle to obtain insurance in the United States or have their insurance coverage reinstated (eg, government-run Medicaid, which is suspended during incarceration but terminated completely in 12 states) (23). Unable to establish primary care, they may be unable to receive timely cancer screening, diagnostic, or treatment services. Medicaid expansion in the United States is associated with improved cancer screening, stage of diagnosis, and mortality (7) and would disproportionately benefit formerly incarcerated individuals, yet 12 out of 50 states have not expanded Medicaid. We set forth a plan of action for cancer equity (Figure 1) and illustrate the contexts, agenda items, and actors responsible for change-making. Although the plan of action is specific to the unique context of mass incarceration in the United States, findings are broadly applicable, because cancer disparities for prisoners and those leaving carceral systems persist globally. --- Consider compassionate release for late-stage cancer patients Systemic efforts to identify individuals who currently qualify for compassionate release could improve care quality and reduce costs near the end of life while reducing incarceration of patients who are unlikely to pose a threat to public safety and whose health needs may be better served in the community. Compassionate release requires linkages to community-based care, as well as desired community social, economic, and housing supports to ensure comfort care is feasible, all of which are likely to be less costly than incarceration-based hospice care. --- Create care pathways that link carceral health with public and community health systems Carceral settings have failed to capitalize on multiple opportunities for cancer prevention, including smoking cessation, human papillomavirus vaccination and cancer screening, hepatitis B vaccination, hepatitis C screening and treatment, and promotion of and access to tobacco and alcohol-related interventions. Although these activities may appear cost prohibitive to states with already overstretched carceral system budgets, prevention for persons with histories of incarceration would have long-term public health and cost-saving payoffs. --- Restructure and prioritize cancer prevention, screening, and care in correctional facilities The current state of cancer prevention and treatment in carceral settings and how these practices align with national practice recommendations should inform clear guidelines to jails and prisons. Cancer treatment for incarcerated patients often occurs in the community. Warm handoffs and navigation programs that track patients through the care trajectory may ensure that fragmented care does not lead to life-altering delays in care. --- Expand access to insurance after incarceration Care continuity is necessary for follow-up of cancer screening and treatment. To improve continuity, Medicaid benefits can be suspended rather than terminated when someone is incarcerated, allowing timely reinstatement of benefits upon release-an issue previously left to states but now being reviewed at the federal level. Medicaid expansion has delivered improvements in cancer screening, stage of diagnosis, and mortality (24,25) and increases insurance rates for formerly incarcerated patients. Medicaid should be expanded in states that have not chosen to do so. States should also take advantage of new guidance from the Centers for Medicare and Medicaid Services to extend Medicaid benefits to people prerelease, as California has recently done. Under this guidance, Centers for Medicare and Medicaid Services has provided the Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities, which would allow more states to adopt similar programs (26). --- Educate health professionals in correctional facilities and the community Medical, nursing, and residency trainees should learn about incarceration as a social determinant of health and traumainformed care. Clinical educators could specifically offer cancer prevention and treatment modules or correctional care fellowships to help learners be more sensitive and aware of the needs of persons with histories of incarceration. --- Capitalize on carceral sites for health promotion and transition to community care People who are incarcerated and formerly incarcerated are motivated to learn, act, and prevent health problems, including cancer. Promoting a peer workforce in health care to facilitate transitions into the community after incarceration (eg, Transitions Clinic Network) (27) could empower the community, families, and others to assist the imprisoned and recently released to engage in cancer prevention and screening. Successful implementation of this plan of action requires resource investments on par with the sustained funding of the US prison system so that a robust infrastructure of community-based health care can be realized. Inaction on this shared responsibility results in a boomerang back of pervasive chronic cancer conditions that overwhelms an already insufficient US health-care system. --- Data availability No original data were used for this commentary. --- Author contributions --- Conflicts of interest The authors have no conflicts of interest to declare.

The cancer disparities between people with incarceration histories compared with those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy; carceral, community, and public health linkages; better cancer prevention, screening, and treatment services in carceral settings; expansion of health insurance; education of professionals; and use of carceral sites for health promotion and transition to community care. Clinicians, researchers, persons with a history of incarceration, carceral administrators, policy makers, and community advocates could play a cancer equity role in each of these areas. Raising awareness and setting a cancer equity plan of action are critical to reducing cancer disparities among those affected by mass incarceration.

Background Scurvy is a disease that affects multiple organ systems but results from a vitamin C deficiency. As humans, we cannot synthesize vitamin C, and therefore, it is of utmost importance to obtain adequate levels through consumption. Scurvy affects collagen and lack of it can result in swollen gums, leg ulceration, and bleeding manifestations, most severely, cardiac failure and rhythm disturbances [1]. In developed worlds, scurvy has become a rarity due to the abundance and accessibility of goods and resources [2]. The World Health Organization defines social determinants of health as, "conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels [3]." Any inequality in these determinants can then affect the care or resources that an individual may have access to. Recently, the United States and even the world has been affected by the Coronavirus pandemic. This pandemic has forced states and counties to issue shutdown orders which in turn has resulted in an unwanted increase in unemployment [4]. Loss of one's job can directly affect finances which have the potential to effect payment for medical bills or medical prescriptions. Even further, low income can impact payment of housing which can be associated with homelessness and mental health issues [5]. We present a unique case wherein an old age diagnosis has reappeared in the developed world secondary to inequalities in social determinants of health. --- Case Presentation A 46-year-old man with a past medical history of hypertension, tobacco use, and alcohol use disorder presented to the hospital with worsening bilateral lower extremity edema. The patient stated that over the past 2 weeks, his legs slowly became more swollen, left more so than the right. The swelling became so severe that the patient could no longer walk without assistance. The patient then noticed erythema on his right lower leg and maggot infiltration in the skin folds of his left lower leg which prompted the patient to go to the emergency room. The patient was not experiencing any fevers, shortness of breath, cough, chills, nausea, or vomiting. The patient stated that he was supposed to be on amlodipine for hypertension but had not taken it in months because the patient did not have medical insurance and could not afford any medications. Further social history revealed the patient was a current smoker of 1.5 packs per day for 10 years, smokes marijuana occasionally, and reportedly, drinks some beers on the weekends. The patient was working full time at the local grocery store but no longer could do so because of his lower extremity swelling. The patient lived alone and denied homelessness or harsh living conditions. The initial workup showed that the patient was hemodynamically stable, tachycardic with a heart rate of around 130. Physical exam was significant for bilateral lower extremity swelling with hardening of the skin as well as wound formation with maggot infiltration on the left leg (Figs. 1 and2). A complete blood count and the complete metabolic panel were unremarkable. The patient was noted to have an elevated lactic acidosis and an elevated blood alcohol concentration. A chest X-ray was unremarkable, and computed tomography arteriography of the lower extremities revealed severe soft tissue swelling. The patient was then admitted for suspected cellulitis of the legs and started on broad-spectrum antibiotics as well as topical permethrin to disinfect the maggots. Additional workup was sought out to find the underlying cause of the severe lower extremity swelling because it would be unusual to have bilateral cellulitis. Workup showed normal vitamin B12, thiamine, and thyroid-stimulating hormone. HIV and hepatitis panel were negative. Also, a transthoracic echocardiogram was done which showed ejection fraction 70-74% with no diastolic dysfunction. Right upper quadrant ultrasound did not show cirrhosis. Lower extremity dopplers were unremarkable for clots. Computed tomography of the chest was unremarkable for any abnormalities. After an extensive workup with no answer, a vitamin C level was ordered in suspicion of nutritional deficiency which was found to be less than 0.1 mg/dL (normal value 0.4-2.0 mg/dL). The patient was diagnosed with scurvy. Before discharge, home care was consulted for wound changes and deemed the patients home unsafe for any of their faculty to travel there. The patient was discharged with thorough instructions and adequate supplies to change his dressings as well as wound care referral to follow up with. The patient was given a month's supply of medications before he left the hospital with anticipation for PCP follow and social work help to hopefully help the patient get health insurance as well as access to food banks. Lastly, patient was prescribed vitamin C to wound healing. --- Discussion In this case, we present a middle-aged man who developed excessive lower extremity swelling with ulceration formation and maggot infiltration from, initially, unclear etiology. Because scurvy is seemingly rare within the developed world, more common differentials needed to be ruled out which is evident by an extensive workup. Reflecting on the case presentation, despite what the patient stated, the inability to pay for prescription medications and lack of medical insurance should prompt physicians to think about financial insecurities. Also, maggot infiltration of the wound could reflect poor care for oneself as well as harsh living conditions such as homelessness. Given the exclusion of more common differentials for lower extremity edema and the suspected poor nutritional status, led us to check vitamin C which diagnosed scurvy. By identifying the patient's social determinants of health, we were able to diagnose scurvy. Scurvy was originally seen in sailors on boats who were at sea for months with lack of nutrition, specifically vitamin C [6]. In developed nations this is a rarity with numerous grocery stories and abundance of goods. However, with inadequate finances, a secure living environment, or inability to care for oneself diseases as scurvy can reoccur. Therefore, patients with poor social determinants of health are figuratively stranded at sea, and we as physicians are the radar to help find them and give them the resources to help them find their way back to shore. In this case, home health deemed the patients living conditions unsafe for visits; therefore, free supplies were given to the patient and referrals were made for close follow-ups to help ensure the patient did not come right back to the hospital with a severe infection. By equaling the patient's social determinants of health, we can hopefully prevent future emergency room visits and hospitalizations. In the developed world, many resources are available even if there are financial insecurities such as health food centers or food banks. It is our job as physicians to refer patients to these resources so that disease like scurvy stay old world and do not reappear. --- Conclusion This case validates the importance of identifying social determinants of health through the evaluation and diagnosis of scurvy in the developed world. As physicians, we have to assess these determinants and provide as many resources as possible for better patient care and outcomes. By equaling social determinants of health, we can hopefully reduce unnecessary emergency room visits and hospitalizations. --- Code availability Not applicable. Author's contribution Nikos Pappan drafting and revising original manuscript. Deeksha Sarma, Timothy Rabe, and Rosaleen Petroccione final revisions and approval of final manuscript. Data Availability Not applicable. --- Declarations Ethics approval This article does not contain any research studies with human participants animals performed by any of the authors. Consent to participate This article does not contain any research studies with human participants animals performed by any of the authors. Consent for publication All authors give consent to publish. --- Conflict of interest The authors declare that they have no conflicts of interest. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Identifying social determinants of health can help diagnose certain nutritional deficiencies. By overcoming these barriers, we can prevent future hospitalizations and better public health. We present a unique case where a 46-year-old man presents with bilateral lower extremity swelling secondary to vitamin C deficiency. Throughout history taking, his social determinants of health were identified and he was diagnosed with scurvy from the suspected poor nutritional intake. His poor nutritional intake could have resulted from a lack of financial stability and a harsh home environment. This case is evidence that social determinants of health can directly impact a patient's well-being, and as physicians, we need to identify them to provide the most resources we can to help improve patient care. This in turn can decrease unnecessary emergency room visits and hospitalizations.

ASSOCIATION OF ASSISTED LIVING HOMES PREPAREDNESS FOR AND RESPONSES TO THE COVID-19 PANDEMIC WITH RESIDENT PAIN Shovana Shrestha 1 , Colleen Maxwell 2 , Hana Dampf 1 , Rashmi Devkota 1 , and Matthias Hoben 3 , 1. University of Alberta, Edmonton, Alberta, Canada, 2. University of Waterloo,Waterloo,Ontario,Canada,3. York University,Toronto,Ontario,Canada The COVID-19 pandemic severely disrupted care processes in assisted living (AL) and negatively affected resident outcomes associated with resident pain (e.g., mobility problems, depression). Pain has severe consequences, including hopelessness, insomnia, depression, poor quality of life. However, we lack research on how the pandemic affected AL resident pain. To address this gap, we linked surveys from 42 AL homes in Alberta, reflecting pandemic waves 1 (Mar-Jul 2020) and 2 (Nov 2020-Feb 2021), to the Resident Assessment Instrument (RAI) records of 1,828 residents (wave 1: 890, wave 2: 938) who lived in these homes during these periods. Using generalized estimating equation models, we assessed whether resident characteristics, physical and occupational therapy received, home preparedness for and responses to the pandemic were associated with resident pain (measured as at least moderate daily pain or pain of excruciating intensity, based on the RAI pain items). Over 19% of the residents reported pain (wave 1: 19%, wave 2: 19.1%). Resident characteristics associated with pain were cognitive impairment (OR=0.4, 95% CI: 0.3-0.6), loneliness (OR=1.8, 95% CI: 1.3-2.6), arthritis (OR=2.1, 95% CI: 1.6-2.8), fractures (OR=1.97, 95% CI: 1.4-2.9), polypharmacy (OR=1.82, 95% CI: 1.3-2.6) and use of analgesics (OR=1.76, 95% CI: 1.3-2.3). Home preparedness and physical and occupational therapy received were not associated with pain, but more communication with family/friend caregivers (OR=0.41, 95% CI: 0.2-0.8) was. Effective communication of family/ friends with residents may promote better management of residents' pain. Further, longitudinal studies examining resident and AL home characteristics and its impact on residents' pain are needed. The onset of COVID-19 was associated with significant, albeit modest, increases in the use of psychotropics and opioids in nursing home residents. Little research exists on whether similar trends occurred among older residents of publicly funded assisted living (AL) homes, a growing and poorly investigated setting. We examined the impact of pandemic wave (1 to 4) and setting type (dementia designated spaces [AL-D] vs other [AL-O]) on prevalent antipsychotic, antidepressant, benzodiazepine, opioid and anticonvulsant use in AL residents from Alberta, Canada. Using linked population-based clinical and health administrative databases, we conducted a repeated cross-sectional study of quarterly medication prevalence from January 2018 to December 2021. Log-binomial GEE models estimated prevalence ratios (PR) for 4 waves (vs 2018-19 historical months) and setting (AL-D vs AL-O) and period-setting interactions. On March 1, 2020, there were 2,874 AL-D and 6,611 AL-O residents in our cohorts (mean age 82.4 vs 79.9 years and 93.5% vs 42.6% with dementia, respectively). Antipsychotic prevalence increased during waves 2-4 for both settings but this increase was significantly greater for AL-D than AL-O in later waves (e.g., AL-D: PR 1.21, 95%CI 1.14-1.27; AL-O: 1.12 (1.07-1.17) for March-May 2021 vs 2018-19). For both settings, there was a significant but modest increase in antidepressants but a decrease in benzodiazepines during several waves. No pandemic effect was observed for opioids in either setting. The AL resident and home characteristics associated with these medication trends, concerns about medication risks (particularly for dementia care settings), and consequent health outcomes for residents require further study. --- SESSION 4285 (SYMPOSIUM) Abstract citation ID: igad104.1632 --- THE NEXUS OF AGING AND MIGRATION: THE CURRENT STATE OF KNOWLEDGE AND WHERE GERONTOLOGICAL INQUIRIES OUGHT TO HEAD Chair: Sandra Torres Co-Chair: Alistair Hunter Discussant: Allen Glicksman Research on older ethno-racialized minorities (which comes primarily from North America) has dominated

of mental and physical illness, cognitive decline, suicidal behavior, and all-cause mortality. However, the impact of the pandemic on AL residents' loneliness is poorly understood. We surveyed 42 AL homes in Alberta to understand whether resident characteristics and homes' pandemic preparedness and response to the pandemic were associated with resident loneliness. The surveys reflected pandemic waves 1 (Mar-Jul 2020) and 2 (Nov 2020-Feb 2021) and were linked to Resident Assessment Instrument (RAI) records of residents who lived in these homes during these periods. Using generalized estimating equation models, we assessed whether resident characteristics, residents' social relationships, and home preparedness for and responses to the pandemic were associated with resident loneliness (measured as present or absent based on RAI items). Our sample included 1,828 residents (wave 1: 890, wave 2: 938). Almost 13% of the residents reported loneliness (wave 1: 11.2%, wave 2: 14.2%). Depressive symptoms (odds ratio [OR]=2.73, 95% CI, 1.9-3.9) daily/excruciating pain (OR=1.97, 95% CI, 1.4-2.8), and cognitive impairment (OR=0.38, 95% CI, 0.2-0.6) were significantly associated with loneliness. Caregiver availability, hours of caregiver help, and home preparedness were not associated with loneliness, but more communication with caregivers (OR=2.19, 95% CI, 1.1-4.2) and same or improved staff morale (OR=0.61, 95% CI, 0.4-0.9) were. Improving staff morale and communication with caregivers is crucial in addressing resident loneliness.

Virtual Reality (VR) technology are entering nursing education at a rapid speed (Foronda et al., 2017). VR has been reported in the nursing literature to significantly improve students' performance (Jenson & Forsyth, 2012;Park, 2016;Foronda et al., 2017) even though the body of evidence in terms of the number and research quality of peer reviewed research papers is not yet substantial enough to identify VR technology's effectiveness. However, VR is not actually reality. VR may not actually reflect reality. Young people (and even adults) may not perceive the different between reality and VR. They may not yet be mature enough to distinguish the difference. However, VR technology are going much further than traditional educational methods by allowing humans to experience a much higher level of immersion through a virtual image. Even the gap between advances in VR technology and its application to education science is widening, causing serious concern. The advance in VR technology is value-neutral. As with all things, whether something is good or bad depends on how humans use it. VR can be useful, for example, when it enables scholars to attend an international conference without traveling to the physical convention center. VR provides the ability to speak, listen, and discuss in real time. Those using VR can choose to view a featured or real-time image of the other participants as if they were actually at the conference. Further, remote participants can feel touch through electronic sensors attached to their body. How amazing! The problem with VR lies in the fact that we are not ready to cope with any possible harmful influences caused by advances in VR technology. But what is the "Dark Shadow of VR," and why does it cause concern, particularly in pedagogy? Luc Besson's 2017 film Valerian and the City of a Thousand Plants showed an exceptional VR world, "Big Market," a shopping-focused VR platform. But such a world is no longer strictly science fiction: many large commercial companies are really building gigantic VR platforms (Kim, 2017). VR developers boast that the platforms can be categorized based on the purpose of the VR platform, e.g., Media, Communication, Travel, Education, Games, Medicine, the Military, and even Adult Movies (Kim, 2017). Also, the platform itself may be another "false" real world built up in the VR platform that mirrors our current real life (Kim, 2017). Imagine: a person could have a dual identity for (1) real life and (2) VR life (Kim, 2017). It sounds fantastic, does it not? Unfortunately, it may not be true. Suppose that a person selects the "Adult Movies" VR platform. Using Head Mounted Displays (HMD) device and electronic sensors, a person would not only experience a vivid and lively video, but also feel a "real-life" touch. Such an option is very dangerous to adolescents because they are particularly vulnerable to sexually explicit content (Adeolu, Owoaje, & Olumide, 2016). While we cannot begin to fathom the implications, it is possible that this technology could lead to higher rates of teen pregnancy or sexually transmitted diseases (STDs) in reality (Kann et al., 2016). Young people might also lose touch with reality, mistaking the virtual world as being more "real" than reality itself. For example, a young couple with a baby were playing a video game in which they were trying to save a baby from harm while neglecting their own baby to the point that the baby died (Kang, 2016). Further, what if the real economy began to operate just like the "Big Market"? In fact, VR developers are already creating such a VR platform (Kim, 2017). Since real estate is unlimited in the VR world, so is the amount of investment. This strongly suggests that VR as well as Artificial Intelligence (AI) can ensure that the winner (primarily developers such as Data Scientists and AI algorithm makers) takes all. Is such a situation fair and just? Here is another example: What if a person's account were unintentionally deleted in the VR platform or removed by someone? If the account is not renewable, another socio-economic problem might arise. --- Perspectives Received 17 September 2017, Revised 18 December 2017, Accepted 18 December 2017

We should be mindful of the possible harmful consequences, the "Dark Shadow of VR," while adopting and applying advances in VR technology to all areas of pedagogy. No matter how effective educational outcomes the integration of VR technology into pedagogy produces, nothing is more important than delivering the highest quality of education -i.e., "Putting People First" -to our next generation.

Introduction The Centers for Disease Control and Prevention (CDC) documented the first United States (US) laboratory-confirmed case of COVID-19 on January 22, 2020 [1]. By June 2020, the US had over 3 million confirmed cases of COVID-19, and low-income neighborhoods showed high positivity rates for COVID-19 testing (30%-35%), compared to nationwide rates of 8.8% [2]. COVID-19 infections, hospitalizations, and deaths are disparate across racial and ethnic groups in the US, disproportionately impacting minority communities [3]. These disparities are magnified in certain areas of the US. For example, majority-minority counties in the US report infection rates 300% higher than that of White-majority counties, and death rates nearly 600% higher [4]. In June 2020, Northwest Arkansas, and in particular Benton and Washington counties, was one of the highest COVID-19 hot spots in the US. The racial and ethnic disparities of COVID-19 cases are so stark that the CDC conducted an in-depth community-level investigation in June and July 2020. The National Institutes of Health (NIH) followed suit in early August 2020. According to the CDC's July 2020 report, 45% of all adult cases in Northwest Arkansas identified as Hispanic/Latinx, and 19% were Pacific Islander [5]. These communities only account for 17% and 2.4%, respectively, of the two-county population. Latinx and Pacific Islander community members encounter many socioeconomic challenges, including low educational attainment and unstable and dense housing. Latinx and Pacific Islander community members are often employed in low-wage jobs, primarily in the poultry industry, which are deemed essential and do not allow them to work from home [5,6]. For the past 5 years, the University of Arkansas for Medical Sciences (UAMS) has worked with Latinx and Pacific Islander community leaders and organizations to address health disparities and promote translational research. As the state's only academic health center, we leverage a community-engaged approach to build trust between academic health centers and community stakeholders [7][8][9][10][11][12]. These partnerships are funded by the Clinical and Translational Sciences Award (CTSA) at UAMS and the CDC's Racial and Ethnic Approaches to Community Health (REACH) program. These partnerships have long-standing community advisory boards and conducted several projects and research initiatives together. Details about the partnership and the collaborative work of the community-academic partnership are published elsewhere [13]. The mission of the CTSA at UAMS is to develop new knowledge and novel approaches that will measurably address the complex health challenges of rural and underrepresented populations. Grant resources provide training and support for community-based participatory research, community engagement, plain language communications, and the expansion of research in special populations [14,15]. The REACH program has a three-pronged focus for advancing REACH: supporting culturally tailored interventions to address preventable health conditions; linking community and clinical efforts to increase access to health care and preventive care programs at the community level; and the implementation, evaluation, and dissemination of practice-and evidence-based strategies to reduce health disparities in chronic conditions [16]. In early 2020, community-engaged partnerships utilized their collaborative capacity to address COVID-19 disparities in the Latinx and Pacific Islander communities. No CDC or NIH funding was spent on COVID-19-specific activities outlined in this article. However, partners continue to leverage existing community-based capacity to engage the Pacific Islander and Latinx community while developing and executing a COVID-19 Response Strategy to Reduce Health Disparities. Funding was provided through the Arkansas Department of Health's distribution of CARES act funding [17]. This strategy is described below. --- A COVID-19 Strategy to Reduce Health Disparities for the Pacific Islander and Latinx communities in Northwest Arkansas Since March 2020, 18 key community partners have had weekly meetings, and there is often daily communication between partners. Partners collaboratively developed a COVID-19 Response Strategy to ensure coordinated effort for Latinx and Pacific Islander communities with four interrelated strategies: health education, testing, contact tracing, and supported quarantine/case management. Partners are listed in Table 1. --- Strategy 1: Health education and prevention Based on the recommendations from the CDC's July 2020 report, partners co-developed a communications strategy designed specifically for COVID-19. This strategy covers four areas: prevention, testing, quarantine, and follow-up care. Prevention communication focuses on behaviors and practices individuals can take to reduce their risk of infection, including when and how to wear a mask, hand washing, and how to stay connected with family and friends while maintaining an appropriate physical distance. Communications about COVID-19 testing focuses on describing when and where people can be tested, provides bilingual videos for those places doing self-administered testing swabs, provides information about costs, and informs on safe behaviors while waiting for test results. The quarantine and isolation guidance focuses on criteria for when quarantine and self-isolation are appropriate and explains the available social services to support those efforts. Follow-up care covers symptom management and when and how to seek additional care if needed. Partners also developed targeted communications for high-risk community members, specifically addressing pregnancy, diabetes, mental health, and asthma. Small business and faith-based tool kits were created and have been distributed to more than 120 local small businesses within the Latinx and Pacific Islander communities. Communications primarily focus on nontraditional and unpaid media. All communications are in English, Spanish, and Marshallese (the native language of most Pacific Islanders in Northwest Arkansas) and leverage local Latinx and Pacific Islander community leaders. The communications materials can be found at https://northwestcampus.uams.edu/ochrcovid/. An outline of communications tools developed as of November 30 is listed in Table 2. New communication tools are added frequently. --- Strategy 2: Testing The COVID-19 Strategy to Reduce Health Disparities for the Pacific Islander and Latinx communities is led by the Federally Qualified Health Center (FQHC), and employs the resources of UAMS, Arkansas Department of Health offices, and local healthcare providers for testing. Based on the CDC July 2020 report, testing primarily focuses on organizations and/or neighborhoods with a high number of cases so that partners can quickly target hot spots and reduce the spread. Targeted serial testing ensures rapid testing of all contacts of known or suspected COVID-19 cases. When a positive case is identified, all of their contacts are offered in-home testing. If the contact(s) prefer to not have testing at their home, they are directed to drive-through testing centers. For in-home testing, a nurse-led team of healthcare workers provide testing to contacts and all household members without contacts leaving their home. In addition, drive-through testing centers are distributed throughout two counties at local healthcare organizations and mobile testing teams conduct tests at churches, worksites, and housing complexes. Most importantly, all testing locations have bilingual staff. Community partners play an important role in helping identify the community-based location for mobile testing and encouraging community members to get tested at any of the testing locations. --- Strategy 3: A dedicated contact tracing center with bilingual workers The COVID-19 Strategy to Reduce Health Disparities for the Pacific Islander and Latinx communities focuses on establishing a bilingual contact tracing center in the region that fully integrates with the Arkansas Department of Health. The contact tracing center is staffed with bilingual contact tracing staff. The bilingual contact tracing center utilizes the same software, policies, and procedures as the Arkansas Department of Health and includes a designated process of identification and follow-up of all persons who may have come into contact with a person infected with COVID-19. Since a positive test for COVID-19 is a mandatory reportable diagnosis to the Arkansas Department of Health, any new cases are reported, and those whose preferred language is Marshallese or Spanish are referred to the bilingual contact tracing center. Bilingual staff at the contact tracing center reach out to the case and determine direct contacts for the case during the period from 2 days before symptoms started until the case quarantined. The case is asked to inform all contacts that someone from the contact tracing center will be calling them. After the case alerts those contacts to expect a call, contact tracing staff will contact them to begin the screening process and advise quarantine. This quarantine applies to their households as well as any other direct contacts. This initial survey triggers a 14-day tracking period, which consists of daily communication with each contact under quarantine. All contact tracing data are entered into the Arkansas Department of Health software and uploaded to the department at the end of each day. All cases and contacts receive education about how to isolate (Strategy 1). Contacts are offered testing (Strategy 2). All cases and contacts who need assistance with food, housing, and medication work with a social worker and bilingual navigators to identify resources to meet those needs (Strategy 4). Strategy 4: Enhanced case management and supported quarantine A COVID-19 diagnosis often exacerbates the socioeconomic challenges that the Pacific Islander and Latinx populations face in Northwest Arkansas. Bilingual social workers, nurses, and community health navigators make up the enhanced case management team. It is critical to provide support services for both cases and contacts as they self-quarantine. Needed support includes essentials like food and medications, coordination with worksites, and coordination with community behavioral health services. Standard contact tracing encourages contacts to stay home and maintain distance from others until 14 days after their last exposure. The enhanced case management process elevates this with follow-up communication with the person who has COVID-19 and contacts to follow all quarantine guidelines. The enhanced case management also discusses their health and inquires about new symptoms. The staff provides resources, education, information, and connection with health care and community-based support organizations. They arrange for both food deliveries and prescription drug refills, if needed, to facilitate the contacts' ability to remain at home. The nonprofit organizations listed in Table 1 have funding and actively take part in ensuring cases and contacts have the support they need. --- Conclusion The COVID-19 Strategy to Reduce Health Disparities for the Pacific Islander and Latinx communities in Northwest Arkansas demonstrates how community-based participatory research and programmatic networks funded by NIH and the CDC can be quickly leveraged to address COVID-19, which has disproportionately affected Latinx and Pacific Islander community members. This example shows the importance of building and sustaining community-based research and programmatic networks. The regional collaborative in Northwest Arkansas plans to leverage their network in the future to ensure Pacific Islander and Latinx communities have the opportunity to participate in vaccine studies and the distribution of COVID-19 vaccines.

Northwest Arkansas, particularly Benton and Washington counties, is one of the highest COVID-19 hot spots in the United States (US), with more than half of all reported cases in this area identifying as Latinx or Pacific Islander, even though these communities account for less than 20% of the overall population. The University of Arkansas for Medical Sciences (UAMS) leveraged their existing relationship with 18 key community partners. Partners collaboratively developed a COVID-19 Response Strategy to ensure coordinated effort for Latinx and Pacific Islander communities with four interrelated strategies: health education, testing, contact tracing, and supported quarantine/case management.

INTRODUCTION Over one billion people live in informal housing worldwide (Gilbert, 2016;Ren, 2018), and while some progress toward improving their lives, slum reforms have lagged behind the expanding numbers of urban poor (Mayne, 2017;Dovey et al., 2021). Poverty is concentrated in urban areas throughout the Global South (Broto et al., 2017;Rigolon et al., 2018), and this is due to a combination of economic and demographic factors (Brady et al., 2016;Cruz & Ahmed, 2018). Several macro-economic models in emerging nations imply that public spending on public infrastructure and services are reducing, which has had a negative impact on the urban poor in these countries (Edriss & Chiunda, 2017;Omar & Inaba, 2020). The COVID-19 epidemic in Indonesia had unparalleled in its scope and severity (Olivia et al., 2020;Im et al., 2021;Roziqin et al., 2021). Not only has the pandemic triggered a public health crisis, but the essential steps to restrict the virus's spread have resulted in significant economic, social, and educational issues as a result of the virus's spreading (Tabish, 2020;Barlow et al., 2021). The impacts of the epidemic have been unevenly distributed across economies and communities (Bambra et al., 2020;Blundell et al., 2020). The fast spread of the new coronavirus illness (COVID-19) around the world is a significant challenge for development practitioners owing to the negative impact it has on socio-economic development (Karunathilake, 2021;Rasul et al., 2021) It has finally led in the creation of global uncertainty (Naeem, 2020;Ciravegna & Michailova, 2022), which has prompted the need for practical and inventive strategies to aid in the management of the disease's spreading (Abdullahi et al., 2020) and the mitigation of its negative consequences (Douglas et al., 2020). Palembang demonstrates its potential in terms of comparatively favorable urban development prospects (Colenbrander et al., 2015;Papargyropoulou et al., 2015), the potential for urban resources including public infrastructure and human capital (Trotier, 2022), as well as more sophisticated technology breakthroughs (Hairi, 2020;Saputra et al., 2020). But, in other side, economic constraints and the scarcity of housing in cities compelled urbanites to occupy suburban regions (Florida, 2017;Karsten, 2020);, resulting in the formation of a slum area (Izzudin, 2013;Cavalcanti et al., 2019). Slum settlements are defined socially by rapid population expansion (Abunyewah et al., 2018;Nassar & Elsayed, 2018); low income levels (Bardhan et al., 2018;Sarkar & Bardhan, 2020), and poor health (Ezeh et al., 2017;Corburn & Sverdlik, 2019). Previous research related to slums only discussed slum settlement patterns (Barros Filho & Sobreira, 2005;Beguy et al., 2010;Friesen et al., 2018), basic infrastructure of slums (Butala et al., 2010;Parikh et al., 2015), health problems in slums (Ezeh et al., 2017), but not much has been linked to social capital in the community, especially when Covid-19 hit Indonesia. The city of Palembang is divided into two areas by the Musi River (Fitri, 2018), namely the Seberang Ulu (northern side) area and the Seberang Ilir (southern side) area. In comparison to the Seberang Ulu area, which is synonymous with slums and impoverished areas, the Seberang Ilir area is recognized as the core of advancement for the city of Palembang's growth. Because employment opportunities are concentrated in Palembang's central business district (Sedyastuti et al., 2021), slums and illegal colonies eventually congregate around the downtown region (Sukmaniar, Pitoyo & Kurniawan, 2020), specifically on the periphery of the Musi River (Pramantha et al., 2021). (Sukmaniar, Pitoyo & Kurniawan, 2020;Pramantha et al., 2021). An effect on slum area due to covid-19 pandemic made suffering people in 12 Ulu Village so the social capital in this area would be interesting to knowing deeper. Since the late 1980s, social capital has gained significant importance among scholars, claiming a prominent position in the social sciences (Vilar & Cartes, 2016;Burt, 2017;Wiltshire & Stevinson, 2018). It refers to a collection of characteristics that are inherent in trusting and cooperating social interactions (Mpanje et al., 2018;Obaitor et al., 2021). The breadth of this definition enables us to use the phrase in place of "civic virtue, social cohesiveness, social solidarity, capacity for collective action, or any other characteristic of a morally valued society" (Vilar & Cartes, 2016;Mitra et al., 2017). --- Palembang The empirical data for this research were gathered through the use of qualitative methodologies (Gerring, 2017;Collins & Stockton, 2018). The recruitment of informants is done using purposive sampling (Etikan et al., 2016;Lenaini, 2021) --- DISCUSSION --- Slum Settlement Condition From our rapid observation, slum settlement conditions can be described as homes that are frequently overcrowded, with dirt floors, leaking roofs, and no windows or doors, leaving their residents susceptible to inclement weather, insects, and rats. --- Inadequate ventilation for cooking fires inside is a frequent source of respiratory issues. Research by Izzudin & Risyanto (2013) in Surabaya also shows that there is a link between low income and slum dwellers. --- Research Policy Implication Several policy implications can be derived to resolve the diffi culties that shanty communities faced during the pandemic. The following are some suggestions for This study has limitations due to its small sample size; in the future, it will be important to undertake research with a large sample size in order to thoroughly discover how to eradicate poverty, particularly as it relates to the fundamental requirements of slum people. --- BIBLIOGRAPHY Abdullahi, L., Onyango, J. J., Mukiira, C., Wamicwe, J., Githiomi, R., Kariuki, D., Mugambi, C., Wanjohi, P., Githuka, G., & Nzioka, C. (2020)

The problem of slum settlements is still a major problem faced in Indonesia and other developing countries. One of the triggers for the emergence of slum settlements is due to the high rate of population growth, both through the birth process and the urbanization process. This study discusses the social capital of the people of the slum area of Palembang City in fulfilling basic needs, precisely in the 12 Ulu Village Area, Palembang City during the Covid-19 pandemic. This research uses a qualitative approach with a descriptive method. Sampling used a purposive sampling method with data collection using observation techniques and in-depth interviews. The study's findings indicate that (1) a high level of social capital as measured by networks, norms, and beliefs enables slum communities to survive the COVID-19 pandemic, and (2) the slum area communities' strategy for survival is to utilize yard land, home industries, social gathering, recitation, and mutual cooperation. There are several policy implications from this research: (1) Strengthen social capital, (2) Enhance community engagement, (3) Targeted support for vulnerable groups, (4) Ensure food security and (5) Strengthen social safety nets.

Introduction The pandemic has disrupted everything, n 11 March 2020, the World Health from the global flow of goods and services Organization (WHO) declared to the actions that individuals can take in their daily lives. The estimated economic COVID-19 a global pandemic; that is, there was the worldwide spread of a new disease. impact on both Australia and the world The last such declaration had been made on at large is significant, with growing unem-June 1, 2009, with "swine flu," or the H1Nr ployment and uncertainty about the future influenza virus. That declaration, in turn, of the globalised economy, and with some drew on lessons learnt from the SARS out-countries expected to enter a recession in the break in 2002. Yet very little of the world's next year. Throughout the first year of the experience of the 2009 pandemic, or indeed pandemic, governments all over the world the various outbreaks of SARS (2002pond), MERS (2013), and"Ebola (2or4-2016) control the impact of COVID-19, including border closures, travel restrictions, stay-at-enacted a range of measures to mitigate and would prepare us for what would happen next -though the blueprint for how to home orders, economic stimulus packages, handle the COVID-19 pandemic owes much and wide-sweeping public health measures, to prior outbreak management, including including contract tracing technologies and quarantines, border closures and selective processes, mandatory masks, and quarantines. quarantining, The WHO's 2020 declaration Many of these measures were enacted repeattriggered action at a speed and scale that edly, as the virus spread and mutated and as was new and startling. our social systems attempted to adapt and manage in response. Strategies around containment, management, and elimination have been adopted, rejected, or adopted anew, and the complexities of mass vaccination campaigns have roiled many nation states. Nearly a year after COVID-19 was first declared a pandemic, there have been over 114 million cases and over 2.5 million deaths (WHO, 2021). The human toll and impact will continue to unfold for years, touching everything from health to education and employment; there remains little to no clear consensus about how or when this pandemic might end, or about how daily life might look in its aftermath. There will be many accounts written about this period and about its consequences. However, even now, as we remain in the midst of the pandemic, there is significant insight to be gained from the ways in which we are experiencing it, col --- Australia and COVID-19 By early April 2020, more than half the world's population was in some form of state-sanctioned lock-down (Kaplan et al., 2020;Sandford, 2020;Storrow, 2020;Woods, 2020), and the use of stay-at-home orders and other forms of restrictions have continued globally ever since, with some countries closing their borders completely and others entering into the second and third periods of city, region and state-wide lockdowns. In Australia, our first stay-at-home orders came in effect late March, when the Australian government announced that all Australians were to stay home, and we would, at a nation-wide level, attempt to "flacten the curve" Johnson & Smale, 2020). There were four categories of exceptions to the stay-at-home mandate: health care; shopping for food and basic supplies; exercise; and essential jobs. The logic behind the stay-at-home orders were two-fold: slow the rates of transmission, and make it possible for the nationwide public health systems to prepare for a predicted inflow of patients. In early May, the co-ordination between the federal and state governments in Australia gave way to a patchwork of responses and restrictions that have persisted ever of our existing cashless infrastructure (Letts, 2020;Collett, 2020). 63 --- Data privacy The trade-off between safety and privacy has become very real, with the need for rapid, accurate contact tracing to help contain the spread of COVID-19, and the use of digital technologies and data to help in those efforts (Bell, 2020;Bell et al., 2020) "vaccination passport" again proposes to bring these issues to the fore (Bell, 2020;Hern, 2021). From data collection to action: (Turner, [1969(Turner, [ ] 2008: 94): 94). He would also go on to write about the rites and rituals that both begin and end a period of liminality, rites and rituals of separation and re-incorporation (Van Gennep, [1960] 2019: 21). This feels like one way to think about, or theorise, our experiences of the COVID-19 pandemic. Liminality, as a way to describe the moment between moments and the places between places, is a concept that seems to resonate with the Australian experience of the pandemic (Bell, 2021). This theoretical frame seems especially evocative now. Is one way to approach the pandemic and to talk about its consequences to think about it as a liminal moment? And --- Presence and embodiment There have been transformations in ideas about presence and embodiment. At its most straightforward, the physical became virtual. We have reimagined the physical, the virtual, the digital, and the analogue, and in so doing also challenged ideas of how things do and do not move. After all, in this moment, certain forms of embodiment were seen as being dangerous, a classic hallmark of liminality. Being present was seen as being dangerous and we have actively re/ calibrated our senses of our social selves to maintain "safe" distances. --- Intermediation and services How things are being intermediated has been unexpectedly hyper-visible during the pandemic. We have had to both encounter seams, borders and boundaries we had not previously seen, and then also manage them. This extended from the seams of the public and the private to the (non-)movements of --- Relationships In Australia during the early days of both the pandemic and the first lockdowns nationwide, there was a lot of borrowed language about "we're all in it together." That language started at a community level; a grassroots statement from households and communities wanting to articulate a degree of communal activity that was admirable and distinctly Australian. The contradistinction between the broader Australian experience of the pandemic and others -for instance the American experience -means the responsive relationship between citizens and their elected officials and their scientific and health advisors has been on display almost daily. Nonetheless, that language of relation- (Van Gennep, 1960). One of the reasons to approach the analysis of the pandemic from this social-centric

On the 224 of March 2020, the Australian government announced Stage 1 restrictions in response to the global coronavirus pandemic (Johnson and Smale, 2020). Since then, numerous nation-wide measures have been implemented in an effort to control the rate of transmission and minimise the pandemic's negative impact on the Australian people and the economy, ranging from lockdowns and stay-at-home orders to border closures and extensive contact tracing systems. As a growing body of research emerges exploring the efficacy and consequences of these strategies, there is an opportunity to reflect on their social and cultural impacts. In this paper I propose two analytical lenses through which to understand these impacts, framing the pandemic firstly as an (unplanned) social experiment which has transformed and illuminated our relationships with digital technologies, and secondly as a liminal moment and a shared set of social experiences.

WORKSHOP DESCRIPTION Integrity 2022 aims to repeat the success achieved in the previous two workshop editions, Integrity 2020 & 2021, hosted in the corresponding years of the WSDM conference. Previous workshops have featured invited talks from industry leads from companies like Facebook, Twitter, Pinterest, LinkedIn, Snap, and Airbnb, along with academic experts from institutions like UC Berkeley, MIT, Princeton, Aalto, and Queensland University of Technology. These talks have exposed challenges, solutions, and ongoing research in areas such as Misinformation, Bias in Machine Learning models, content-and behavior-based detection of quality problems, Display Advertising Integrity, Safety vs Privacy, Opinion Dynamics, and several other topics. The previous workshops have resulted in fruitful discussions and engagement from the audience, and a unanimous push towards organizing a recurring workshop exploring these problems and potential solutions, with participation from academics and industry researchers. Besides, there is a strong interest in the community in integrity, with several related workshops and conferences on related topics [1, 2, 6]. In the past decade, social networks and social media sites, such as Facebook and Twitter, have become the default channels of communication and information. The popularity of these online portals has exposed a collection of integrity issues: cases where the content produced and exchanged compromises the quality, operation, and eventually the integrity of the platform. Examples include misinformation, low quality and abusive content and behaviors, and polarization and opinion extremism. There is an urgent need to detect and mitigate the effects of these integrity issues, in a timely, efficient, and unbiased manner. This workshop aims to bring together top researchers and practitioners from academia and industry, to engage in a discussion about algorithmic and systems aspects of integrity challenges. The WSDM Conference, that combines Data Mining and Machine Learning with research on Web and Information Retrieval offers the ideal forum for such a discussion, and we expect the workshop to be of interest to everyone in the community. The topic of the workshop is also interdisciplinary, as it overlaps with psychology, sociology, and economics, while also raising legal and ethical questions, so we expect it to attract a broad audience. As indicated by the organizing committee and the speaker list, the workshop aims to bring together researchers and practitioners from both industry and academia, leading to exchange of knowledge and cross-cutting collaborations. The event consists of a series of invited talks by reputed members of the Integrity community from both academia and industry, contributed talks or posters, and a panel with the speakers. The workshop topics include, but are not limited to: • Low quality, borderline, and offensive content and behaviors: Methods for detecting and mitigating low quality and offensive content and behaviors, such as clickbait, fake engagement, nudity and violence, bullying, and hate speech. • Personalized treatment of low quality content: Identification, measurement, and reduction of bad experiences. • COVID-19 on social media: Authoritative health information; Covid misinformation; Vaccine hesitancy; Anti-vax movements. • Misinformation: Detecting and combating misinformation; Prevalence and virality of misinformation; Misinformation sources and origins; Source and content credibility; Inoculation strategies; Deep and shallow fakes. • Polarization: Models and metrics for polarization; Echo chambers and filter bubbles; Opinion Extremism and radicalization; Algorithms for mitigating polarization. • Fairness in Integrity: Fairness in the detection and mitigation of integrity issues with respect to sensitive attributes such as gender, race, sexual orientation, and political affiliation. --- WORKSHOP FORMAT • Duration & Format: Full day, invited and contributed speakers. • Number of participants (estimated): 40 • Schedule (tentative): Table 1 details the proposed schedule. • Call-for-papers, Poster session and Contributed talks: The committee will open the workshop to additional contributors through contributed talks and a poster session, via a call-for-papers. The schedule will be adapted based on the contributed material. Retrieval. He has served several times as a PC and Senior PC member for premier Data Mining and Data Bases conferences such as KDD, WWW, WSDM, VLDB, ICDE, and as a reviewer for journals such as TKDE, TWEB, CACM, TODS, KAIS, DMKD, while he is an associate editor for the TKDE and OSNM Journal. He was in the organizing committee of the OCeANS workshop at KDD 2018. He has served in 3 NSF panels, and as a reviewer for Hellenic Research Foundation. During his tenure at Microsoft he received 3 technology transfer awards for successful transfer of research results to product groups. He has published 60 papers in peer-reviewed conferences and journals, and has filed for 12 patents, 8 of which have been awarded. He organized the Integrity 2020 workshop collocated within WSDM'20 [4]. --- ORGANIZERS Anand Bhaskar, Facebook. Anand Bhaskar is a Research Scientist at Facebook, where he works on building and incorporating content quality signals into News Feed ranking and studying the network effects of ranking changes. Prior to that, he was a postdoctoral researcher at Stanford University and HHMI, where he applied techniques from statistics, computer science, and applied mathematics to large-scale genomic datasets for addressing scientific questions such as the genetic basis of disease, human demographic history, and forensics, among others. His Prathyusha Senthil Kumar, Facebook, is an Engineering Manager at Facebook, where she leads News Feed Integrity efforts leveraging machine learning techniques to understand and utilize content quality in feed ranking and to reduce subjective bad experiences through personalized ranking interventions. Prior to joining Facebook, she led the Search Query Understanding and Relevance Ranking applied research teams at Ebay Inc. Prior to that she worked as a researcher at EBay applying machine learning, natural language processing and information retrieval for various search problems. She holds a master's degree in Computer Science from the University of Texas at Austin and an undergraduate degree in Information Technology from the College of Engineering Guindy, Anna University. Her research has been published in conferences such as SIGIR, CIKM and IEEE. Roelof van Zwol is the head of Ads Quality at Pinterest. The team is responsible for (1) helping advertisers define the audience they want to reach through services such as Act-alike modeling, interest targeting, etc, as well as the ML models that power the ads delivery system to determine which ads to show to a Pinner in a generalized second price auction. Previously, Roelof was the Director of Product Innovation at Netflix. There he was responsible for the innovation of Netflix's content promotion and acquisition algorithms. Prior to joining Netflix, Roelof managed the multimedia research team at Yahoo!, first from Barcelona, Spain, and later from Yahoo!'s headquarters in California. He started his career in academia as an assistant professor in the Computer Science department in Utrecht, the Netherlands, after finishing his PhD at the University of Twente in Enschede, the Netherlands. He organized the Integrity 2021 workshop collocated within WSDM'21 [4]. Timos Sellis is a visiting scientist at Facebook and an Adjunct Professor in Computer Science at Swinburne University of Technology, where he also served as the director of the Data Science Research Institute (2026-20). He received his M.Sc. degree from Harvard University (1983) and Ph.D. degree from the University of California at Berkeley (1986). He has served as a professor at the University of Maryland (1986-92), the National Technical University of Athens (1992-2013), and was the inaugural Director of the Institute for the Management of Information Systems of the "Athena" Research Center (2007-13).He is IEEE Fellow (2009) and an ACM Fellow (2013), for his contributions to database systems and data management. In March 2018 he received the IEEE TCDE Impact Award, for contributions to database systems research and broadening the reach of data engineering research. Anthony McCosker is Associate Professor of media and communication, Deputy Director of the Swinburne University's Social Innovation Research institute, and Chief Investigator in the ARC Centre of Excellence for Automated Decision Making and society. He researches the impact and uses of social media, data and new communication technologies, with a focus on mental health, digital citizenship, inclusion and literacy. He is co-author of the book Automating Vision: The Social Impact of the New Camera Consciousness (Routledge), and co-author of the forthcoming book Everyday Data Cultures (Polity Press). Paolo Papotti got his Ph.D. degree from the University of Roma Tre (Italy) in 2007 and is an associate professor in the Data Science department at EURECOM (France) since 2017. Before joining EURECOM, he has been a scientist in the data analytics group at QCRI (Qatar) and an assistant professor at Arizona State University (USA). His research is in the broad areas of scalable data management and information quality, with a focus on data integration and computational claim verification. --- RELATED WORKSHOPS 4.1 Integrity 2020 & 2021 Hosted in WSDM 2020 at Houston, TX 1 and WSDM 2021 in an online event 2 , the previous editions of this workshop [4, 5] brought together Integrity experts from industry leaders with researchers, and focussed on content-based integrity, integrity and abuse in display advertising, misinformation, behavioral analysis, and integrity challenges for machine learning applications. --- Misinfo 2021 The Workshop on Misinformation Integrity in Social Networks3 [3], held in conjunction with The Web Conference 2021, focused on topics related to detecting, measuring, and mitigating misinformation and polarization. --- CyberSafety 2019 Hosted In The Web Conference 2019 4 , this workshop focussed on anomalous behaviors such as fraudulent engagement, misinformation and propaganda, user deception and scams, harassment, hate speech, cyberthreats, cyberbullying on social networks. --- MisinfoWorkshop2019 The International Workshop on Misinformation, Computational Fact-Checking and Credible Web, in The Web Conference 2019 5 , focused on computational methodology for Misinformation and fact-checking detection, and Ethical pitfalls and solutions, as well as Education on Misinformation. --- FATES on the Web'19 Hosted by The Web Conference 2019, this workshop, with a focus on Social Sciences, discussed issues such as Transparency, Credibility, Fairness, Bias and Ethics in computational research and analysis. --- OCeANS Workshop'18 The Opinions, Conflict, and Abuse in a Networked Society 6 , hosted in ACM SIGKDD'18, had talks on crowdsourcing and the effects of the usage of user data in detection tasks, methods for low-quality content detection, and adversarial system design. --- ROME 2019 The Workshop on Reducing Online Misinformation Exposure7 , colocated with SIGIR 2019, presented work on subjectivity on crowdsourcing, credibility and bias, medical misinformation, user-generated video verification and time-sensitive fact-checking. --- Truth Discovery 2019 The Truth Discovery and Fact Checking: Theory and Practice8 workshop, collocated with ACM SIGKDD'19, discussed a broad range of topics related to the Misinformation discovery problem: general architectures, natural language processing for claims, using fact-checking in supervised settings, information extraction, plagiarism.

This is the proposal for the third edition of the Workshop on Integrity in Social Networks and Media, Integrity 2022, following the success of the first two Workshops held in conjunction with the 13th & 14th ACM Conference on Web Search and Data Mining (WSDM) in 2020 [4] and 2021 [5]. The goal of the workshop is to bring together researchers and practitioners to discuss content and interaction integrity challenges in social networks and social media platforms. The event consists of (1) a series of invited talks by reputed members of the Integrity community from both academia and industry, (2) a call-for-papers for contributed talks and posters, and (3) a panel with the speakers.

Introduction Emerging adulthood is defined as a stage of the life span between young adolescence and young adulthood. According to Arnett, it is developed by the four revolutions during the 1960s and 1970s. Adult transitions happen later with the Technology Revolution, Sex Revolution, Women's Revolution, and Youth Revolution. As shown in Figure 1, the median marriage age for men has increased to over 30, and for women has increased to over 28 in the United States. The delayed age of marriage, as an example, indicates the transition period from young adolescence to young adulthood. Arnett's theory about emerging adulthood shows five pillars of this period, identity exploration, instability, self-focus, feeling in-between, and optimism [1]. The age range of emerging adulthood is 18 to 29, which is consistent with the age to attend and finish undergraduate and graduate schools. However, from 2019 to the present, individuals have been suffering from the pandemic more or less. Emerging adults experience shelter-home orders, social distance policy, and other policies that affect social interactions. Understanding how these factors influence emerging adulthood and emerging adults' identity exploration is essential. This paper is a qualitative research based on document and data analysis. With the help of multiple sources, the influence of the pandemic is analyzed from different aspects. This study can help people understand the influence of the pandemic on emerging adults' identity exploration process and raise their attention to the pressure emerging adults are now suffering from. --- Influence Analysis of COVID-19 on Emerging Adulthood and Identity Exploration --- Identity Exploration and Emerging Adulthood Emerging adulthood is a period that individuals are not completely independent but are already finished secondary school. In this period, emerging adults are trying to get ready to take the role of stable adults. Identity exploration is activated when individuals can access new people or things to explore. Compared to adults who have a more stable life and responsibilities but have less time to explore new things and chance to change their life, emerging adults have more opportunities and time to have deep exploration of love, work, ideologies, and experiences. From Figure 2, data collected from the studies by Alan and his colleagues, individuals aged from 18 to 23 have the highest score in the identity exploration subscale, consistent with the emerging adulthood age range. In this case, identity exploration is a centerpiece during this period and is viewed as one of the pillars of this period. People who successfully explore their identity can better define their sense of self in different times and situations. In contrast, the lack of identity exploration or disturbance of it may lead to many types of mental illness. With identity exploration, emerging adults can find their place in society, which helps them to become stable adults. The process of forming an identity for young people involves exploring a variety of possibilities, choosing one or more of them, and then committing to that choice [3]. Based on Marcia, by the level of exploration and commitment, identity statuses can be divided into four types, foreclosure, achievement, diffusion, and moratorium [4]. Individuals with low exploration and high commitment will fall into the foreclosure category, while those with low commitment will fall into the diffusion category. Individuals with high exploration and high Figure 1: Median age at first marriage: 1890-2021 [2] The International Conference on Interdisciplinary Humanities and Communication Studies DOI: 10.54254/2753-7048/6/20220641 commitment will fall into the achievement category, while those with low commitment will fall into the moratorium category. --- COVID-19 and Emerging Adulthood --- Decreased Social Interaction During the COVID-19 pandemic, the government and related institutions presented policies restricting social interaction and activities, such as shelter-home order and social distance policy. Despite these pandemic-related alterations, the emergence of mental illness is particularly susceptible to occur in young adulthood [6]. The highest rate among all age groups, up to 40% of American emerging adults have a diagnosis of a mental health issue [7]. What's more, compared with stable adults, emerging adults can spend more time exploring new things and meeting new people. However, the policies restricting individual social interactions and reducing the opportunities for people to go out and meet people highly interfere with emerging adults' daily social life. In this case, the pandemic greatly impacts emerging adults and makes their life more unstable than before. --- Increased Time Living at Parental Home Another impact of the shelter-home order is that it increases emerging adults' time at their parental homes. According to Sharon, residential independence is regarded by 80% of emerging adults as a key indicator of independence [8]. In this case, living with their parents will weaken their sense of independence, impacting their acquisition of stable adult roles. Young people consider themselves adults if they can accept responsibilities for themselves, make independent decisions, and establish financial independence. In this case, living with parents will interfere with the necessary development during emerging adulthood. --- Decreased Income and Job Opportunities The pandemic caused decreased income and job opportunities, the increased price of daily necessities, and uncertainty in the labor market. Of the 16.9 million people unemployed in July, 9.6 million (57%) were unable to work because their employers closed or lost business due to the pandemic [9]. Although the number of unemployed people includes individuals other than emerging adults, it still shows the losses of job opportunities and the turmoil in life. Because of the hardness of finding jobs and maintaining lives, the degree of difficulty in having financial independence is harder than in the time before the pandemic. These social impacts caused by the pandemic increase the instability of emerging adults and make them have less financial independence, which may increase anxiety and mental health problems. --- Impact on College Students Aimed at emerging adults attending college, the pandemic altered traditional studying methods to decrease the interaction between people and control the spread of the virus. Schools asked us to use Zoom to have classes and use ProctorU to take exams. However, these alternatives limit students' interactions and increase their anxiety caused by the technical issues they may meet and are not familiar with. In this case, emerging adults may have less time to self-focus and feel less optimistic, which are two important pillars of emerging adulthood. As mentioned earlier, the pandemic decreased job opportunities, which also increased the pressure for students to find internships and jobs after graduation. --- COVID-19 and Identity Exploration --- Impact of Identity Statuses Based on the policies and restrictions caused by the pandemic, there are fewer opportunities and freedom to explore new things and meet new people. In this case, emerging adults are more likely to fall into diffusion and foreclosure identity statuses, especially in the interpersonal relationship identity domain. As mentioned before, diffusion individuals have low levels in both exploration and commitment. The hallmark of the diffusion domain is the lack of agency and direction. People in this domain often score lowest on well-being measures and highest on risk-taking [5]. Moratorium individuals have a high level of exploration and low level of commitment, which makes them exhibit high openness and curiosity, but mixed good and bad when it comes to well-being [5]. In this case, emerging adults during the pandemic are more likely to fall into these two domains and increase the risk of having well-being problems, especially in the interpersonal domain, which was influenced by the policies to control COVID-19 the most. In this case, the situation caused by the pandemic and the identity statuses influenced by the pandemic will work together on the individual's interpersonal relationships, causing more pressure on emerging adults. However, identity statuses are transitional in that most people's statuses can increase to a higher level of commitment with the past time [10]. Identity statuses can also regress temporarily associated with distress and environmental changes, which are normal and adaptive [11]. In this case, individuals can progress on their identity statuses after living normally, but it can also worsen if the restrictions are more severe. --- Results in Neo-Eriksonian Perspective of Identity Styles Based on the Dual-Cycle Process Model by the Neo-Eriksonian Perspectives, there are five steps to explore identity, exploration in breadth, commitment making, exploration in depth, identification with commitment, and ruminative exploration [12]. Individuals form their identity in the first two steps and evaluate their identity in the next two steps [12]. Based on Kazumi, support, open disclosure, and meta-exploration functioned to build the conditions for exploration while investigating, creating an idea, and conflict-facilitated (or conflict-triggered) exploration. Demotivating blocked exploration, on the other hand [13]. During COVID-19, demotivating situations increased, and meta-exploration opportunities decreased, which interfered with the identity exploration process. Identity style in Neo-Eriksonian perspectives is the decision-making processes that underlie exploration and commitment [14]. There are three identity styles, informational, normative, and diffuse-avoidant. Most achievement and moratorium identity statuses people have an informational identity style, which is a proactive, intentional, and flexible approach. And most diffusion and some moratorium individuals have diffuse avoidant identity styles. These people avoid making decisions and situations to determine who they are. In this case, more people will have informational and diffuse-avoidant identity styles because of the lack of exploration opportunities caused by the pandemic. --- Conclusion As analysis above, COVID-19 caused more anxiety and instability for emerging adults in many aspects and decreased exploration opportunities, optimism, and social interactions. These influences disrupt the transition from dependent adolescence to independent adulthood, which occurs during emerging adulthood. In this case, the pandemic increased the mental health risk among emerging adults and also impacted identity exploration. This study aims to raise public attention on emerging adults during the pandemic. Emerging adults' mental health is vulnerable, and the identity development process in this period is important. This study is only based on document and data analysis and integration. Understanding the causal relationship needs further experiments, surveys, and other research methods. In addition, most of the data and experiments in the documents are based on WEIRD samples, which may influence the results.

The emergence of COVD-19 evokes not only public's concerns on health problems, but also concerns on social development. Emerging adulthood was proposed by Jeffrey Jensen Arnett in 2000 to illustrate a period of transition from adolescence to adulthood, which followed the development of the revolutions in the 1960s, making adult transitions happen later. The current study examined how the pandemic influences emerging adulthood and identity development. Emerging adulthood is the period between achieving independence, from age 18 to 29. In emerging adulthood, individuals experience identity exploration, instability, self-focus, feeling in between, and optimism. The pandemic influences the youth's lifestyle by decreasing their social interaction and annual income and increasing the time spent alone or with their families. This study is a qualitative research based on document analysis, which is useful in exploring how or why things have occurred. The result shows that the pandemic influences emerging adults' life satisfaction and identity exploration by increasing life instability and decreasing social interaction. Possible solutions to the result are provided and discussed. Knowing how the pandemic influence emerging adults can raise public attention on mental health problems for individuals in this age range. This study can also provide information for further research on emerging adulthood development.

(Hopton and Hunt, 1996) . ‫أنشئت‬

This study examines the state of housing support for orphans in Saudi Arabia-a group that suffers from poor financial capacity and social deprivation. It proposes a framework that enhances the participation of all relevant authorities in the housing support system, enabling orphans to obtain housing needs, social stability, and economic empowerment within the framework of Saudi Vision 2030. A descriptive approach was used to determine the role of partnership in housing support programs for orphans. A questionnaire was administered to a sample of 41 experts, and the numerical data were analyzed. The study results showed that orphans face several challenges when seeking housing support. There is a lack of legislation and rules defining the roles of partner agencies in providing housing support, poor coordination between concerned government sectors, and no clear criteria for support priorities. This study highlights the need for developing an effective partnership for the housing support system for orphans, starting with building a clear strategic plan to support them based on three main principles: the incubation environment, infrastructure, and beneficiaries.

Limited Evidence on the Effects of the Interventions One significant challenge is that rigorous research evidence on the health effects of social determinants of health interventions is limited and mixed. 3 Some studies do suggest that attending to social determinants-such as addressing housing and the social services needs of older adults and children's families-can lead to health improvements, such as reductions in hospital admissions and possible savings. But it is often unclear which specific interventions matter and to what degree. For instance, a recent assessment of 35 peer-reviewed studies of social screening and referral programs found most studies had limitations that could bias the conclusions. 4 Another recent analysis of randomized trials of social interventions also found bias. 5 The mixed findings from this research do not mean we should deemphasize social determinants of health screening and interventions. But it does mean more experimentation and better study designs to understand social determinants of health are needed. We also need to be cautious before committing to large and expensive changes in care patterns until better evidence is available. Meanwhile, it is helpful that some professional advisory bodies, such as the US Preventive Services Task Force, are providing careful guidance on how to address social risk during care. 6 --- Need for Better Data Sharing Barriers to sharing data are another obstacle. Different data systems, privacy rules, and sharing protocols often make it difficult for community-based organizations in nonmedical sectors to work in concert with health care organizations. Fortunately, the growth of intermediary networks, such as the company Unite Us, is creating a data infrastructure to help social service organizations and health systems coordinate person-centered care. Also, community initiatives such as the San Diego-based Community Information Exchange, assemble partners to create integrated data systems to enable multiple sectors to provide holistic care. The federal government can help by offering greater clarification and guidance on privacy rules and grants for local initiatives. sharing at the community level includes several steps the federal government could take to improve the sharing of information. --- Determining Who Should Pay Another nettlesome issue concerns who should pay to address social determinants. Legislative and administrative rules often limit or prohibit health programs from using funds for nonmedical services, even if doing so would lead to better outcomes or lower total costs. However, at the federal level the §1115 Medicaid waiver process has permitted some flexibility for state social determinants of health pilot programs to proceed. In 2019, for instance, the Trump administration authorized North Carolina to use a Medicaid managed care model to combine nonmedical and medical services for certain populations with complex and chronic illness. In addition, changes in Medicare Advantage rules now allow plans to include more nonmedical services related to food insecurity, transportation, and housing instability within their benefits. During 2021, more than 900 plans offered such benefits. Still, much more needs to be done to permit health sector programs and plans to invest in social determinants of health. --- Encouraging Collaboration A related payment issue is how to address the reluctance of different sectors to share the initial cost to obtain health quality improvements or future cost savings. The problem is that in many cases, one sector foots the bill while another reaps the savings-the so-called wrong pockets problem. For example, a housing department might be urged to spend resources on bathroom safety for older adults to reduce falls, but the subsequent savings would accrue to Medicare or Medicaid, not the housing department. Even when each sector would gain from a collaboration if they shared the upfront cost, it can be difficult to find a commitment formula that each would consider fair. Some models of cooperation suggest possible solutions to this problem. One promising example is CommonSpirit Health's "Connected Community Network." This network uses a trusted community convener, together with a technology platform for referrals and coordination, to connect multiple health plans with community-based organizations providing a range of social services. The neutral convener is the key to this unusual example of "co-opetition" between competing health plans that jointly shoulder the cost of creating an infrastructure for their mutual benefit. Meanwhile a series of pilot programs being undertaken in several locations by the Collaborative Approach to Public Goods Investments is exploring a variety of ways to achieve cooperation by using a trusted neutral convener combined with a formula for allocating costs and benefits to each partner. Governments are also developing ways to encourage departments to work together for a common goal. The expansion of "children's cabinets" to more than half the states is an example of one approach creating a special executive-level body to coordinate cross-department planning and budgeting for such areas as health, transportation, education, and social services to advance the health and welfare of a targeted population. There have been proposals for a White House-based children's cabinet to achieve similar collaboration at the federal level. --- Author Affiliation: Brookings Institution, Washington, DC. --- Conflict of Interest Disclosures: Dr Butler reported he is the unpaid advisory board chair of the Collaborative Approach to Public Goods Investments.

In a remarkably short period, attention to social determinants of health-nonmedical factors influencing health, such as housing, adequate nutrition, 1 and transportation-has become a central feature of efforts to improve health and health equity. In just the last 10 years, the term's annual frequency in journal articles has increased 7-fold. More recently, COVID-19 has underscored the link between social factors and inequities in health care. It is now common to have screening questions about social conditions during patient intake and for referrals to be made. 2 And there are calls for Z codes identifying social needs to be used more extensively in the health system to improve care. However, despite this growing focus on social determinants, the health care system is far from able to effectively address these influencers of health. There has been progress, but several challenges require attention.

In their recent paper, Kim and colleagues provided a very interesting analysis of the characteristics that can affect Social Network Service (SNS) use, with particular mention of SNS fatigue and living disorders. The authors put a light on some dark sides of SNS derived from personal characteristics such as engagement and maintaining self-reputation, and SNS characteristics such as irrelevant information overload and open reachability. All these variables should be positively associated with SNS fatigue, meant as a discomfort or stress while using SNS. SNS fatigue would be a predictor of living disorders, which, in turn, could reduce SNS use intention and this latter relation could be moderated by the experience of privacy violation. As far as we are concerned, in this interesting model there are several variables that are relevant in a work context as well. Indeed SNS is an essential part of occupational life, from the employees' recruitment, to selection and management processes [1]. The most important and delicate dimension is the perception of privacy-it is both private and subjective to becoming a jurisdictional issue. The concept of privacy related to online data is strictly related to informational privacy [2], which is the control of personal data. Kim and colleagues define the experience of privacy violation as the users' concern about escapes of personal information. Privacy can also be defined as "the right of someone to keep information to themselves or at least share it only with relevant people" [3] p. 2. This latter viewpoint can have several implications in terms of organizational digital surveillance. The current literature concerning the consequences of social network use in the workplace is mostly limited to the jurisdictional dimension. There are instead several variables that are worth considering in order to expand knowledge and improve organizational management. This comment considers one of the relevant aspects related to SNS in the workplace. So, it is now worthwhile to introduce the meaning of the term doocing-it is the job termination caused by illicit or inappropriate behavior on social media that does not fit with corporate policies [1,4]. It is exactly a boundary issue between the employee's right to privacy and the organization's duty to monitor [5]. More specifically, it can happen that an employee posts an irrespective comment on a social network regarding his/her organization or employer or colleague. This behavior can damage the organization's imagine and reputation, so there can be a disciplinary procedure that the organization can apply in order to avoid such incidents. There are several variables that can predict the improper use of social networks related to one's own job, such as low job satisfaction and engagement and a lack of organizational support, and we also imagine that living disorders-as defined by Kim and colleagues-can be related to this behavior. Moreover, the experience of privacy violation or the perception of corporate surveillance can predict the reduced use of social networks and an amount of the fear of doocing [4]. As stated by Kim and colleagues, a living disorder can negatively affect work and learning. This assumption reflects the ambivalent perspective on technology-on the one side the personal use and abuse of new technologies can cause discomfort and stress, on the other side there are some positive impacts as well, for example online interactions can positively affect the learning process in a community of practice online [6,7]. The model outcome in Kim and colleagues' study was the reduced intention of SNS use. This could of course prevent doocing, but this is not the solution. In a sense, we do agree with one of the conclusive implications-users should receive education for the correct use of SNS. Moreover, the current huge amount of data and the free access to them make even more difficult the personal management of information with unpredictable outcomes in terms of data security. The large distribution and use of information is one of the most powerful and dangerous weapons within everyone's reach [8]. Also for these reasons, at present it is quite common for organizations to implement social network guidelines in their corporate policy, in order to inform employees regarding their data responsibility and to prevent the doocing phenomenon. The right distribution and communication of social network policies is the main factor that affects employees' perceptions of termination fairness [9]. Parker and colleagues verified the need for social media governance by the implementation of role theory and script theory [9]. Employees will play a role based on the expectations of customers and supervisors. To conclude, doocing is a real risk employees have to cope with, partly derived from living disorders and moderated by the experience of privacy violation or the perception of corporate surveillance. Future studies could enlarge the model tested by Kim and colleagues in a work context, having as the outcome the awareness of doocing. --- Author Contributions: S.F. and M.C. substantially contributed to the conception and design of the paper. Both have written the manuscript and reviewed all parts of the manuscript and agree to be accountable for all aspects of the work.

In light of the recent work by Kim and colleagues about Social Network Service (SNS), examining the individual and SNS characteristics as predictors of SNS fatigue, we hypothesize to enlarge their model to the job context. SNS is a relevant issue in occupational life as employers use it to have a deeper knowledge of their employees and as a tool of corporate communication. Employees can use SNS as a social platform and as a way to express discontent. In this latter case, the organization can implement a disciplinary procedure toward employees, known as doocing. The perception of privacy violation is strictly related to the fear and awareness of doocing, which in turn can predict SNS fatigue as well. So, it could be worthwhile to extend Kim and colleagues' model to the workplace with particular attention to the doocing phenomenon.

Guy Hans 1.2 , Jolijn Apers 1 , Michael Vanmechelen 1 , Brigitte Claes 1 , Kristel Moons 3 1: Antwerp University Hospital (UZA), Edegem, Antwerp, Belgium 2: University of Antwerp (UA), Wilrijk, Antwerp, Belgium 3: Altrio Home Care, Antwerp, Belgium During the summer of 2020, government agencies in Belgium were hasty to create additional test capacity for the diagnosis of acute infections with SARS-CoV-2. Large-scale initiatives were necessary to absorb the waves of covid-19 infections throughout all levels of society. Within the Antwerp University Hospital (UZA) we realized that it would be impossible to perform large-scale testing of schools, universities, companies, or other collectivities if sampling capacity would not be made available within the collectivities themselves. A large number of scholars or students would not be able to move toward test centers. So, we created a mobile testing team that on-call would be sent to the collectivities to perform testing within the schools, universities, and companies. The test team started in October 2020 with a single bus which was transformed to accommodate the administrative handling of the test e-form, the scanning of the eID of the person to be tested, as well as the sampling through a nasopharyngeal itself. The structure of the bus allowed to perform the testing of 12 students every 15 minutes. Within a couple of weeks, the demand for large-scale testing increased to more than 1000 a day. Towards the end of 2020, a second bus was put into operation. During the year 2021, additional vans were put into operation as the daily number of tests further increased. The mobile test team remained in operation until the end of May 2022. During this lifespan, more than 200,000 nasopharyngeal samples were collected by the test team. The highest number of tests on a single day was 4,200. The mobile test team operated within three Belgian provinces, serving more than 2,500,000 people. Besides the testing teams, we created a dispatching team which was evaluable 7/7 for calls and registration of demands for new testings. Besides schools, we performed collective testing in colleges, universities, nursing homes, large companies, prisons, and hospices for homeless people. We even performed large-scale tests within municipalities at the hights of the covid waves. TAT for reporting results was less than 24 hours after sampling. The mobile test team, CoBUSters, became known throughout the entire country as a truly innovative social project. Many wondered why a hospital developed a service that was well outside of the regular hospital-related activities. We however did this because this aligns with our mission as a community-based hospital with a strong societal-oriented focus. Hospitals should not remain within their walls, but when society needs them they should quickly develop activities Hans: CoBUSters: organization and deployment of a mobile Covid -19 test team for large-scale testing in collectivities as a societal outreach from a university hospital to support society as a whole. This project allowed us also to interact on an almost daily basis with healthcare providers on the first line of healthcare (GPs, home care nurses). From the hospital, we provided the services that the first line could have never mobilized like administrative and nursing staff or manipulation of huge numbers of PCR tests. Together we were able to protect our collectivities against massive outbreaks of the SARS-CoV-2 virus. Even tertiary hospitals have a fundamental societal role when called upon. We should never forget this.

CoBUSters: organization and deployment of a mobile Covid-19 test team for large-scale testing in collectivities as a societal outreach from a university hospital.

Background It is imperative that the healthcare system be prepared to care for the growing Latino population and its burden of diabetes [1,2]. Many Latinos who are uninsured or live in medically underserved settings receive care in community health centers [3]. However, there has been no comprehensive assessment of the accessibility of diabetes services for patients at health centers or of specific resources for Latino patients [4]. We conducted a crosssectional survey of providers at Midwestern community health centers to assess their access to services for their patients with diabetes and measure how these services vary by the proportion of Latinos served at the site. --- Participants and Data Collection Between August 2010 and November 2010, we mailed a survey to 1,471 eligible providers at 97 health center sites affiliated with MWCN. Eligible providers currently treated or managed patients with diabetes. Participants gave informed consent by returning the completed survey. The study received human subject approval from the University of Chicago Institutional Review Board. --- Measures A 28-item questionnaire included multiple-choice questions on participant and workplace characteristics and health center resources. --- Provider Characteristics Providers were asked their position at the health center, year of birth, gender, race/ethnicity, number of years in practice, and percent of patients with diabetes who were Latino. --- Health Center Characteristics Providers were asked their center's location (city, suburban or rural), wait for a routine physician appointment, and health center hours. Respondents reported the percentage of the site's diabetes patients who were Latino and the percentage of the patients who were foreign born and uninsured. Providers were labeled as working in high proportion (HP) sites if >25 % of their site's diabetes patient population was Latino. The rest were labeled as working at low proportion (LP) sites. --- Health Center Personnel Providers reported their access to the following personnel when needed: (1) primary care physicians, (2) advanced practice nurses, (3) physician assistants, (4) endocrinologists, and (5) certified diabetes educators. Respondents who took care of Latino patients with diabetes were asked if the following personnel and services were available at their site: (1) Spanishspeaking front desk staff, (2) Spanish-speaking providers, (3) on-site interpreter services, and (4) telephone lines for off-site interpreters. Respondents chose from 5 responses: never, occasionally, sometimes, often, or usually. We classified responses as "having access" if the respondent reported accessibility to services "often" or "usually." --- Culturally Tailored Services Providers who reported caring for Latino patients were asked if they had access to the following programs for their patients: (1) community health workers, (2) physical activity classes in Spanish, (3) culturally tailored nutrition counseling for Latinos, (4) culturally tailored diabetes education for Latinos, (5) partnership with local organizations, (6) telemedicine services to access off-site healthcare professionals, (7) diabetes group visits in Spanish, and (8) multidisciplinary teams. --- Analysis We examined descriptive statistics of participants' individual and workplace characteristics and access to personnel and diabetes services. To analyze the relationship between participant characteristics and proportion of Latino diabetes patients served, we conducted bivariate analyses using Chi square test for categorical variables and Wilcoxon rank sum tests for continuous variables. To investigate how provider access to health center personnel and site services varied by proportion of Latino diabetes patients served at the site, we used a generalized linear mixed effect model with random effects for each site. The analyses were performed using SAS 9.2 (Cary, NC, 2009). --- Results A total of 620 of 1,471 eligible providers responded to the survey, for an adjusted response rate of 47 %. Female providers were more likely to return the survey than male providers (46 vs. 39 %, p = 0.04). The physician response rate was lower than that of advanced practice nurses and physician assistants (35, 50, and 42 %, respectively, p <0.001). We analyzed data from the 577 respondents from 85 health center sites across 10 states who reported the percent of Latino patients with diabetes seen at their site. --- Provider Demographics and Health Center Characteristics: Table 1 Providers at HP sites were more likely to be of Latino ethnicity, work at urban sites, have foreign-born Latino patients, and have higher rates of uninsured patients. Most respondents (84 %) reported caring for Latino patients. --- Overall Access to Personnel and Resources: Table 2 The majority of respondents reported having access to primary care physicians (95 %), advanced practice nurses (85 %), physician assistants (64 %), and certified diabetes educators (56 %) for their patients; however, few had access to an endocrinologist (30 %). Many respondents reported having access to on-site interpreter services (72 %) but access to Spanish-speaking providers (38 %) was low. More than half of the respondents noted the availability of community outreach workers (65 %) and multidisciplinary teams (54 %) but less access to other culturally tailored services. --- Access to Resources by Proportion of Latino Patients at Site Healthcare Personnel-Providers at HP sites were more likely to have access to physician assistants (71 vs. 58 %, p = 0.002) and certified diabetes educators (61 vs. 51 %, p = 0.01) compared to providers at LP sites (Fig. 1). Providers at LP sites had higher rates of access to an endocrinologist than did providers at HP sites (35 vs. 25 %, p = 0.02). Bilingual Personnel and Language Services-Providers who cared for Latino patients at HP sites had access to Spanish-speaking front desk staff (88 vs. 50 %, p <0.001), Spanish-speaking providers (48 vs. 26 %, p <0.001) and on-site interpreter services (83 vs. 59 %, p <0.001) more frequently than did LP site providers. Diabetes Services and Programs-Providers at HP sites who cared for Latino patients were more likely to have access to community outreach workers (77 vs. 52 %, p < 0.001), physical activity classes in Spanish (35 vs. 5 %, p < 0.001), culturally tailored nutrition counseling (63 vs. 23 %, p < 0.001), culturally tailored diabetes patient education (64 vs. 26 %, p < 0.001), and partnerships with local organizations (49 vs. 20 %, p < 0.001) for their patients than did LP providers (Fig. 2). Providers at HP sites noted higher rates of group visits for diabetes patients in Spanish (40 vs. 12 %, p < 0.001) and of multidisciplinary teams compared to providers at LP sites (64 vs. 43 %, p < 0.001). --- Discussion Our study is the first to measure the availability of culturally tailored diabetes programs at health centers across a region of the US and how availability of these services differs by the proportion of Latino patients served. Providers who worked at centers that served many Latino patients had access to many culturally tailored programs and to interpretation services. This finding dovetails with evidence that culturally tailored healthcare interventions can improve diabetes outcomes and that access to interpretation services improves patient satisfaction and patient receipt of clinical information [5][6][7][8]. However, since reimbursement for these service is not always available, it is unclear how centers are financing these programs [9]. Centers may be using grants to offer culturally tailored services, however sustaining these programs requires ongoing support and innovative, longer-term funding streams. Additionally, the quantity and quality of culturally tailored programs needed to impact diabetes outcomes is unclear [5,6,10]. A set of best practices that describes the personnel, programs, and systems of care needed to serve Latino patients with diabetes may be important to establish to ensure that sites are offering the right kinds of services for their patient population. Despite the paucity of bilingual healthcare personnel in the US, we found that community health centers are able to attract personnel who are Spanish-speaking. Health centers may be uniquely positioned to hire bilingual personnel by being situated in communities with larger pools of minority job applications and by appealing to minority providers who have the inherent desire to practice in under-served areas. However, more programs are needed that mentor minority students and encourage them to pursue careers in healthcare [11]. Providers working at centers with many Latino patients reported greater access to many nonphysician personnel. Training physician assistants, nurse practitioners and other nonphysician providers will be especially important as they increasingly serve as primary care providers and co-manage patients with diabetes [5,6]. However, we still need to understand the best ways of coordinating care among different types of providers. Nevertheless, access to culturally tailored programs, interpretation services, and subspecialists needs to be strengthened across all sites. We found that some providers had no or limited access to culturally tailored programs. And despite a federal mandate that obligates the provision of interpretation services to all patients, not all the providers in our survey reported having access to interpretation services [12]. Additionally, health center providers across all sites had limited access to endocrinologists, corroborating other studies that have reported poor access to subspecialists within the safety net healthcare system [13]. --- Limitations We had a lower survey response rate from physicians, although our overall response rate was high compared to other provider surveys. Additionally, we were unable to account for financial resources available to the sites that may have affected the types of services and programs available. --- Conclusions Our study provides insight into how some health centers have strengthened their services and their workforce to better meet the needs of their Latino patients. Further work needs to examine how these centers are able to offer these services, why others are not, and what the impact is of these services on diabetes disparities.

Latino patients with diabetes is unknown. We analyzed survey data from 577 community health center providers and staff who manage diabetes from 85 sites across 10 Midwestern states. Respondents were labeled as high proportion (HP) providers if >25 % of their site's diabetes population was Latino. HP providers were more likely than non-HP providers to have access to physician's assistants (71 vs. 58 %) and certified diabetes educators (61 vs. 51 %), but less access to endocrinologists (25 vs. 35 %) (p < 0.05). HP providers had greater access to Spanish-speaking providers (48 vs. 26 %), on-site interpreters (83 vs. 59 %), culturally tailored diabetes education programs (64 vs. 26 %), and community outreach programs (77 vs. 52 %) (p < 0.05). Providers at HP sites reported greater access to a range of personnel and culturally tailored programs. However, increased access to these services is needed across all sites.

Objective: There is a well-established relationship in the literature between cognitive impairment and functional disability, such that, increased cognitive impairment is associated with diminished capacity to perform daily activities independently. However, there has been limited research on the relationship between cognitive impairment and daily functioning in older adults from an Indian population, or differences between Indian and U.S samples. The relationship may differ across these two populations due to their unique cultures. For example, India and the United States have significantly different social systems and family structures, with different emphases placed on the community as compared to the individual. Therefore, the role that older adults play or the support they receive within the family and society differs between the two countries and could significantly impact the relationship between cognitive ability and functional disability. The primary objective of this study is to further explore the similarities and differences in this relationship across cross-cultural populations. We hypothesized that individuals across both samples with lower cognitive functioning will have increased disability. Furthermore, we propose that the relationship between cognitive functioning and functional disability will be stronger in the U.S sample as compared to the Indian sample. Participants and Methods: Communitydwelling older adults were sampled through local senior centers and by convenience sampling in the United State and India, respectively (N = 40 and 36, respectively). All participants were administered the Montreal Cognitive Assessment (MoCA) to evaluate cognitive ability. Functional status was assessed using the Activities of Daily Living section of the OARS multidimensional functional questionnaire and the World Health Organization Disability Assessment Schedule (WHODAS). Results: A significant association between cognitive functioning and functional disability was demonstrated in the combined sample, i.e., the MoCA was correlated with OARS ( r[70] = .42, p < .001) and the WHODAS ( r[59] = -.32, p = .009). However, when comparing samples, significant differences in associations between the MoCA and functional measures were noted in the Indian and U.S. samples: In the Indian sample, the MoCA was not significantly correlated with either the WHODAS (r[38] = -.28, p = .09) or the OARS (r[39] = .17, p = .31). Comparatively, in the United States, the MoCA was correlated with the OARS ( r[32] = .51, p = .002) and the WHODAS ( r[26] = -.40, p = .04). Conclusions: These results, in keeping with most previous studies done in the U.S. point to a robust relationship between cognition and functional disability in the U.S sample. However, this association is substantially diminished in the Indian sample. One possible reason maybe, greater support available to older Indians may mitigate the negative effect of cognitive impairment on adaptive function. A major limitation of this study is the small sample size. Additionally, due to vast cultural differences that exist across India, the sample collected from an urban well-education population will likely not generalize to the larger country. Future research from larger and more diverse samples across the country will likely provide more valuable insight. --- Performance between bilinguals and monolinguals: Anxiety as a moderating effect across executive functioning and processing speed in a multicultural cohort with ADHD symptoms Christopher Gonzalez 1 , Demy Alfonso 2 , Brian M Cerny 1 , Karen S Basurto 3 , John-Christopher A Finley 4 , Gabriel P Ovsiew 3 , Phoebe Ka Yin Tse 5 , Zachary J Resch 3 , Kyle J Jennette 3 , Jason R Soble 3 1 Illinois Institute of Technology, Chicago, IL, USA. 2 Northern Illinois University, Dekalb, IL, USA. 3 University of Illinois at Chicago College of Medicine, Chicago, IL, USA. 4 Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5 The Chicago School of Professional Psychology, Chicago, IL, USA Objective: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly associated with relative impairments on processing speed, working memory, and/or executive functioning. Anxiety commonly co-occurs with ADHD and may also adversely affect these cognitive functions. Additionally, language status (i.e., monolingualism vs bilingualism) has been shown to affect select cognitive domains across an individual's lifespan. Yet, few studies have examined the potential effects of the interaction between anxiety and language status on various cognitive domains among people with ADHD. Thus, the current study investigated the effects of the interaction of anxiety and language status on processing speed, working memory, and executive functioning among monolingual and bilingual individuals with ADHD. Participants and Methods: The sample comprised of 407 consecutive adult patients diagnosed with ADHD. When asked about their language status, 67% reported to be monolingual (English). The Mean age of individuals was 27.93 (SD = 6.83), mean education of 15.8 years (SD = 2.10), 60% female, racially diverse with 49% Non-Hispanic White, 22% Non-Hispanic Black, 13% Hispanic/Latinx, 9% Asian/Pacific Islander, and 6% other race/ethnicity. Processing speed, working memory, and executive function were measured via the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index, Working Memory Index, and Trail Making Test B, respectively. Anxiety was measured via the Beck Anxiety Inventory (BAI). Three separate linear regression models examined the interaction between anxiety (moderator) and cognition (processing speed, working memory, and executive function) on language. Models included sex/gender and education as covariates with Processing Speed Index and Working Memory Index as the outcomes. Age, sex/gender, and education were used as covariates when Trail Making Test B was the outcome. Results: Monolingual and bilingual patients differed in mean age (p < .05) but did not differ in level of anxiety, education, or sex/gender. Overall, anxiety was not associated with processing speed, working memory, and executive function. However, the interaction between anxiety and language status was significantly associated with processing speed (β = -0.37, p < .05), and executive functioning (β = 0.82, p < .05). No associations were found when anxiety was added as a moderator for the associations between language and working memory. Conclusions: This study found that anxiety moderated the relationship between language status and select cognitive domains (i.e., processing speed and executive functioning) among individuals with ADHD. Specifically, anxiety had a greater association on processing speed and executive functioning performance for bilinguals rather than monolinguals. Future detailed studies are needed to better understand how anxiety modifies the relationship between language and cognitive performance outcomes

outperformed the low-performance group on the CNT, p = .000, ηp² = .53. Additionally, results revealed the low-performance group reported higher temporal demand and effort levels on the CNT compared to the high-performance group, p's < .05, ηps² = .05. Conclusions: As we predicted, the lowperformance group overestimated their CNT performance compared to the high-performance group. The current data suggest that the Dunning-Kruger effect occurs in healthy Latinx participants. We also found that temporal demand and effort may be influencing awareness in the low-performance group CNT performance compared to the high-performance group. The present study suggests subjective features on what may be influencing confrontational naming task performance in lowperformance individuals more than highperformance individuals on the CNT. Current literature shows that bilingual speakers underperformed on confrontational naming tasks compared to monolingual speakers. Future studies should investigate if the Dunning-Kruger effects Latinx English monolingual speakers compared to Spanish-English bilingual speakers on the CNT.

Introduction As a result of the spread of self-production tools, Web 2.0 services enable cooperation between Internet users as a side effect of their individual publication activities. The 'strength of weak cooperation' (Aguiton, Cardon, 2007) lies in the fact that it is not necessary for individuals to have a cooperative plan of action or an altruistic concern beforehand. They discover cooperative opportunities simply by making their individual productions public. A typical example of this process is Flickr: not only a website for photo publication, it also provides tools that enable coordination. Our goal here is to sketch a way to study Flickr groups as a key element of this weak cooperation. Our experiments are done on a sample of an extensive database we have collected from the Flickr website and whose detailed figures and analysis will be published soon (Prieur et al, 2008). --- Flickr Groups: Thematic and Social Tool Flickr(.com) is a website that enables users to upload photos, index them with freely chosen keywords called tags (cat, paris, etc.) and post them to thematic user-created groups ("Cats rule", "People in the street", etc.) They can also put comments on other users' photos, mark them as their favorites and mark these users as their contacts. Among the site's functionalities, tags, contacts and groups are the three giving direct access to photos. The first two have very distinct functions: tags are essentially used for indexing -a photo with the tag cat will appear in global searches made on this tag. As for contacts, they are the core material of the social media -Flickr shows you the recent photos of your contacts with the idea that people don't only want to see photos of something but also someone's photos. Now groups draw on both aspects: they gather not only photos on one topic but also people, who contribute (or not) to give a social identity to the group by their activity. --- An Analytical Scheme In order to sketch a map of the groups following the two aspects just described, namely tags and contacts as respectively thematic and social indicators (of course these criteria are used only as a proxy), let us present briefly two measures of these. Given a group g, we will call the thematic graph (resp. social graph) of g the graph whose vertices (i.e. nodes) are the members of g having posted at least one photo with at least one tag, and where an (undirected) edge (i.e. link) between users u and v denotes the fact that they have at least one tag in common (resp. one is a contact of the other). Thematic edges will be weighted using a function w defined as follows. Given a tag t and a user u, n t and n t (u) denote respectively the number of all Flickr photos and the number of photos of user u, both having tag t (including photos outside studied groups). The maximal value of n t is denoted by n max . The rarity coefficient ² t of a tag t is defined by log(1+n max /n t ). This coefficient ranges from 1 for the most used tag beach to approximately 10 for the rarest ones. The tag weight w u,t of tag t on user u is defined by 0 if n t (u)=0, by 1+log n t (u) otherwise. The idea of the log is of course to reduce the impact of users posting thousands of photos about the same topic (their wedding, baby, cat, holiday...) Finally the edge weight between users u and v is: w u,v = w v,u = t (² t h min(w u,t , w v,t ), which is meant to tell whether u and v share many tags, taking into account the rarity of these tags: the rarer are the tags, the closer the users are to each other. Let us now recall that a Lorentz curve graphically shows a cumulative distribution function (Figure 1 shows a Lorentz curve of all Flickr public photos, where the first 10% of the users own 70% of the photos) and that the Gini coefficient of a distribution is the area between the Lorentz curve and the diagonal (which is the Lorentz curve of the uniform distribution). This coefficient is a measure of the heterogeneity of the distribution: on the example, the highest numbers of photos owned by individuals are very high in comparison to photos owned by average people, the curve is thus far from the diagonal, the Gini coefficient is thus high. We will now label a group by its social density, defined as the density of its social graph (i.e. the ratio of existing edges among all possible edges given the number of vertices) and its tag dispersion, defined as the Gini coefficient of the distribution of edge weights in its thematic graph. --- Results Figure 2 shows the results for a sample of the 450 groups having between 433 and 500 members (at the time of the crawl). What is interesting is to look at the groups lying away from the upper-left cloud of mainstream groups with low social density and high tag dispersion. The most thematic ones, whose position is in the lower part of the chart, are listed on the left-hand side of the chart. Three-quarters of these group are in two categories: geographical, especially cities (Buenos Aires, Tel Aviv, Taipei etc.) and technical groups (K750i, XPRO, Fuji etc.), whose social densities range from very low values (Vienna, Stockholm for cities, K750i, expired films for technical) to quite high ones (Tel Aviv, Buenos Aires and toycamera, XPRO). In the case of cities, the social density may distinguish between tourism groups (where people just post photos of their travels without having much contact with others) and everydaylife groups, as suggested by the name of the group Tel Aviv Stories. Now groups with high social density are listed on the righthand side of the chart. Let us discuss on the first three easily distinguishable on the far right on the chart. The group Paralelas/Parallels is intended for photos with… parallel lines (wires, skyscrapers etc.), which could mean any kind of photos (the tag dispersion is high). But as suggested by the title in Portuguese, many members are from Brazil. This is an example of a social group whose social activity comes from a geographical proximity of its members (as was the case for Tel Aviv Stories). The group FLICKRGAYS is one of the (quite few) examples of both thematic and social groups and may have some relevance in terms of social cohesion. Finally, Fifty Faves is for photos having been marked as favorites by at least fifty users. Of course not thematic, this group is for very experienced Flickr users, who know each other and have discussions about their productions. In short, there is a wide range of these "social" groups, whose names and declared purposes don't necessarily tell they are social. --- Conclusion Besides showing the great diversity of uses of Flickr groups, these empirical results suggest that the methodological scheme presented in this paper may indeed be used in order to detect groups having a presumably strong social and/or thematic "identity". This could serve many purposes like targeting specific communities for designing of new services, studying how to make thematic groups become social etc.

We study here Flickr groups in order to see whether they are actual communities or rather essentially thematic clusters. We describe a methodological framework for the analysis of networks of group members, measuring social density and tag dispersion among groups and give some results on a sample of 450 groups having around 500 members each.

Introduction Urban segregation is the unequal distribution of different social groups in the urban space, based mainly on occupation, income and education, as well as on gender and ethnicity (European Commission -Joint Research Centre, 2019). Social segregation can lead to class conflicts and uneven distribution of resources, such as unequal access to education and healthcare (Croxford & Raffe, 2013; Ko et al., 2013). This is harmful for government management and hinder the long-term sustainability of cities (Cruz et al., 2017). Currently, many studies focus on social segregation in different cities worldwide and attempt to propose solutions for these cities. However, few articles try to examine social segregation from the perspective of housing prices and observe the its status in the urban areas. Housing prices, as an important indicator of a city's socio-economic environment, can accurately reflect the situation of socio-ecnomic factors like education, healthcare resources, and income levels (Brasington et al., 2014;Mirkatouli et al., 2018). Compared to other sociol-economic indicators mainly collected by public agencies, housing price data are more accurate, and because of their commercial value, companies in the real estate industry provide more detailed and up-to-date open-source data. This makes it easier for researchers to use housing prices to observe urban social segregation. This study analyzes social segregation in the Boston area from the perspective of housing prices. To achieve this goal, we first conducted a regression analysis of Boston's housing prices and its socio-economic attributes to ensure their correlation. Secondly, we divided Boston's housing prices into two parts, above and below the mean price, and observed the differences in their socio-economic indicators. The results show that in the Boston area, places with higher housing prices tend to have better socio-economic conditions, such as lower crime rates, higher income levels, and abundant education resources. Conversely, areas with lower housing prices tend to be more chaotic, have lower incomes, and higher crime rates. These characteristics indicate that housing price information effectively reveals significant social segregation in the Boston area. This research can help the government better understand the situation in the Boston area and assist them in formulating new policies to alleviate urban inequalities, thereby promoting better urban development. The article is organized as follows: section 2 talks about the data used in this investigation; section 3 provides the detailed illustrated the methodology used in this article; section 4 displays the result of this article; section 5 talks about the conclusion and the potential policy invention from the government; section 6 summarized the whole article. --- Data This study uses the Boston house price dataset to examine social segregation in Boston from the perspective of house prices. This dataset includes median house price data for the Boston area in 506 neighborhoods as well as a number of socio-economic indicators (such as crime rate, land use, race, education, Commercial sites, air quality etc.). This data is widely used in socio-economic related analyses such as house price analysis, urban social segregation analysis, etc (Bailey et al., 2018;Graves, 2008;Li et al., 2019). A detailed description of the data is given by Table 1 Comparing and analysing the data in the table, it is clear that the Boston area has a higher overall house price of $22,530 per square metre, and that there is a clear divide in terms of taxes, ethnicity, demographics, and so on. --- Methodology Firstly this study used multiple linear regression to assess the degree of social segregation in the Boston area by analyzing the correlation between house prices and socio-economic indicators in the Boston area. 1). Here are factors: • 𝑥𝑥 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 is per capita crime rate by town • 𝑥𝑥 ZN represents proportion of residential land zoned for lots over 25,000 sq.ft. • 𝑥𝑥 INDUS which reflects proportion of non-retail business acres per town. • 𝑥𝑥 CHAS embodies Charles River dummy variable (1 if tract bounds river; 0 otherwise) • 𝑥𝑥 NOX shows nitric oxides concentration (parts per 10 million) • 𝑥𝑥 RM is the average number of rooms per dwelling • 𝑥𝑥 RAD which reflects index of accessibility to radial highways • 𝑥𝑥 TAX shows full-value property-tax rate per $10,000 • 𝑥𝑥 PTRATIO represents pupil-teacher ratio by town • 𝑥𝑥 B compares where 𝐵𝐵 𝐾𝐾 is the proportion of blacks by town • 𝑥𝑥 LSTAT embodies the % lower status of the population Then, In order to analyze the extent of social segregation, we divided house prices into two parts based on the median of house price in Boston. Areas whose house price higher than the average value are defined as places with good economic status. Conversely, areas which has house price lower than the average value has poor economic status. We analyze these two parts through statistically description and visualize their socio-economic condition to observe the socal segregation in Boston. --- Results --- Multiple linear regression We ran a linear regression on house prices and Boston area socioeconomic indicators, and the results of the regression are shown in Table 2 In this case, the linear regression result has an R-squared of 0.74, indicating that there is a significant positive correlation between socio-economic indicators and the distribution of house prices in the Boston area. Where the weight of each factor involved in the calculation in the model is shown in Table 3 While, the p value of both owner-occupied units built prior to 1940 (i.e., 𝑥𝑥 AGE )and proportion of non-retail business acres per town(i.e., 𝑥𝑥 INDUS )are lagger than 0.05. The tested p calue do not pass the hypothesis test and therefore could not guarantee a linear relationship between the two variables and house prices in the Boston area, all the other variables passed the hypothesis test. So we remove these two variables during the following investigation. Based on the results of the analyses, it can be seen that nitric oxides concentration (𝑥𝑥 NOX ), average number of rooms per dwelling (𝑥𝑥 RM )，weighted distances to five Boston employment centres have significant impact to the house price in Boston (𝑥𝑥 DIS ) , other variables are less influential, especially the proportion of blacks by tow and full-value property-tax rate. This suggests that air quality and distance to the company have a greater impact on home prices, while race and taxes are not the primary factors that Boston-area residents consider when buying a home, which in turn embodies that the racial balance in the Boston area is relatively good, and that there is still room for improvement in air quality and distance to the job market in Boston accordingly. --- Investigating social segregation in Boston To further investigate the relationship between social segregation and house price in Boston area, we divide the house price through the average value into two parts, which is higher than average value and lower than average value. The result shows that areas with higher house price and lower house price have obvious difference in their socio-economic context, such as crime rate per capita (𝑥𝑥 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 ), property-tax rate (𝑥𝑥 𝑇𝑇𝐶𝐶𝑁𝑁 ), accessibility to highways (𝑥𝑥 𝐶𝐶𝐶𝐶𝐼𝐼 ), and so on. The detailed information are listed in Table 4. 1, many socio-economic indicators, such as per capita crime rate by town (𝑥𝑥 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 ), nitric oxides concentration (𝑥𝑥 𝑍𝑍𝑁𝑁𝑁𝑁 ), full-value property-tax rate per $10,000 (𝑥𝑥 𝑇𝑇𝐶𝐶𝑁𝑁 ), the index of accessibility to radial highways (𝑥𝑥 𝐶𝐶𝐶𝐶𝐼𝐼 ), etc. have obvious difference, assigning that neighborhoods residents with higher house price lives a much better live than citizens in lower house price areas, such as safer neighborhood, more refreshing air, more accessible to railway, and so on. Conversely, neighborhoods with lower house price, they prone to have less education resources and pay more tax than the riches, less residential lands.Such phenomenon shows that house price reflects the severe social segregration in Boston areas. --- Discussion According to the prodominant social segregation in the Boston area, the government needs to take some intervention measures to reduce this situation and achieve a more sustainable urban development. Overall, the Boston government should propose targeted policies based on the specific situation of different areas. For example, the governments can for appropriately increase the tax quota for the wealthier residents of Boston, and provide more welfare subsidies for relatively poorer households. What's more, the government can allocate more resources, such as education and healthcare resources, to the poorer areas to construct a more equal Boston. For example, try to plan more hospitals and schools in the suburbs area to let citizens with less fortunate more accessible for the urban welfare. Regarding urban management, it is crucial for the government to improve the infrastructure in poorer areas, such as road repairs and increasing public spaces. Through a series of actions like these, we believe that the social segregation situation in the Boston area can be alleviated. --- Conclusion This study analyses the relationship between housing prices and socio-economic conditions in the Boston area, and based on the observation of housing prices on socio-economic indicators in different areas, it reflects that there is a clear social segregation in the Boston area, that is to say, the rich and the poor in the Boston area live unequal lives. In response to this phenomenon, and based on the findings of our study, we encourage the government to intervene to improve the living conditions of the poor in the Boston area, including building more comfortable urban infrastructure for the poor, giving the poor more resources for education and healthcare, and increasing sustainable development in poorer areas. The methodology of this study is easily transferable to other cities and can help governments understand urban inequality and promote sustainable development.

Social segregation has a significant impact for urban development. It can lead to class conflicts and unfair distribution of resources, which in turn affect the city's long-term growth. Many studies focus on social segregation in cities and try to find solutions, but very few articles analyze it from the perspective of housing prices. This article takes housing prices as an example and divides the Boston area into high or low housing prices based on its average value. It then observes the differences in the socio-economic indicators. The results show that housing prices can effectively reveal clear social segregation in the Boston area. This research can help the government better understand the socio-economic situation in the Boston area, which can lead to a more balanced urban development.

Introduction Immunization is often cited as being one of the greatest public health achievements of 20th century, [1] but effective immunization requires population coverage levels of 90 to 95% depending upon the vaccine-preventable disease [2]. Immunization coverage refers to information on the proportion of children who have received specific vaccines or are up to date with the recommended vaccine schedule. This information is essential for planning immunization programmes, identifying vulnerable groups or areas that require targeting of increased resources, assessing the acceptability of a programme, and predicting likely vaccine-preventable disease epidemics [2]. Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12-23 months are fully vaccinated and about 5% have not received any vaccination at all [3]. In spite of 20 years of efforts and millions of dollars poured into Universal Immunisation programme (UIP), our coverage rate has still not crossed the 50% mark. Immunization coverage showed improvement since National Family Health Survey-1 (NFHS-1), when only 36% of children were fully vaccinated and 30% had not been vaccinated at all. But there was very little change in immunization coverage between NFHS-2 (42%) and NFHS-3 (44%) [3]. Coverage of BCG, DPT, and polio (except "at birth" polio dose) is much higher than all other vaccines. BCG, DPT-1, and polio-1, -2, -3 dose has been received by at least 76% of children, while only 55% of children have received all three doses of DPT. Although DPT and polio vaccinations are given at the same time as part of routine immunization programme, the coverage rates are higher for polio than for DPT (all three doses), undoubtedly because of the pulse polio campaigns. Not all children who begin the DPT and polio vaccination series go on to complete them. The difference between the percentage of children receiving the first and third doses is 2 Advances in Preventive Medicine 21% for DPT and 15% for polio. Around 59% of children aged 12-23 months have been vaccinated against measles. The relatively low percentage of children vaccinated with the third dose of DPT and measles is mainly responsible for the low percentage of fully vaccinated children [3]. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. It is therefore essential to know if under-vaccination is a problem in specific population group, which involves determining inequalities in coverage level. Thus, the present crosssectional study was undertaken to assess the immunization coverage and various socio-demographic factors affecting the same in an urban slum population of Mumbai, India. --- Aims and Objectives To assess the immunization coverage in an urban slum area of Mumbai and determine the various socio-demographic variables affecting the same. --- Materials and Methods The present community based descriptive study was conducted at Cheetah Camp The study population comprised children aged 12-23 months. Age was confirmed by birth certificate or immunization card or, when it was not available, by asking the mothers (using a standardized Indian calendar and major holidays as reference points). Complete Immunisation. Children have received BCG, measles, and three doses of DPT, hepatitis B, and OPV each (excluding OPV-0). Partial/Incomplete Immunization. Children who have received at least one of the above-mentioned vaccines. Unimmunised Children. Children have not received any vaccine. --- Sample Size and Data Collection. WHO's 30 cluster sampling method was used for evaluation of immunization coverage. [4] Thirty clusters in the community were demarcated based on its population and sector-wise distribution. In Cheetah Camp there were a total of 11 sectors with total population of 79,783 which were represented in Table 1. In So, based on above sampling interval, clusters were formed sector-wise as shown in Table 1. Seven subjects between age group of 12-23 months were selected from each of the 30 clusters. So, the final sample size was 210 children. The first household was selected randomly in each cluster and every next household was studied in a sequence, until a total of seven eligible children in the age group of 12-23 months were covered. On reaching the selected household, the mother of the eligible child (12-23 months) was interviewed. If no child belonging to the target population was found, next households were checked till an eligible child was found. Only one child per household was selected. Preformed, pretested, semistructured questionnaire was used to collect information from mothers regarding sociodemographic parameters, status of immunization of their child, and reasons for noncompliance (if applicable). To maintain privacy, information was collected maintaining utmost privacy as per the convenience of respondents. Time required to complete one interview was 5-7 minutes. The collected data was numerically coded and entered in Microsoft Excel 2007, and then transferred to the SPSS (ver. 19). Data was analyzed using appropriate statistical tests. --- Results Study findings revealed that 80.95% of the children were completely immunized while only 1.43% of children had not received any vaccination (Table 2). On assessing individual vaccines (Table 3), the coverage of birth dose of BCG was found to be the highest (97.1%) while coverage of hepatitis Advances in Preventive Medicine 3 vaccine was lower than that of OPV and DPT (all three doses). Coverage of Measles vaccine was also below 90%. The main reason for noncompliance was given as child's illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization (Table 4). On assessing various socio-demographic factors, low education status of the mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage (Table 5). --- Discussion The present study was conducted during the period of August to November 2012. Study findings showed higher immunization coverage of 80.95% as compared to NFHS-3 data (43.5%). The results were supported by report of Suresh Sharma, which showed immunization coverage of Maharashtra to be above 70% [5]. The overall coverage for different vaccines ranges from 97.14% for BCG vaccine to 87.61% for measles, which was above the 85% target set by Universal Programme of Immunisation (UIP) in India. A study conducted by Singh and Yadav on immunization status of India showed BCG and measles coverage of 86% and 67% respectively [6]. Similar results were found by Yadav et al. in an urban slum of Jamnagar where coverage of BCG was maximum (94.75%) followed by OPV (84.7%) and, DPT (81.4%) and that of measles was the least (75.7%) [7]. Although DPT and polio vaccinations are given at the same time as part of the routine immunization programme, the coverage rates are higher for Polio than DPT, probably because of the Pulse Polio Programme [8]. The most common reasons for not immunizing the child as cited by respondents were illness of the child (29.52%), unawareness of the need for immunization (8.1%), being busy with other works (5.24%) and visit to native place (3.81%). A study conducted by Kar et al. [9] showed that the major causes for incomplete immunization were illness of child (30.8%), unawareness (23.1%), and migration to native place (23.1%). Another similar study by Nath et al. [10] showed that visit to native place (14.7%), carelessness (11.7%), sickness of child (11.7%), and lack of knowledge (10.4%) were reasons for incomplete immunization. There was significant association between immunization status of the children and mother's education status, birth order, and place of delivery. A study done by Vikram et al. [11] found significant association between maternal education and child immunization status. A study in urban slums of Lucknow by Nath et al. [10] found that children born at home were found less likely to receive any vaccination. Studies done by Bobo et al. [12] and Brenner et al. [13] revealed that birth order was inversely related to vaccination coverage. --- Recommendations More focus should be given on factors which are more amenable to change like illiteracy and lack of knowledge regarding immunization. Outreach workers during their home visits should impart knowledge regarding various vaccines and importance of timely vaccination. Regular IEC activities in the form of group talks, role plays, posters, pamphlets, competitions, and so forth, should be conducted in the community to ensure that immunization will become a "felt need" of the mothers in the community. Health education to mothers should be given at every interface with health facility like ANC/PNC/immunization visits and in under-five clinics. Revitalize and strengthen routine immunization services with particular reference to urban slum areas, illiterate parents, and population groups or areas hitherto not reached. Address the issues of poor utilization of immunization services, obstacles, and lack of awareness through professionallydesigned behaviour change communication interventions. Impact evaluation of improvements ensuing such intervention measures should be meticulously done. As a long-term measure, improving the female literacy and population stabilization will go a long way in achieving universal coverage of immunization. --- Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.

The paper titled "Immunization Coverage: Role of Sociodemographic Variables" [1], published in Advances in Preventive Medicine, has been retracted upon the authors' request due to a flaw in data acquisition.

Introduction Infrastructure system in the U.S. have been shown to be linked to social and health inequities (1,2). This has been highlighted by the COVID-19 pandemic, which has caused disproportionate health and economic harm to racial minority groups and socially disadvantaged communities (3). The objective of this study was to calculate driving distance to the closest health care facility for a representative sample of the U.S. population, and identify areas where Black residents have a longer driving distance to the closest facility than White residents. --- Methods We obtained the addresses of community pharmacies from the National Council for Prescription Drug Programs, addresses of federally qualified health centers from the Health Resources and Services Administration, and of rural health centers and hospital outpatient --- FIGURE Proportion of population with a driving distance to the closest facility ≥ miles, by county. The map represents the proportion of population in each county with a driving distance > miles to the closest health care facility. departments from Centers for Medicare and Medicaid Services. The U.S. population was characterized with the 2010 U.S. Synthetic Population developed by RTI International (4). For a 1% sample of the synthetic population (n = 2,982,544), we computed driving distance to the closest facility using ArcGIS Network Analyst and a national transportation dataset (5). For each county, we calculated the proportion of the population with >5 miles distance to the closest facility, and the odds ratio of having a distance >5 miles to the closest facility for Black compared to White residents. --- Findings The mean (median) number of health care facilities per county was 22 (7). In 889 counties, over 50% of the population had a driving distance >5 miles to the closest facility (Figure 1). These counties were concentrated in the Midwest. Black residents were significantly more likely to live >5 miles to the closest facility than White residents in 56 counties (Figure 2). These counties accounted for a total population of 8.3 million and included 18 counties with more than 100,000 residents. The highest concentrations of these counties were in Mississippi (10 counties), Virginia (10), Louisiana (5), South Carolina (5), and Georgia (3). In 233 additional counties, Black residents had higher odds of living >5 miles to the closest facility than White residents, but the difference was not statistically significant. These counties accounted for a total population of 21 million. --- FIGURE Counties with disparities in access to health care facilities. The map represents counties where Black residents had higher odds of having a driving distance > miles to the closest health care administration facility, compared to White residents. Red indicates counties where these disparities were significant at the p < . level. --- Discussion Racial disparities in access to health care facilities present large geographic variation. Counties with significant racial disparities were concentrated in the Southeast and did not correspond to counties with a greater proportion of the overall population >5 miles to the closest facility, which were concentrated in the Midwest. This geographic variation demonstrates the need to adopt a spatially explicit data driven approach in the design of equitable health care facility establishment that address the specific limitations of the local infrastructure. Individuals' socioeconomic status, such as income and education attainment, has been the focus of discussion around barriers to health care access and quality of care among racial and ethnic minority groups, including Black Americans (6). These discussions have often ignored how proximity to healthcare facilities present additional barriers to accessible care. Our geographic information system analysis can guide public health officials to identify areas that necessitate additional infrastructure as well as innovative community partnerships for equitable health infrastructure access. This is of utmost importance to prevent the historical disparities in access to healthcare from further magnifying disparities during public health crisis such as COVID-19 pandemic. The strengths of the study include nationally representative samples, and the identification of geographic variation in racial disparities in spatial access to health care facilities. Nevertheless, our study is subject to limitations. Non-significant disparities are presented because our 1% sampling of the US population may have resulted in under-power to detect disparities among nonmetropolitan counties at the statistical significance level. Due to lack of ethnicity data in the U.S. synthetic population, it was not possible to estimate access for Hispanic residents. Our data demonstrates the structural inequities in access to the existing health care infrastructure across racial groups. These inequities should be addressed through the establishment of high-quality health care facilities in under-resourced communities, the expansion of public transportation, and improved community partnerships. --- Data availability statement The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author. --- Author contributions JG: conceptualization, formal analysis, investigation, methodology, visualization, and writing-original draft. IH and LB: conceptualization, investigation, methodology, funding acquisition, supervision, resources, and writing-review and editing. SD, ST, and UE: investigation, methodology, writing-review, and editing. All authors contributed to the article and approved the submitted version. --- Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. --- Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

and Hernandez I ( ) Racial disparities in access to health care infrastructure across US counties: A geographic information systems analysis.

Introduction The desire to capture photographs of ourselves and others is not new, and many applications have arisen to support this desire; with HCI researchers studying these from photobooths [6] to mobile photoware [1]. Social media has made it faster and easier than ever to share such images. In particular, "selfies" or photographs taken of oneself, have invaded popular culture. Instagram accounts are filled with them [4], U.S. courts have ruled on the ownership of a monkey selfie 1 , and the word "selfie" was added to the Oxford English dictionary in 2013, becoming their word of the year. The abundance of these photos, shared on social media platforms, has facilitated HCI research across a number of disciplines. For example, social scientists have studied cultural differences [8] as well as personality and interaction style recognition [3] through social media profile pictures. They have also shown that photos containing human faces are particularly engaging on these sites, being 38 % more likely to receive likes and 32 % more likely to receive comments on Instagram [2]. Others working in face detection and recognition have taken to mining social media sites for this rich source of data. Facebook itself, with their DeepFace system, has used this data shared on their site to achieve face recognition accuracy beating the current state of the art by more than 27 %. 2 Still other researchers have focused on tools to help users pose for better selfies [7] and interactions to trigger the photos [5]. The current popularity of the "selfie" phenomenon, vast amounts of photos of people shared on social media sites, complex issues around presentation of self, ethics and privacy, along with the breadth of applicability in HCI research warrants further discussion. The goal of this workshop is to create a forum for exchange and learning by bringing together researchers from a variety of disciplines, across industry and academia, who study images of people in the context of HCI and social media. As such, we encourage submissions from a variety of areas, including data science and image processing (such as mining or creating datasets of faces from social media sites or quantitative analysis of these), social science (such as studying benefits, challenges, and perception of such photos on social media sites), information systems (such as studying the business impact and use of selfies in an organizational context), and novel applications and interfaces (such as novel interfaces, interactions or hardware for taking pictures of people and using faces in interface design or applications). --- Organizers The workshop organizers represent both academia (Sven Laumer, Assistant Professor, University of Bamberg) and industry (Casey Dugan, IBM Research). They have a history of studying the use of social media (Facebook, Twitter) and enterprise social networks. In 2014, they deployed kiosks for taking selfies at IBM locations around the world. Their research, as well as the increasing attention being paid to "selfies" in popular culture, has inspired them to bring together researchers from across disciplines to exchange ideas. They have organized workshops at ICWSM'13, RecSys'09 & '10, served on numerous HCI/IS program committees, and co-edited journals.

Capturing and sharing images of ourselves and others has given rise to many applications and much human-computer interaction research. Social media has made it faster and easier than ever to share such photos, with "selfies", or photographs taken of oneself, invading popular culture. In this workshop, we will bring together researchers studying images of people in the context of HCI, whether thru mining such data, analyzing its use, or creating novel UIs for such.

derived three replicable profiles of aspiring. Chapters 4 and 5 showed that profile membership predicted additional variance in well-being, even in highly conservative tests that control for the aspirations that comprise the profiles. The profiles also differed in the breadth of their care for others. From Profile 1 to Profile 3, increasingly more (and more distal) others are central in the configurations of aspiring, starting with the self (Profile 1), then close others (Profile 2), and then the world in general (Profile 3). These studies make a unique contribution to the literature by synthesizing the available evidence and by identifying replicable latent profiles of aspiring that account for variance in well-being and other-oriented-ness over and above the constituent variables.

OF THE ROYAL SOCIETY OF NEW SOUTH WALES Various -PhD thesis abstracts suggests that they are not universally divergent. Indeed, consistent unexplained heterogeneity in the results indicates there are unobserved sources of heterogeneity in the data, suggesting there may be subgroups with distinct patterns of aspiring. In Chapter 2 of this thesis, a meta-analysis of more than 1,000 effect sizes showed support for the universality of goal contents theory across countries, age groups, and socioeconomic statuses. In Chapters 3, 4, and 5, bifactor structural equation modelling (B-ESEM) was combined with latent profile analysis (LPA) in three large, independent samples from Hungary, Australia, and the United States of America, and the Nigerian Civil War,

The issue begins with an overview of transforming higher education to meet changing societal needs (Chodzko-Zajko, 2023). Chodzko-Zajko points out that kinesiology leaders can play a significant role creating, innovating, and developing educational opportunities that pace with technological demand, align with the changing job market, and successfully accommodate the changing student demographic. He provides innovative examples of educational reform from the University of Illinois Urbana-Champaign related to nontraditional programs, innovative learning environments, and partnerships. These innovative programs, ideas, and partnerships foster inclusiveness and extend the educational reach to all facets of the community. The next two articles focus on the concept of belonging, an important factor in the well-being of faculty, staff, and students. Armstrong (2023) suggests creating an inclusive environment to support inclusive excellence where all feel welcomed and engaged. A sense of belonging requires an understanding of personal and positional culture, organizational cultural environments, and transformational leadership. Carter-Francique (2023) extends the discussion by emphasizing the importance of fostering a sense of belonging for students of color with a focus on extending belonging beyond the classroom. Carter-Francique emphasizes that developing an academic sense of belonging does not necessarily translate to social or community belonging. Several strategies are offered for academic units to foster social integration beyond the classroom. Further extending the discussion of creating departmental environments where faculty well-being is embraced, and professional success of all faculty is equally valued and supported, is the concept of identity taxation. Rowley et al. (2023) discuss the potential burden and negative consequences of increased and inequitable service workloads based on marginalized social identities. They share two case examples from their work at California State University, East Bay, demonstrating how intentional, collaborative efforts designed to create service-workload equity can be successful and impactful for the lives of faculty members. Equity-focused approaches to student recruitment and retention are key to fostering inclusivity in kinesiology graduate programs. Davis Brooks et al. (2023) present autoethnographic accounts from female Black scholars in leadership positions to help us understand their experience navigating graduate school at predominantly White institutions (PWIs). They provide advice and recommendations on how to strategically navigate successful partnerships between historically Black colleges and universities (HBCUs) and PWIs that are based, in part, on their personal experiences at both types of institutions. Liu et al. (2023) extend this discussion by providing a step-by-step case example of the process of establishing an HBCU/ PWI partnership. Once students are in a graduate program, they suggest mentoring and alumni connection programs, which have been demonstrated as key factors for student success and retention. The next two articles focus specifically on infusing DEI into a graduate program and incorporating it into a curriculum. Kochanek (2023) presents a nice, comprehensive example of infusing DEI into an athletic training master's program, including creating a mission statement, conducting a needs assessment, developing a curriculum, and carrying out an outcomes assessment. Culp (2023) further reflects on reenvisioning the curriculum to make it inclusive. He proposes and discusses five conceptual areas (public pedagogy, interrelationship, dehumanization, spatiality, and technology) and strategies to incorporate inclusive behaviors within each area. Culp also offers examples of inclusive strategies designed to facilitate curriculum implementation. These two articles are valuable to leaders who are working on implementing DEI into their programs and curricula. The articles in this special feature provide valuable information about social justice and equity for kinesiology leaders. The AKA will again demonstrate its commitment to this topic at its upcoming meeting on January 25-27, 2024, in Albuquerque, NM. The "Social Justice and Equity Imperatives" theme will focus on providing participants with "real world" models and exemplars of excellence. Following the 2023 workshop that introduced social justice, equity concepts, and general strategies for establishing a climate of inclusive excellence in departments of kinesiology, the 2024 workshop will engage participants in conversations that focus on administrative and curricular action steps that address social justice and equity imperatives. Sessions will provide examples of programmatic excellence and address policy and professional development opportunities that impact both faculty and student success. Participants will have ample time to network, share ideas during structured activities, and engage in cultural/heritage events.

The American Kinesiology Association's (AKA) annual workshop was conceptualized to bring together leaders in the field of kinesiology to address topics that are timely, meaningful, challenging, and impactful. The development of topics, ideas, or workshop themes arises through extensive in-depth discussions, analysis of the shifting academic landscape, and reflection and consideration of AKA's prior and future programming. The development of the theme for the 2023 workshop on social justice and equity evolved over several years, gaining focused momentum with a statement released on Juneteenth of 2020: "AKA : : : resolves to undermine racism, value Black lives and perspectives, and equip kinesiology leaders to promote social justice, equity, and inclusive excellence" (AKA, 2020). Since that time, AKA's commitment to diversity, equity, and inclusion (DEI) is evidenced by special sessions on DEI at the annual workshop, DEI topic-related trainings as part of the Leadership Institute, and DEI-focused webinars as part of regular programming. AKA's commitment and passion to social justice and equity and the rising attention and awareness of the social justice crisis in academia led to the theme of the 2023 annual workshop held in

Background: Rising global obesity rates coincide with increasing weight stigmatization, affecting various life aspects, including healthcare. Discrimination impacts patient well-being and care quality, leading to suboptimal treatment. This research compares weight stigma among healthcare professionals in Romania, UK, and Greece, addressing personal and secondhand weight bias. --- Methods: The study used cross-sectional data from the Breaking Weight Bias survey, including 125 healthcare professionals from Romania, Greece, and the UK. Data collection occurred between June and August 2021 via an online survey. Measures included the Universal Measure of Bias-FAT (UMF-FAT) questionnaire, personal experience with weight bias, and experiences of weight bias in medical settings. --- Results: More women participated in the study across all countries. The mean age was 37.12 years (SD = 10.92). Bachelor's degrees were most common (43.4%), with Greece having the highest percentage of Master's (41.7%). Romania had the highest Doctoral degrees (32.4%). Private healthcare settings were the most common (51.3%). UMB-FAT results showed varying bias between countries. Romania had the highest rates (M = 3.08, SD = 0.768). Statements indicating more bias included poor hygiene (M = 2.40, SD = 1.832) and lacking consideration for others (M = 1.74, SD = 1.459). Over half of the participants (53.3%) experienced personal weight-related teasing. Greece had the highest rate (62.9%). Regarding second-hand weight bias experiences in medical settings, a high level of agreement (30-50%) was observed. --- Conclusions: This study confirms weight bias in healthcare professionals across multiple countries, revealing moderate bias levels. Despite limitations, the findings contribute to understanding weight bias across different regions and fields. There is a need for weight-bias education among healthcare professionals, as it can harm patient-provider relationships and care quality.

Research confirms moderate weight bias in healthcare professionals across Romania, UK, and Greece. Study highlights the need for weight-bias education in medical training to improve patient-provider relationships.

Introduction The percentage of older adult populations is increasing globally. According to the World Population Aging 2019, there were 703million persons aged 65 years or over within the global population, and this number is expected to double to 1.5billion by 2050 [1]. Previous gerontological studies have revealed that living in a place where one is familiar in their geriatric years is essential for healthy aging. For example, being able to continue living in a place where social interactions have been developed was found to be related to an optimistic mental outlook [2]. In order for one to continue their independent living, maintaining their functional capacity [3] is fundamental. Functional capacity is a general term that refers to various physical and mental functions necessary for older people to lead their daily lives [4]. However, little is known about the factors that can lower the level of functional capacity, and further understanding is, therefore, required to support independent living. Meanwhile, the state of one's social network is associated with multiple health outcomes (e.g., [5]) and functional capacity could also be affected by their social network condition. For example, the report by Fiori et al., suggests that an absence of family in the context of friends is less detrimental than the absence of friends in the context of family, with regards to depression [6]. Furthermore, Park et al., report that physical and mental health risks among older adults in South Korea are associated with their social network typology, or more specifically, that having a friend leads to a better state of self-rated health and a lower probability of depression [7]. As introduced above, previous studies have focused on common geriatric symptoms. Although such findings can be applied to the context of care for older adults, the association of an individual's social network and functional capacity should be explored to determine risk of a discontinuation of healthy aging before contracting serious symptoms. Therefore, in this study, we aimed to explore the association of the social network and functional capacity of older adults. Social network was studied in detail in two ways: family and friend networks. --- Materials and methods --- Study design A community-based cohort study was conducted in Kashiwa City, Japan (hereafter, the Kashiwa study). The Kashiwa study first recruited 2,044 community-dwelling older adults using random selection from the basic resident register of Kashiwa City in 2012. Data from the year 2016 were used as the baseline data, and that from the year 2018 as data for the 2-year follow up. Cognitive functions were used as the exclusion criteria. Those who scored below 24 in the Mini-Mental State Examination were removed from the analysis. The number of participants was 1,329 in 2016, which is the baseline of this analysis, and 875 in 2018 during the two-year follow up. Some reasons for dropout were overlaps with other plans, contraction of medical symptoms that prevent attendance, confinement to the hospital, or death. After removing those with bad cognitive function, the final number of traceable participants was 638. The Japan Science and Technology Agency Index of Competence (JST-IC) was used to assess the functional capacity in older adults [4]. A score of 12 or more was defined as the individuals having high functional capacity, and those with a score of less than 12 were assumed as having low functional capacity. To define the network typology, the independent variable (type of personal network) was classified into four groups using the Lubben Social Network Scale (LSNS-6) [8], which assesses social networks from the perspectives of family and friends. The median score of the family and friends networks were 11 each. Therefore, those with score of 11 or more were defined as having high friend or family networks, and those with score of less than 11 were defined as having low friend or family network. Finally, four groups were created: (1) having both a high family and friend network; (2) having a high family network but low friend network; (3) having a low family network but high friend network; (4) having both a low family and friend network. --- Statistical analysis Binomial logistic regression analysis was conducted to evaluate the association between individuals' social network and their functional capacity; JST-IC was used as the dependent variable. The group with a high network of both family and friends was used as the reference group. Age, sex, cohabitation, mental state, comorbidity, and JST-IC at the baseline were adjusted as covariates. After conducting analysis using the whole data, the same analysis was conducted after stratifying participants by their age. Based on the age range of medical care system of older adults in Japan, the participants were classified into 65-75 years of age, and 75 years and older. --- Results Participant characteristics are shown in Table1. The mean age was 75.7 ± 4.8 years old, and 53.3% of them were male. Those living with others made up 85.9% of the study sample and 73.5% were free of hypertension, diabetes, or stroke. A high percentage of participants (87.6%) had a good psychological wellbeing. Regarding the social network typology, 41.0% of the sample had both a high family network and friend network, 17.4% had a high family network and low friend network, 15.9% had a low family network and high friend network, and 25.7% had both a low family network and friend network. High functional capacity was observed in 56.4% of the participants at the baseline. The binomial logistic regression analysis (Table2) showed that, compared to the reference group, the group with low family and friend network (OR: 0.58, 95% CI: 0.34-1.00), and that with high family but low friend network were associated with lower functional capacity (OR: 0.47, 95% CI: 0.26-0.85) two years later. Furthermore, the group over the age of 75 had a lower score of functional capacity when considering those with both a low family and friend network (OR: 0.40, 95% CI: 0.19-0.86) and a high family but low friend network (OR: 0.38, 95%CI: 0.17-0.87). This trend was not observed in the group under the age of 75. --- Discussion The findings showed that those with low friend networks were likely to have a lower functional capacity two years later. When stratified by age, participants younger than 75 maintained their functional capacity, despite the level of friend network. The overall results showed that when compared to having a low family network, a low friend network more significantly affected the functional capacity of older adults. Fiori et al. reported that older adults with a friend network participated in a higher number of social activities as compared to those with only a family network [6]. Active social participation correlates with better health and well-being [9,10]. For example, the frequency of social outing behavior is associated with a better functional state [10], and a similar trend could, therefore, be observed with the functional capacity. On the contrary, similar to results from another study [11], having only a high family support network could indicate a lower functional capacity, in that older adults might be under hospitable care from family members and rely on them. Furthermore, the decrease in functional capacity was not observed in those with a low friend network under the age of 75. The percentage of younger older adults participating in social activities is higher compared to those above 75 [12]. This suggests that younger older adults might still have access to resources such as places and opportunities to interact with others, and the effect of the level of friendship network on functional capacity could be reduced, as compared to those over 75. The results from this study suggested the importance of arranging a place where older adults, especially those over 75, can attend and socialize with non-family members. For example, it has been noted that a community place within walking distance from the older adults' residence contributed to maintaining a social network [13]. Approximately 73% of the participants were over the age of 75 and accessibility of a social place could have contributed to maintenance of their social network. Neighborhood interventions considering the functional ability of older adults could result in the maintenance of friend networks. --- Conclusion The results from this study implied that maintaining a friend network is essential for better functional capacity in older adults, especially in those above the age of 75. Future community interventions could focus on preparing a place for friendly interactions that is easily accessible by older adults above the age of 75. --- Limitations The present study has some limitations. First, data from a cohort study were used for the analysis, and the dropout rate of participants over time should be considered. We analyzed the data of older adults who attended the third and fourth waves of the cohort study; however, we were unable to trace older adults who dropped out, which may have resulted in biased results. Follow-ups of older adults who dropped out are necessary to further examine the effect of lower friend networks. Second, this study was conducted in an urban area of Japan. Additional studies are required to further discuss the effect of family and friend networks on health-related outcomes of older adults residing in rural areas, since environmental factors such as availability of transportation resources could be limited. --- Data availability The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. --- Abbreviations --- JST-IC The Japan Science and Technology Agency Index of Competence. --- LSNS-6 Lubben Social Network Scale. OR odds ratio. CI Confidence Interval. --- Author contributions MT and KT analyzed the data. MT, KT, RO, RN, SS, JG discussed and interpreted the results. MT and KT was the main writer of the manuscript and RO, RN, SS, TT, JG, KI assisted with the writing procedure. All authors read and approved the final version of the manuscript. --- Declarations Ethical approval and consent to participate The approval of this study design was provided by the ethics committee of the University of Tokyo (approval numbers: 12 -8 and 18-166). Written informed consent was obtained from the participants. --- Consent for publication Not applicable. --- Competing interests There are no competing interests to declare. --- Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective Maintaining a level of functional capacity is essential for healthy aging. In this research, the association between the change in the level of functional capacity and social network typology was explored over a two-year period. Participants were recruited from a community-based cohort study within Kashiwa City, Japan, and data from the years 2016 and 2018 were used. Cognitive functions, functional capacity, and social network typology were assessed using the Mini-Mental State Examination, the Japan Science and Technology Agency Index of Competence, and the Lubben Social Network Scale, respectively. Binomial logistic regression analysis was then conducted to evaluate the association of individuals' personal network and their functional capacity.Results showed that, when compared to the group with both a high family and friend network, the group of community-dwelling older adults with both a low family and friend network (OR: 0.58, 95% CI: 0.34-1.00), and the group with a high family but low friend network demonstrated a lower functional capacity (OR:0.47, 95% CI: 0.26-0.85). Active social participation, facilitated by a friend network, could be a contributing factor to the maintenance of functional capacity.

Researchers and policymakers have used the CSHCN-S to investigate health disparities and advocate for allocation of state and other resources [3]. However, parent-reported prevalence of children with special healthcare needs (CSHCN) is markedly lower among Latino children from Spanish-language households and among children in immigrant families relative to children with US-born parents [2,[4][5][6][7]. It is possible that chronic conditions are less prevalent among children in immigrant families, or chronically-ill children in these populations may have fewer functional impairments. Alternatively, the CSHCN-S may perform differently among immigrant populations. For example, immigrant parents who speak Spanish have reported reluctance to answer CSHCN-S questions via telephone, and refugee parents may have a higher threshold for concern about early childhood development [6,8]. Using the 2011-2012 NSCH, we investigate the likelihood of children in immigrant and non-immigrant families screening positive with the CSHCN-S, with specific attention to children with an equivalent number of currently-diagnosed chronic conditions. By making comparisons between children with an equivalent number of currently-diagnosed chronic conditions-who likely have similar health service needs-we explore whether the CSHCN-S may under-count children from immigrant households. --- METHODS The 2011-2012 NSCH is a nationally representative telephone survey conducted by the National Center for Health Statistics in collaboration with and supported by the MCHB. Administrative procedures and data collection methods are detailed elsewhere [9]. Parents/ guardians reported demographic and health information for one randomly-selected child per household. --- Key Variables We used the NSCH data file provided by the Data Resource Center for Children and Adolescent Health (DRC). This file includes indicator variables developed by the Child and Adolescent Health Measurements Initiative and State and Local Area Integrated Telephone Survey (SLAITS) team [10]. The primary outcome was whether a child screened positive on the CSHCN-S (Appendix Table A). Each child's household generational status was categorized using the NSCH-defined summary variable: First generation (child and parents born outside the US), second generation (child born in the US and at least one parent born outside the US; or child born outside the US and one parent born in the US), or third generation (both parents born in the US) [9]. A DRC summary variable was used to determine whether each child had 0, 1, or 2+ currently-diagnosed chronic conditions from a list of 18 possible conditions (Appendix Table D). --- Analysis All analyses were conducted in STATA 15.0 [11] using svy estimation to account for weights and survey variances. Models were representative of non-institutionalized children aged 0-17 in the US [9]. Children with missing generational status were excluded (5.5%). We used Pearson chi-squared tests to compare the likelihood of screening positive with the CSHCN-S for children from first, second, and third generation households with equivalent numbers of currently-diagnosed chronic conditions. We then used logistic regression to examine the relationship between CSHCN status, generational status, and number of chronic conditions, adjusting for characteristics previously shown to be associated with likelihood of screening positive for CSHCN that were also significant in our bivariate analysis: child age, sex, race/ethnicity and insurance status, and household language and educational attainment [4][5][6]. Household income was examined but not included, as it was found to be non-significant in bivariate analysis. Additionally, we used bivariate and multivariate analyses to examine the relationship between generational status and each of the five CSHCN-S criteria [5]; children with missing data were excluded from these models (1.1%). The analysis used a de-identified dataset; IRB review was not sought per institutional policy. --- RESULTS Our analysis included 90,417 children, comprising 94.5% of the total sample. The sociodemographic characteristics of the population were concordant with prior research [7] (Table I). Approximately 17% were children in first and second generation households, aka "children in immigrant families." Regardless of the number of currently-diagnosed chronic conditions, children in third generation households were most likely to screen positive on the CSHCN-S (Table II). For example, among children with no reported chronic conditions, 6.3% of children in third generation households (95% CI 5.9-6.7), 4.2% of children in second generation households (95% CI 3.5-5.0), and 2.6% of children in first generation households (95% CI 1.3-4.8) screened positive. Among children with 2+ reported chronic conditions, the CSHCN-S was positive for 85.7% (95% CI 84.0-87.3) of third, 76.8% (95% CI 69.3-83.0) of second, and 75.0% (95% CI 49.8-90.1) of first generation household children (Table II). After adjusting for sociodemographic status, the effect of generational status was most marked when comparing children in first and third generation households (Table III). As generational status was also significantly associated with number of currently-diagnosed chronic conditions (F(8,90302) = 656.51, p <0.001), we considered a possible interaction effect, but none was detected (data not shown). Number of currently-diagnosed chronic conditions, child age, insurance status, household language, and household educational status were also associated with CSHCN-S results in the adjusted model (Appendix Table B). Examining each the five CSHCN-S criteria individually revealed that adjusting for the number of currently-diagnosed chronic conditions and sociodemographic characteristics attenuated the differences between children in first, second, and third generation households for all but one criterion: use of or perceived need for a prescription medication (Appendix Table C). --- DISCUSSION We investigated the concordance between CSHCN-S results and relative chronic disease burden among children in first, second, and third generation households using the 2011-2012 NSCH. As previously reported, we found significantly fewer children in first and second generation households screened positive relative to children in third generation households [7]. Lower reported levels of currently-diagnosed chronic conditions among the children of immigrants paralleled this finding. However, when we examined the probability of screening positive with the CSHCN-S among children with the same number of currentlydiagnosed chronic conditions, the association between generational status and CSHCN-S results remained significant. These findings may be largely attributable to differences in responses to the CSHCN-S's prescription medication criterion, the most common qualifying criterion in this and other samples [2]. Our analysis suggests the CSHCN-S may perform differently for children in immigrant families. Read et al observed that immigrant parents interviewed in Spanish expressed reluctance to disclose the kind of health information solicited via the CSHCN-S to anonymous telephone interviewers [6]. Kroening et al found that parents in some refugee populations may be less likely to perceive young children as delayed or impaired relative to their peers [8]. Hence, parental reticence and differences in the perception of impairment/ need for children in immigrant families may contribute to our findings. Alternatively, our findings may reflect actual differences in the healthcare needs of chronically-ill children in immigrant and non-immigrant households. Chronically-ill children in non-immigrant households may have more severe chronic conditions with a greater need for services. However, this is unlikely to fully explain our results given that functional limitations were not reported more frequently among non-immigrant children (Appendix Table C), and this criterion is often endorsed by parents of children with more severe disabilities (e.g., those enrolled in SSI) [1]. Differences in the relative distribution of specific chronic conditions, e.g. ADD/ADHD and vision problems, among children from immigrant and non-immigrant families may also influence screener outcomes (Appendix Tables D,E). This study has important limitations. Categorization of children as having 0, 1, or 2+ chronic conditions was based upon a list of 18 conditions. Children with conditions not on this list may be mis-categorized. However, the inventory includes the most commonly-diagnosed chronic childhood conditions (e.g., asthma and ADHD) and uses broad terms (e.g., "intellectual disability") pertinent to multiple diseases. Additionally, as subgroup analysis was not possible for specific languages, ethnicities, or immigrant subgroups (e.g., refugees), we were unable to describe CSHCN-S results for these subpopulations. Prospective research is needed to confirm or refute our findings. Overall, our research suggests the CSHCN-S may undercount the prevalence of special healthcare needs among children in immigrant families. This has implications for resource allocation for programs at the local, state and national level that rely upon CSHCN prevalence estimates to determine whether efforts to ensure the quality and accessibility of care for CSHCN should target children in immigrant families [3]. --- Supplementary Material Refer to Web version on PubMed Central for supplementary material. --- Author Manuscript Author Manuscript Warden et al. --- Author Manuscript Warden et al. Page 7

The Children with Special Health Care Needs Screener © (CSHCN-S) is among the most widely used tools for assessing the prevalence of children with greater than typical need for healthcare due to chronic illness. Designed to operationalize the Maternal and Child Health Bureau's (MCHB) definition of children with special healthcare needs (Appendix Table A), children screen positive if they meet at least one of five criteria pertaining to any medical, behavioral, or other health condition lasting or expected to last ≥1 year: (1) needing or using a prescription medication; (2) needing or using more health or educational services than is usual for children of the same age; (3) being limited in their ability to do things most children of the same age can do; (4) needing or receiving special therapy (e.g., physical therapy); or (5) needing or receiving treatment or counseling for a chronic emotional, developmental, or behavioral problem [1]. Although the screener is not designed to identify all children with chronic conditions, 94.6% of children enrolled in Supplemental Security Income (SSI) and 65.8% of children with reported diagnoses of at least one of 18 chronic conditions screen positive with the English-language CSHCN-S[1, 2].

I. INTRODUCTION Bangladesh is a highly populated developing country with a population of more than 160 million people, and its economy is heavily reliant on agriculture and allied industries. Poultry, a sub-sector of livestock, is an important aspect of Bangladesh's agricultural farming system for ensuring sustained protein intake for the population. Although raising poultry birds is primarily a subsistence industry in Bangladesh, it is critical to the national economy in terms of creating job opportunities and boosting people's nutritional levels (Ali et al., 2015;Chowdhury & Chowdhury, 2015). Over 8.5 million people in Bangladesh are directly or indirectly working in this industry, which is regarded as the second significant source of employment (Hossain, 2020). Poultry accounts for 37 % of the country's total meat production and 22-27% of the animal protein supply and forms a substantial fraction of the livestock sector's 1.4% contribution to the country's GDP (DLS, 2020). In most developing countries, livestock raising plays valuable roles in human food and nutrition security, livelihood improvement, gender mainstreaming, and poverty alleviation (World Commission on the Social Dimension of Globalization, 2004). Livestock production, particularly poultry farming, contributes greatly to people's well-being at the household and national levels (Dhakal, 2019). According to an FAO survey done in 2002, almost 70% of the world's rural poor people rely on livestock as a source of income or a source of subsistence. Backyard poultry farming is an essential aspect of rural poultry production in developing nations (Sarwar et al., 2015). Women are generally involved in this sort of poultry farming. However, most of them are subsistence in character and indigenous breeds. Rural women in Bangladesh are still disadvantaged and have limited access to income-generating activities owing to sociocultural constraints. Nonetheless, they support their families by raising local poultry varieties such as chicken, duck, and pigeon. Women in Bangladesh contribute not just to their households by assuring sustainable meat consumption but also to the national level in a larger sense by securing national demand for animal protein. However, their impact was disregarded in scholarly research. Few studies have been undertaken to enclose their contribution to their families' livelihood. Islam et al. (2010) showed that greater female engagement in broiler farming might result in considerable development and significantly improved output performance. In times of financial hardship, disadvantaged women can turn to commercial broiler farming, according to Chowdhury and Chowdhury (2015). Chakma and Ruba (2021) assert that women's involvement in agricultural pursuits improves socioeconomic conditions by enhancing food security status, family well-being, and employment opportunities. A critical analysis of women's entrepreneurship in Bangladesh through poultry farming by Begum et al. (2019) reveals that women face a number of technical, social, financial, and marketing barriers in the industry. These issues must be resolved right away. Previous research has shown that various studies have been undertaken in terms of women's participation in poultry farming in Bangladesh, but little emphasis has been placed on indigenous poultry farming to enhance the livelihood of rural women in Bangladesh. As a result, the purpose of this research is to analyze the impact of indigenous poultry farming on the livelihoods of rural women in Bangladesh. This study will assist policymakers and academics in gaining an understanding of women's contributions to their families through indigenous poultry farming at the household level. The next part will go over the study's methodologies and materials, findings, conclusions, and recommendations. --- II. MATERIALS AND METHODS --- A. Study Area The area in which the survey will be performed is determined by the specific goal of the survey and the respondents' potential cooperation. Due to the availability of women farmers, the current study was undertaken in two places in Bangladesh: Sylhet and Mymensingh. In north-eastern Bangladesh, Sylhet boasts a subtropical climate and lush highland scenery. The area has a population of about 5 million people and is one of Bangladesh's major cities after Dhaka, Chittagong, and Khulna. The area is geologically complicated, with various sacrificial geomorphology and high topography of the Plio-Miocene age. Mymensingh covers 4363.48 square kilometers and is situated between 24°15' and 25°12' north latitudes and 90°04' and 90°49' east longitudes. It is bordered on the north by the Garo Hills and the Indian state of Meghalaya, on the south by the Gazipur district, on the east by the Netrokona and Kishoreganj districts, and on the west by the Sherpur, Jamalpur, and Tangail districts. --- B. Sampling and Data Collection Procedure A full enumeration necessitates data collection from every segment of the population, making the survey both expensive and time-intensive. The current research was based on a household sample survey that may plausibly reflect the total population. Due to a lack of time and funds, a total of 60 respondents (30 from each district) were interviewed employing convenient sampling techniques. A closed-ended questionnaire was developed prior to gathering sample data. Following the pilot survey, required question modifications were made, and data was collected from March to April 2022. --- C. Analytical Techniques Descriptive statistics are concise descriptive coefficients that describe a particular data set, which might represent the complete population or a sample of a population. The data was analysed using descriptive statistics. This study investigated the influence of poultry farming on the livelihoods of women farmers. Because of the simplicity, descriptive statistics, such as mean median, were generated for several livelihood factors. --- III. RESULTS AND DISCUSSION --- A. Sociodemographic Status of the Respondents In this study, respondents' ages were categorized into three groups, as shown in Table I. According to the data, respondents aged 31 to 45 years old made up 55% of the total, while the young made up 30%. Only 15% of those polled were beyond the age of 65. As a result, the group of middle-aged people was the most populous. Education is important for all types of inhabitants in a country. The process of assisting learning, or the acquisition of information, skills, values, morals, beliefs, habits, and personal growth, is known as education. It has a significant impact on all types of inhabitants in a country. To analyze the respondents' educational levels, they were separated into five groups. According to Table I, 15% of respondents had finished secondary school. Respondents from various categories, such as those who can only sign, those who have finished elementary school, and those who have finished secondary education, made up 16.67, 31.67, and 8.33% of the total, respectively. A family or home was described as a group of people who lived together, ate from the same kitchen, and were ruled by one person. As shown in Table I, 36.67% of respondents had a small family (up to 4 members). Other groupings, such as medium and big families, accounted for 35 and 28.33% of respondents, respectively. The data on respondents' land ownership indicated that most respondents (60%) held small property (0.1-2.49 acres), followed by medium land (2.50-7.49 acres) in the research region. --- IV. IMPACT OF INDIGENOUS POULTRY FARMING Table II shows that about half of respondents said their health status had improved, one-third said it had not changed, and 11.67% said it had decreased. The results also revealed that 66.67% of total respondents responded to better education and 46.67% responded to decision-making participation with poultry farming, respectively. At the same time, 20 and 48.33% of respondents said that their education and decision-making skills had not changed, respectively. Table II makes it obvious that just one-fourth of respondents said their leased or mortgaged land had risen, while 60% said it had remained steady, and only 15% said it had declined. It shows that 61.67% of all respondents indicated their monthly income had grown over the survey period, compared to roughly 21.67% who said it had remained the same and 16.67% who said it had declined. It is clear from the analysis that about 58.33 and 25% of respondents reported a rise in their cash on hand and bank deposit, while 33.33 and 51.67% said their position was steady, and just 8.33 and 23.33% of respondents, respectively, stated their position had declined. 48.33% of respondents were in favour of growing their savings, compared to 28.33% who said it remained the same and 23.33% who said it had decreased. It also indicates that approximately 70% of all respondents believed the value of their poultry bird assets had grown, while just 20% said it had remained steady, and 10% believed it had decreased. Table II also revealed that just 5% of respondents stated their assets had fallen, while roughly 58.33% of respondents www.ej-develop.org DOI: http://dx.doi.org/10. 24018/ejdevelop.2023.3.5.303 Vol 3 | Issue 5 | September 2023 51 said their situation had remained similar, and 36.67% of respondents said their livestock holdings had increased. The data in Table II also reveals that around 53.33% of respondents claimed their sanitation status had improved, while 40% said it had remained the same, and 6.67% said it had become worse. Table II also showed that over 75% of respondents said their television viewing had increased, while 21.67% said their perceptions had not changed, and 3.33% said their viewing had decreased. V. CONCLUSION Bangladesh is a developing country and heavily reliant on agriculture as a means of livelihood. Eggs and poultry meat are good sources of protein in terms of nutrition in Bangladesh for the rural community. For rural women seeking to generate cash, keeping family poultry might be a good opportunity, and almost every household in rural areas is engaged in indigenous poultry farming. Family poultry farming can assist in achieving socioeconomic development in the rural economy since many rural women don't have access to income-generating activities due to social and cultural barriers. Because poor rural women have considerable time to raise home poultry, there is sufficient space for the expansion of family poultry farming in Bangladesh. It would be beneficial for generating cash, empowering women, and enhancing the farm family's nutrition. The results showed that indigenous poultry farming contributes significantly to their livelihood in different ways, like ensuring regular cash flow, increasing savings, contributing to education, and improving sanitation. Overall, it improved food patterns, strengthened female empowerment among poultry farmers, and enhanced family health. In light of the study's findings, it is possible to draw the following conclusions: 1) The standard of living for the respondents has significantly improved since they started the poultry farm. 2) Women might contribute significantly to the socioeconomic development of the family and the country. The socioeconomic advancement of the family can be significantly aided by the right environment and facilities being offered. 3) The accessibility of poultry farming is a crucial element in involving rural women in endeavours that generate income and advance development.

The goal of the current study was to determine how indigenous poultry farming in Sylhet and Mymensingh districts affected rural women's means of subsistence. Data were gathered at convenient sampling techniques from sixty respondents who were active in poultry farming with these viewpoints in mind. The necessary data was gathered using the survey method and a well-designed questionnaire. Descriptive statistics and a sustainable livelihood framework were employed for the data analysis and assessment of the effects of chicken farming. Results revealed that after starting the chicken farm, the respondents' assets significantly increased in support of an enhanced standard of living. The results showed that raising poultry had a favorable effect on the respondents' ability to support themselves. Indicators of women's social empowerment, such as their attitudes toward their children's education, their mobility outside the home, and their capacity for involvement and decision-making, were also found to be significantly positively impacted. Finally, the current study recommends performing additional research of a comparable nature in other regions of the nation in order to make the findings representative.

섹스 로봇의 실태 --- 파악하여 인간의 존엄성, 자율성, 상호존중을 침 해하지 않도록 주의를 기울여야 할 것이다. --- Conflict of Interest No potential conflict of interest relevant to this article was reported.

This article examines and evaluates the views of David Levy, Kathleen Richardson, and John Danaher on the ethical and legal issues involved in human-robot sex. While Levy welcomes the introduction of sex robots and extols the benefits of this technology, the other two writers are much more critical of sexual relationships with robots. Richardson campaigns against sex robots, warning that they will lead to the further objectification of women and commodification of sex; and Danaher, who considers a complete ban on sex robots unrealistic, argues that it is necessary to regulate and even criminalize particular sex robots, such as those embodying child sex abuse or rape fantasies. In a pluralistic society, individual freedom or autonomy should be respected as long as doing so does not cause harm to others or threaten public safety or social order. Therefore, this article defends a view similar to Danaher's on policies concerning human-robot sex: it is argued that while sex robots should be permitted for individual use, the industry should be strongly regulated, and sex robots associated with rape fantasies or child sex abuse should be prohibited.

volumes of smoke. [6,7] Studies investigating the acute and long-term effects of hookah pipe smoking show that it is a risk factor for lung cancer, periodontal diseases, cardiovascular disease and adverse pregnancy outcomes. [8] It also poses the risks of transmission of acute and chronic infections, such as tuberculosis and hepatitis, with sharing of the hookah pipe mouthpiece. [6,8] Thus, while hookah pipes are commonly perceived to be safer than cigarettes, [3] they may be even be more harmful. Hookah pipe smoking is a highly social practice occurring on campus, in the family home, at parties, at a friend's place, or in restaurants. [9] The influence of peers is a major factor in determining the initiation of using hookah. [2] The South African Tobacco Control policy prohibits tobacco smoking in public spaces, but policies specifically prohibiting hookah pipe smoking in public spaces have not yet been implemented. [9] Research shows that knowledge about the hazards of hookah pipe smoking tend to be limited in adolescents. [2,9,10] Easy social and retail access to both the hookah and its tobacco, combined with a lack of alternative activities, [11] contribute to the popularity of hookah. In South Africa (SA), the use of hookah pipes among students is highly prevalent. [9,11,12] This has been noted with concern by the Cancer Association of South Africa (CANSA), resulting in them approaching the School of Public Health and Family Medicine at the University of Cape Town (UCT) to conduct a study exploring the knowledge, attitudes and practices regarding hookah pipe smoking. The extent of this practice among health sciences students who will become future health professionals is unknown and they could impact on the practice of individuals and communities. --- Objective To explore the knowledge, attitudes and practices with regards to hookah pipe smoking among students at the Faculty of Health Sciences, UCT. --- Methods A cross-sectional study was conducted in March 2013 among the 3 582 undergraduate and postgraduate students registered in 2013. The minimum sample size was calculated to be 256 based on a 40% smoking prevalence estimate for the Western Cape [9] and a precision of 6%. A self-administered questionnaire was adapted from a previous hookah pipe study conducted in the Western Cape. Data were collected via two methods: distribution of hard-copy questionnaires on campus, and an online survey. Hard copies were more likely to be completed by undergraduates who make the most use of campus areas, while the online questionnaire served to reach senior undergraduate students and postgraduates. Informed consent was obtained prior to participation in the study. The study was approved by the UCT Human Research Ethics Committee. --- Results --- Sample A total of 228 students completed the questionnaire; 111 in hard copy and 117 online. The majority of participants were female (64%). The mean age of participants was 21.4 years (standard deviation ±4.38). Over half were undergraduate medical students (54%); 29% health and rehabilitation sciences and 9% postgraduate health sciences students. A further 8% were taking subjects in the faculty towards degrees registered in other faculties. --- Hookah pipe practices Two-thirds of respondents had smoked a hookah pipe before, even if only once or twice, while 18% are currently smoking. Of the current smokers (n=41), the majority smoked occasionally socially (65%). The most common place for smoking hookah was at friends' houses (41%), at home (30%), or in clubs and cafés (21%). A small number smoked on campus (8%). Most participants smoked with friends (59%), while some smoked with family (20%). Most participants (61%) smoked between 30 -60 min/session. Almost a third of participants (29%) supplemented hookah products with other substances, most often cannabis (86%), with a small number adding alcohol. Methamphetamine ('tik') and other drugs were not added. A minority of those who currently smoke hookah pipe smoked cigarettes too (11%), most daily (60%). A minority of students (27%) reported adverse health effects (e.g. cough, shortness of breath, loss of taste and headaches) that they attributed to hookah pipe smoking. Most current smokers did not wish to quit (84%). Most participants began smoking in high school (67%), while a quarter (26%) began in university. The majority of participants began smoking hookah pipes because they 'just decided to' (67%), while a smaller number were recommended to do so by someone else (19%). For most smokers (55%), parents or partners knew that they were hookah pipe smokers and most (76%) were accepting of the practice. --- Knowledge and attitudes Only 31% of participants had prior infor mation regarding the dangers of hookah pipe smoking, with 60% obtaining knowledge from printed and audiovisual media. Knowledge of the health effects of hookah pipe smoking, drawn from answers to six questions that referred to these health effects, was categorised as good (29% of respondents), average (55%) and poor (16%). Almost all participants (91%) knew that smoking hookah pipes was harmful. Responses to an open-ended question about why they thought hookah pipe smoking was harmful or not are shown in Fig. 1. The majority had a permissive attitude towards hookah pipe smoking, with 80% believed it to be socially acceptable, and 84% were willing to recommend it to others. Contrary to this, the majority of individuals (74%) believed the practice should be subject to legal regulation. --- Discussion While it was encouraging that most of the sampled students were not currently hookah pipe smokers, the majority had tried it at least once, suggesting an ease of accessibility and acceptability of the practice. Of those smoking, a third smoked on a regular basis, in contrast to other SA research indicating that the majority of hookah pipe smokers smoke daily. [9] The social element of hookah smoking is significant, and peer pressure is a major factor in initiating usage, [2] and the majority of participants started smoking in high school and university, with peers. It is concerning that hookah pipe smoking is permissible in families, as there are high levels of acceptance and practice among family members. Hookah bars, cafés and restaurants are social places for hookah smoking. [9] However, selection of smokers' or friends' homes were more common among the sample. In contrast to the findings of a study done at another local university where a large proportion of students smoked hookah on campus, [9] few students smoked on campus in our survey. This may be attributable to the strict policies on any tobacco products on UCT campus. Although the number of concurrent cigarette users may be higher than that of exclusive users of hookah, [9] we found that only 11% smoked cigarettes and hookah concurrently. Nearly a third of hookah smokers in the current sample supplemented their hookah products with cannabis, which suggests that this practice could provide an opportunity for the use of narcotics, thus increasing associated risks. Only a small number of hookah pipe smokers noticed any health effects attributable to their smoking, which suggests that the effects are not readily apparent. Thus, the practice is seemingly innocuous, concealing the serious long-term consequences. [6][7][8] --- Knowledge and attitudes Most students had only an average level of knowledge of the risks associated with hookah pipe smoking, indicating a need for education on the topic. Important to consider, is that a large number of participants had not received any health information about hookah pipe smoking previously. While most could identify that hookah pipe smoking was harmful, many gave incorrect reasons, indicating a knowledge gap. Some perceived hookah pipe smoking to be less harmful than cigarette smoking, suggesting that hookah is perceived as a safer alternative. However, previous studies have suggested that hookah pipe and cigarette smoking share similar health risks, with more carbon monoxide, similar nicotine and more smoke exposure during a session of hookah pipe smoking. [6,7] It is concerning that the health effects of hookah pipe smoking are unclear. Most students had permissive attitudes towards hookah pipe smoking, believing it to be socially acceptable and that they could easily access hookah pipe products. However, not as many would recommend it to others and the majority believed that the practice should be subject to stricter regulation. Currently, while the South African Tobacco Control policy prohibits tobacco smoking in public spaces, such prohibition does not explicitly extend to hookah pipe smoking. [9] --- Study limitations Limitations of the current study include possible response and recall bias in questionnaire responses, as well as selection bias. Hard copies were distributed to students in the social areas of the campus, which may influence the composition of the sample despite an online questionnaire being available to all health sciences students to counteract this effect. The current study neither explored reasons why those who no longer smoked hookah pipe had stopped, nor the temporality of cigarette smoking on hookah pipe smoking. This would have been useful in the interpretation of attitudes towards the practice. --- Conclusion The current study was conducted among a subset of SA's future health professionals. Their poor knowledge about the dangers of hookah pipe smoking, coupled with the extent of its practice is alarming. Permissive attitudes toward the practice, the young age of first experimentation in high school and at university, together with low exposure to information about hookah smoking highlights the need for school and university health-promotion campaigns, as well as for the better regulation of hookah pipe smoking and awareness campaigns at a national level.

The practice of hookah pipe smoking is centuries old and has long been used in India, Pakistan, China and the Eastern Mediterranean. [1] Its use has now permeated many countries and is becoming a popular social practice globally, especially among young people. [1][2][3][4] While the water filter and the fruity flavoured tobacco of hookah may make it seem innocuous, inhaled smoke contains toxic compounds such as nicotine, carbon monoxide, formaldehyde, polyaromatic hydrocarbons, arsenic and lead. [4,5] A hookah smoking session is usually longer in duration and involves exposure to much larger

Mansfield, Connecticut, United States, 2. UCONN, Storrs Manfield, Connecticut, United States As the pandemic wrought wide-reaching disruption across the world, younger adults appeared to be faring more poorly than other adults. We hypothesized that younger adults might possess fewer emotion regulation resources and skills, accounting for their relatively high levels of distress. In data gathered from a national sample of 1258 adults, we examined how baseline resources (in mid-April, during initial peak infections) predicted distress (depression, anxiety, PTSD symptoms) five weeks later, when states began initial re-openings. Younger adults (18-35 years; n = 317; mean age = 29.2 years) reported greater distress and less social support, mindfulness, and emotion regulation skills than did middle aged (36-60 years; n = 513; mean age =51.7 years) and older adults (61-88 years; n =428; mean age = 70.1 years). Controlling for stress exposure, younger adults' distress was predicted by impulsivity and lack of perceived strategies while middle-aged and older adults' (lower) distress was predicted by acceptance of negative emotions and emotion regulation abilities; perceived social support was related to lower distress for all groups but mindfulness was unrelated. Results suggest that emotion regulation resources and skills are a promising prevention and intervention focus. Abstract citation ID: igad104.0395 --- THE EFFECTS OF WISDOM AND HEALTH ON NORTH AMERICAN SENIORS' WELL-BEING SINCE COVID-19 Zhe Feng 1 , Michel Ferrari 1 , Pouria Saffaran 2 , Melanie Munroe 3 , Asma Shamim 1 , and Stephanie Morris 1 , 1. University of Toronto,Toronto,Ontario,Canada,2. University Of Toronto,Toronto,Ontario,Canada,3. Remedy Institute,Toronto,Ontario,Canada Public health restrictions necessitated by COVID-19 resulted in significantly reduced social contact for many older people, given their increased risks of infection and developing severe symptoms, even death. While reduced social contact can be a major cause of distress, our recent North American study (n=307) found 3 levels of resilience to the impact of COVID-19 -high ("well-adapted"), average ("getting-by") and low ("struggling") -associated with changes to wellbeing before (Time1), in summer 2020 (Time2), and about 18 months after (Time3). The present study investigates the wellbeing trajectory of 69 older individuals (Mage = 58.83, SDage = 7.21, max. = 77, min. = 50) within that larger sample who reported closely following local physical distancing recommendations. Specifically, it examines how their wellbeing was affected by their country of residence, and self-reported personal wisdom, self-transcendence, and health at Time2 and Time3. Simple logistic regression models suggest that, across Time2 and Time3, higher wisdom and better health were associated with higher likelihoods of being well-adapted vs. just getting-by. Higher self-transcendence at Time3 but not Time2 increases the likelihood of being well-adapted. Multiple logistic regressions with country, personal wisdom, self-transcendence, and health as predictors show that, controlling for all other variables in the model, higher wisdom and better health at Time2, as well as higher self-transcendence and better health at Time3, increase the likelihood of being well-adapted vs. just getting-by. Our findings demonstrate the protective values of personal wisdom, Downloaded from https://academic.oup.com/innovateage/article/7/Supplement_1/121/7487388 by Hochschule Luzern user on 17 February 2024

to describe and understand the experienced outcomes and mechanisms of their caring neighbourhood. In evaluating projects it is interesting to see what is going on, what they are doing, what their outputs are. But this presentation will focus on what they were not doing. The question will be raised whether caring neighbourhoods are intended to only provide "small care" and "little help", or to help people with complex needs, in the most difficult moments of life? Second, findings are presented from the current 133 Caring Neighbourhoods and how some of them are trying to respond to issues associated with serious illness, dying, death and loss. The presentation will give insights in actions in how neighbourhoods are encouraged to give more attention to end-of-life topics, and will provide examples on how they are transforming caring neighbourhoods into compassionate neighbourhoods.

Introduction Infectious diseases are a major contributor to racial and ethnic mortality disparities in the United States, with inequities in social vulnerability (SV) factors (including poverty, minimal transportation access, and crowded housing) being considered key contributors. 1,2 In areas populated by a majority of racially and ethnically minoritized (REM) individuals, these inequities may impact patients' ability and perceived need to access health care. Differences in healthcare utilization inevitably translate to an increased reliance on higher acuity resources within REM communities, such as emergency departments (EDs) and urgent care (UC). 3 Urinary tract infections (UTIs) are one of the leading outpatient indications for antimicrobial therapy, and while associated morbidity may be low, injudicious antimicrobial use represents a risk of inappropriate prescribing. 4,5 There is a paucity of literature that explores racial, ethnic, and SV differences in the outpatient treatment of UTI. 4 Here, we attempt to describe racial and SV differences in the utilization of ED and UC resources for the treatment of UTI, with a focus on uncomplicated cystitis, as a first step to improving prescribing and treatment practices in vulnerable communities. --- Methods --- Study design, patient population, and location This retrospective, observational study evaluated adult patients with a diagnosis of cystitis treated in the ED and two UC centers associated with Loma Linda University Health from January 1, 2021 to April 30, 2021. Patients were included if they had a urine culture collected in the ED or UC and were diagnosed with acute cystitis by International Classificaiton of Disease (ICD-10) code N30. Patients were dichotomized to REM and non-racially and ethnically minoritized (n-REM) groups based on patientreported race and ethnicity. REM groups include self-identified race as Black or African American, Asian or Pacific Islander, Middle Eastern, or Hispanic origin or Latin race as well as selfidentified ethnicity of Hispanic or Latino, and the n-REM group only included self-identified race as White with an ethnicity not defined as Hispanic or Latino. This study was approved by the institutional review board of Loma Linda University. --- Data collection and study definitions Patient demographic information and comorbid conditions were collected by chart review. Urine culture microbiologic results were recorded only for initial cultures collected in the ED or UC. Admission and discharge dates were collected, and a length of stay longer than 2 days was selected to identify patients likely requiring inpatient admission. Antibiotic susceptibility was defined by CLSI M100. Encounter antimicrobials were defined only as antimicrobials given during ED or UC encounter. Discharge antimicrobials were recorded. --- Results --- Study population During the study period, 250 patients with either an ED or UC encounter with a diagnosis of acute cystitis were screened, and 114 REM patients and 73 n-REM patients were included; patients identifying as female were most represented (151/187; 87%), and most patients were overweight (BMI 25-29.9, n = 56/187, 33%) or obese (BMI 30-34.9, n = 32/187, 19%). In the REM group, 79 patients (69%) identified as Hispanic or Latino, 20 patients identified as Black non-Hispanic (18%), and 13 (11%) identified as Asian. REM patients were significantly younger than n-REM patients (median age 47 vs 67 years, p < 0.001). Despite differences in age, there was no statistically significant difference in comorbidities between REM and n-REM groups, with similar rates of diabetes and chronic kidney disease (CKD). REM patients were also significantly more likely to be at the highest level of SV group when compared to n-REM patients (72% vs 44%, p <0.001) (Table 1). --- Microbiology and treatment The most commonly isolated primary organism was Escherichia coli (n = 80, 43%) followed by Klebsiella spp. (n = 15, 8%), and 55 (29%) patients had only mixed flora isolated on urinary cultures. Ceftriaxone was the most common antimicrobial administered during EC or UD encounters, while 89 patients (48%) received no antimicrobials during their encounters. On discharge, 168 patients (89%) were prescribed oral antibiotics, most commonly cephalexin (n = 98, 52%) or nitrofurantoin (n = 35, 19%), consistent with local antimicrobial susceptibility. REM patients were less likely to have documented susceptibility (48% vs 55%) and more likely to have documented resistance (37% vs 30%) to the agent prescribed on discharge when compared to n-REM patients, although these differences were not statistically significant (p = 0.689). Only eight patients across both groups had antimicrobials adjusted after discharge when culture susceptibilities resulted. REM patients were also less likely to have a length of stay longer than 2 days when compared to n-REM patients (16% vs 25%, p = 0.183), although this difference was also not statistically significant. --- Discussion In this study, our findings identified no significant differences in the treatment approaches or outcomes between these REM and n-REM groups. However, notable demographic differences were appreciated, including age differences in comorbidities which may contribute to the increased likelihood of required readmission and significant SVI disparities in the REM cohort. These results denote a potential area for the development of ED-or UC-specific clinical pathways for REM patients who present with suspected UTIs to hospital centers that primarily serve vulnerable communities. Recognizing the significance of age as a potential factor in healthcare disparities, efforts can be directed toward tailoring educational materials and interventions specifically for this demographic. By considering the unique needs and health literacy of this population, healthcare providers and organizations can potentially engage patients in lifestyle changes to prevent uncomplicated cystitis. Microbiological distribution of uropathogens was similar between REM and n-REM patients; however, REM patients were more likely to have been prescribed antimicrobials on discharge with documented inactivity against their uropathogen, which may have collateral effects and result in a need for continued ED and UC utilization and incurred costs. 7,8 These study results highlight opportunities to improve both institutional empiric and culturedirected antimicrobial use. This study has several limitations to consider. The retrospective nature of this study and reliance on ICD-10 diagnosis, rather than clinical presentation, likely limits the accuracy of UTI diagnosis, although these diagnosis codes likely indicate provider perception. It is important to note that the study aimed to describe differences between REM and n-REM patients with UTI, and outcomes were not available for comparison. Assessments of health literacy were also missing, which is a recognized independent predictor of health behaviors and could further impact outcomes. 9 Finally, our institution serves a predominantly Hispanic population within an area of high SV. To gain a more comprehensive understanding of health disparities in uncomplicated cystitis, future studies should include patients from low to moderate SVI and evaluate the impact of both deprivation and health literacy on clinical outcomes.

Racially and ethnically minoritized (REM) patients are disproportionately impacted by infectious diseases. In our study, REM patients were more likely to receive care for urinary tract infections in the emergency department or urgent care, were younger, and were more likely to have higher social vulnerability.

Introductory Remarks Let us start with a statement formulated by one of the leading Polish female rural sociologists, a specialist in analyzing the problems of rural families. She points out: "[…] roughly 60 per cent of agricultural production [in Poland -K.G.; 1 An earlier draft of this paper was presented at the XXIV European Congress for Rural Sociology, Chania, Greece, 22-25 August, 2011. --- 25' 2019 Monika Stanny * --- Continuity and Change -One Hundred Years of Polish Countryside. Interdisciplinary Cooperation of Humanities and Social Sciences For Academic Dialogue The year 2018 marked the centennial of Poland's independence. This anniversary was a good reason for various institutions and organisations to review what they have achieved during the century. The Polish Academy of Sciences' Institute for Agriculture and Rural Development (IRWiR PAN) made an attempt at making a synthetic academic presentation of Polish rural areas and agriculture evolution throughout the century; the evolution mechanisms, regularities and effects have been analysed in a long-term. The one hundred years of politically variable development conditions are a fascinating period of reforms and changes observed in all domains of life, of fundamental remodelling of society, culture, education and the economy. Rural areas and agriculture have played a significant role in those changes. Let us remember that, following the regaining of independence, income sources of approximately three quarters of the Polish inhabitants were related with agriculture, while today this proportion has decreased to approximately 10%. Concurrently, for the majority of today's rural inhabitants, the agricultural sector is neither a workplace nor a source of income. Today, rural areas cover 93% of Poland and are inhabited by 40% Poland's population; 100 years ago rural areas were home for 75% of the Polish inhabitants. The anniversary which marks regaining independence by Poland is a good occasion to take a challenge and start a major discussion, followed by an academic synthesis, about rural transformation seen from a number of perspectives. Such a challenge was taken by an interdisciplinary team of academics from IRWiR PAN, who have for many decades been preoccupied with studying rural aspects which must be considered from a multidisciplinary perspective, including economics, sociology, demography, cultural anthropology, spatial planning, socio-economic geography, political sciences, etc. Comprehensive examination of the rural issues is considered effective only when approached from the perspective of various scientific disciplines. Apart from reporting on rural development, another essential goal set and consistently pursued by the team was to ensure that the sciences exploring Polish rural areas are capable of developing in the right direction. Funds for the project implementation were obtained thanks to the "Dialogue" programme of the Ministry of Science and Higher Education and from public institutions dealing with rural and agricultural issues. The main cognitive goals set by the team members included: 1) A description of how and to what extent agriculture (as an economic subsystem and related community) has impacted the character of the 2nd Republic of Poland, the communist Polish People's Republic and the current 3rd Republic; 2) Identification and description of adjustment mechanisms observed in agriculture and rural areas during three historic periods which differed with regard to institutional and system backgrounds as well as external conditions; 3) Explanation of regularities and peculiarities related with the continuity of agricultural and rural socio-economic institutions and institutional changes, i.e. institutional development taking place in the long term and under the influence of turbulent events in history. The major analyses were focused on rural community, rural economy and environment and on rural culture, which corresponded with the areas of research conducted by the IRWiR researchers. The same structure was followed throughout the implementation of all the tasks of the project. The most important and measurable results of this stage of the project include: Several dozen articles comprising the publication paint a picture and describe the importance of rural community, with particular focus on peasants -the biggest social group which played especially important in the 20th century history of Poland. The role of peasant community in history and in the development of Poland needs greater emphasis; this was the objective of this publication that has hopefully been achieved. Our intention is that the results of our studies will trigger a discussion which will spread outside the scientific circles. 2) An album entitled "Patrząc na wieś. Sto lat rozwoju polskiej wsi/ Glimpses of the Countryside. One Hundred Years of Polish Countryside" (hereinafter, the Album, rys. 2) including old pictures to illustrate the transformation analysed, published in Polish and English. The team effort of Andrzej Rosner, Ruta Śpiewak and Edyta Kozdroń, published by IRWiR PAN, is an impressive collection of snapshot images of rural environment, toil and everyday life, holidays and customs. A juxtaposition of pictures from past and contemporary times, sometimes not that obvious, clearly demonstrates that some social, economic and environmental phenomena still prevail, and some things have changed within the last century. A selection of black and white pictures increases the emotional and historical value of the Album. The preface introducing the theme of the Album serves as a guideline and forms an integral part of the publication. Works are ongoing on a list of bibliography of publications describing Polish rural areas and agriculture of the last century. The list is thought to highlight the achievements of Polish researchers studying the subject. It helps to bring attention to a lot of little known publications and source materials which are often difficult to access, and to present a certain continuity (including institutional continuity) as far as conducting, what is today referred to as "rural studies", is concerned. Hitherto, results of studies point to some common features of "rural studies" which bring together researchers operating in different scientific disciplines. The most important is the interdisciplinary nature of the studies, which enables examining rural issues and communities from a broad perspective. Another one is bringing attention to the continuity and change, which is highlighted in all the articles. Showing what is long-lasting and what is subject to continuous alteration within rural areas makes us see the trajectory of changes and enables a dialogue among generations. The Project itself may be treated as an interesting form of a dialogue between the authors of the articles and reviewers thereof, a dialogue among the authors themselves, among conference lecturers and audience, or among the editors of the Monograph. What unites the participants of the dialogue is the understanding of rural areas, which is not easy because of the complexity of rural development issues. The understanding of rural areas also requires understanding of peasant economy, peasant emotions and peasants themselves. In order to understand all of this, one has to keep observing the life of that group. The Monograph, intended for a broader circle of readers than researchers and academics, is also thought to trigger a discussion on myths and stereotypes -still present in public as well as academic discourse -concerning the actual role of rural areas and agriculture in the Polish society, national economy and culture. Moreover, the publication of the Monograph results from insufficiency of research in the area of social sciences, which is of not only purely academic importance, but which helps better understand the evolution of the Polish economy, society and culture and the roots of a lot of contemporary problems which Poland is forced to face today. [271]

The authors discuss the main characteristics of women as farm operators using national sample studies conducted in 1994, 1999 and 2007. After an analysis of literature and various research results some hypotheses were formulated, i.e.: the better education of rural women than rural men, women as "unnatural" or "forced" farm operators due to various household circumstances, the "weaker" economic status of farms operated by women. Basic results of the studies carried out in 1994, 1999 and 2007 confirm the hypothesis about the weaker economic position of female operated farms. Moreover, women farm operators were slightly older and far better educated than their male counterparts. On the contrary, the males were more active off the farms in the public sphere. In addition, the circumstances of becoming farm operators did not differ significantly between males and females. Finally, there were no significant differences between "male" and "female" styles of farming.

Introduction Artificial Intelligence (AI) has gained significant attention from various sectors and fields and became a major topic of discussion. Teaching these AI skills has traditionally been done at the university level. In recent years several initiatives have emerged which pursue the mission of AI education at the K-12 level. The selection of relevant scientific venues, journals, projects and resources presented in this article should be seen as a suggestion and starting point for interested readers. Since the field is rapidly evolving, no claim is made for completeness. [22] -Teachable Machine [23] -Machine Learning for Kids [24] -KI macht Schule [25] 4 Further Reading -Artificial Intelligence: A Modern Approach [26] -The Quest for Artificial Intelligence: A History of Ideas and Achievements [27] -Teaching AI: Exploring New Frontiers for Learning [28] -What to Think About Machines That Think [29] -Future Frontiers: Education for an AI World [30] Funding Open access funding provided by Graz University of Technology. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.

This article provides an overview of relevant scientific venues, journals, projects and resources in the context of AI K-12 education.

Cannavò starts by exploring the meaning of place by discussing founding and preservation, and showing how place is threatened by globalisation. To explain the politics of land use practices and the conflict between founding and preservation, three important case studies are given. The first is about the war over the Northwest forest; the second focuses on the issue of sprawls; and the third case study considers the rebuilding of the former World Trade Center site in New York -Ground Zero. Cannavò proposes an adjustment by emphasising the commonalities between founding and preservation. He then proceeds to discuss the crisis of place, criticising the founding of place from philosophical, political and economic perspectives, through which places are turned into an abstract space or commodity and threatened in an era of globalisation due to modern methods of communication. Cannavò highlights the role of environmentalists who defend the value of place, but he also criticises the 'doubly Preservationist view' of some environmentalists (p. 213), who take an extreme stand against the human founding of places. Since the framework of the book is based on the study of cases in the USA (although its discussion also has wider implications), Cannavò proposes an elected regional government to support a democratic approach to integrating the founding and preservation of space by empowering local communities. He also makes some specific policy recommendations in order to draw together different initiatives by public officials, activists and new environmental political movements. To conclude, Cannavò uses the example of Hurricane Katrina to argue that resolving issues around the practice of place will ultimately help deal with the disasters caused by global climate change. The book presents engaging theoretical discussions, policy implications and practicalities which are helpful in understanding the issues related to the politics of place in a local and global perspective. However, it lacks a chapter about learning and comparing from the developing world, where the practice of place at a local level has not encountered the crisis of place to such a huge extent. Human geographers, environmentalists, sociologists and anthropologists at the graduate or professional level working on issues related to the politics of place and urban development will all find this book very useful. --- MUHAMMAD AURANG ZEB MUGHAL Durham University

In this book Peter Cannavò discusses the practice of place in order to deal with the crisis of place that happens due to the conflict between founding and preservation. The book is comprised of seven chapters along with an introduction and a postscript.

Introduction In this passage, we will talk about some concepts like 'tie strength' and 'hubs'. By using the method of case analysis and taking Pinduoduo social network platform as an example, the concept of social fission is introduced to show the power of social networks. Taking Oriental Selection as an example, discussing the role of social networks in the development of e-commerce and consumer behavior in this context will be the next research topic. There will be two research significance, first of all, taking the transformation of New Oriental as an example, which can be used as a reference by enterprises, and using the strong or weak relationship and social capital in social networks to promote word-of-mouth communication and the fission effect. Second, promoting the live broadcast team and e-commerce team to start from consumers and pay more attention to the role and value of 'people' in the marketing process, such as promotional discounts for friends circle, discounts for inviting friends and so on. --- 2. --- Social Network and E-Commerce --- Important Concepts in Social Networks Tie strength usually represents the closeness between nodes. If two people communicate often and communicate through more than one medium, they are said to have strong, or close ties. Strong ties, take it into a simple example, when we want to talk about something private or more intimate, the strong ties may help, just like a concept 'Social distance' or 'Intimate distance'. But it is weak ties which can enlarge your social circle, for example, the prototype of 'public comments' is Yelp, which is the largest review website in the United States. Merchants in restaurants, shopping centers, hotels, tourism and other fields are included. Users can rate merchants, submit comments, and exchange shopping experiences. You can search for a restaurant or hotel and see its brief introduction and comments from Internet citizens. How many stars will the reviewers give? Usually, the reviewers are consumers who have experienced the merchant's service, and most of the comments are detailed. Depending on the weak ties, we can explore different kinds of worlds. Hubs, we called some people who knows more acquaintances or have a relevant fans or follows, hubs more like centers. Based on a Chinese popular question-and-answer website Zhihu, many people announce their opinions there, this paper found a person called 'Bi Dao' , through data analysis, this paper finally got a conclusion that he has 30 hubs and 83 concerns, its social network seems like a big circle. --- Social Network Application in E-Commerce (Pinduoduo'sSsocial Fission) As a platform based social e-commerce, the success of Pinduoduo lies in its low formation of massive rate of flow based on WeChat cost user fission, seizing the needs of third and fourth tier users for low prices, seeking the real pain point, and then to find 'hot' products to complete a closed loop of sales. It also use WeChat to develop social shopping, occupy the 'sinking market' and activate a large number of people at low cost [2]. When a user likes a product, he or she can send an invitation to their friends and relatives to buy the product at a lower price. Through sharing, the shopping list was completed, and with the help of WeChat social network, the shopping list was split again. This social concept formed through communication and sharing has formed Pinduoduo's unique new social e-commerce thinking. That's also the power of hubs [1]. --- Significant Impact of Social Networks (Case of United Breaks Guitars) Now, let's focus on a news in 2009, 'United Breaks Guitars'. On March 31, 2008, Carroll and members of the band were flying from their hometown of Halifax, Canada, for a week of shows in Omaha, Nebraska. During a connection in Chicago, other passengers aboard the flight noticed some very rough handling of cargo, and Carroll's bandmates watched helplessly as Dave's $3, 500 Taylor guitar was mishandled by United's baggage handlers. On July 7th, Carroll's friend posted the video to Youtube, before any blogger or mainstream news medium had reported the story. A staff member was trying to contact Carroll, but he didn't really consider it a crisis situation, he also used the words 'make it right', when they contacted Carroll successfully, they just want to use money to appease the incident. In this case, social media is only a limited way for people to focus on this incident, the official media, the bloggers, mainstream news medium's report's made it a viral game mechanics, based on networks, it caused a fission propagation. The 2022 International Conference on Financial Technology and Business Analysis DOI: 10.54254/2754-1169/5/20220070 --- Successful Case of Tiktok Platform Now, let's talk about the live broadcasting in Tiktok platform. Take the live broadcast room of 'Oriental Selection' to make New Oriental return to the peak after the loneliness of the K12 education line, and push it to the first and second positions in the ranking list as an example to explore. New Oriental's ways to sell goods by bilingual speaking and knowledge inside have achieved a high level of word of mouth communication. From then on, selling goods online relying on culture has become popular. Many young people of the Z generation have an old feeling to New Oriental. In those years, the New Oriental's teaching and training spots flooded around schools and communities crisscrossed, not only New Oriental, but also many other similar teaching and training institutions. Students of this age group who have just finished compulsory education and their parents would have a high degree of sensitivity and attention to the transformation of the teaching and training industry, of course the K12 education line. As a 'connector hub', a family will make the communication network interlaced, dense, tight and expanded, which constantly promote the popularity of the live broadcast in Tiktok. After the popularity of 'Oriental Selection', most of the consumers wanted to follow this trend and shared past photos in the teaching classes with those teachers who was selling goods after they ended their teaching career on the social platform to keep up with the popularity, which also led to viral transmission in the live broadcast room. --- Analysis of the Impact of Social Networks on Consumer Behavior under the Development of Live Broadcast E-Commerce --- Current Situation of Live Broadcast E-Commerce Market Live broadcast e-commerce refers to the form of e-commerce in which a KOL (a key opinion leader who has more and more accurate product information, is accepted or trusted by relevant groups, and has a greater influence on the purchase behavior of this group) recommends selling goods through live video, short video, and other forms and finally clinches a deal [2]. We would divide the market into two parts: an advantaged part and a disadvantageous part. For the advantage part, because of COVID-19 and depending on government policy support, live broadcast e-commerce has become a new engine to drive consumption and promote double circulation. The audience is widespread, everyone can participate, and they can enjoy the dividends it brings without leaving home. For the disadvantage part, the industry's supervision is not strict enough. There are still live broadcasts that have a negative impact on society. In addition, the quality problems of goods are emerging in an endless stream and need to be addressed urgently [3]. --- Domestic Live Broadcast E-Commerce Platform Among live broadcast e-commerce users, category interest users and KOL talent followers are the most. Younger users prefer the latter, while older users prefer platform followers and brand orientation [4]. In Tiktok, we can found that when some live broadcasting rooms accomplish an order, the consumers can participate in a certain sharing group which only allowed those who have bought goods in their rooms [5]. In this way, the weak tie played an important role, gathering consumers from all directions to share shopping experiences and something they recommend which makes customers spontaneously strengthen the product publicity and also reduce the publicity cost of sellers to some extent. As for the strong ties, do you remember when the 'Double 11 shopping carnival' comes, big spenders and shopaholics also comes out. Last year, in 2021, the transaction volume of the whole network during the Double 11 Festival was 965. 12 billion yuan, with a year-on-year growth of 12. 22%, an interesting phenomenon was that, many live broadcast e-commerce platform built a virtual The 2022 International Conference on Financial Technology and Business Analysis DOI: 10.54254/2754-1169/5/20220070 team which allowed the teammates can divide the red envelope, which can be deducted on the shopping day, during this time, the strong ties came into play, we can share the links with close family members or friends to invite them to join our team so as to increase the upper limit of red packets, depends on strong ties, the kinds of behaviors become more easily to achieve [6]. --- Discussion So, how to better apply social network to promote the development of live broadcast e-commerce? Let's take Tiktok platform as an example and make some marketing strategies. First, focusing on the communication of official media. In the case 'United Breaks Guitars', we can find the importance of using an official media reasonable, as for the live broadcast e-commerce, they should also establish a more timely feedback mechanism to response any similar incident, they should also corporate social responsibility and focus more on the 'human' or 'customer'. Second, try to use strong relationships to increase users' loyalty, and use weak relationships to develop new users. People always trust people who they related to them, grab those strong ties can form a broadcasting link which can make it more strong and tight. People also like to share opinions and listen to others' advice today, so grab those weak ties not only can implement user's classification but also expand new users with lower cost. --- Conclusion In the introduction, we have discussed some questions. First of all, how will the positive and negative effects of social networks play important roles in Tiktok's e-commerce live broadcast? We can draw the conclusion that strong ties may help with "social distance" or "intimate distance." But depending on the weak ties, we can explore different kinds of worlds. Secondly, how will social networks have an impact, and how will a key hub play an essential role in social networks? As a "connector hub," the communication network can be interlaced, dense, tight, and expanded by a family. Through some real-world cases we discussed above, we found that the social concept formed through communication and sharing has formed a new social e-commerce thinking, which could help to strengthen the social networks. This passage also has some shortcomings. Only the Tiktok platform was specifically studied, and the live broadcast room only took Oriental Selection as an example with just a small coverage. But there are also some future measures to improve. The situation on each platform and live broadcast room is different. More live broadcast platforms and live broadcast rooms can be studied in the future.

Chapter 9 in 'Social Media' written by Humphreys introduce a topic called Social Networks, which includes the social network in word of mouth communication, the role and influence of strong and weak relationships, the role of hubs and the powerful resource impact that the activation of social capital will bring. It is meaningful to have a deep understanding and exploration of the impacts, roles, advantages, and disadvantages of these contents in Tiktok's e-commerce live broadcast. The study explores the impact of social networks through some methods, such as literature analysis, data comparison and case studies. These methods can use the ideas of some researchers to study similar aspects of the market, such as live broadcast and social media, and cite real-life cases of some companies to explore the impact of social networks. In this article, we raised some questions, such as how the positive and negative effects of social networks will play important roles in the Tiktok's e-commerce live broadcast, how social networks will have an impact and how a key hub will play an essential role in social networks. We have also reached some conclusions through research, focusing on the spread of official media, using strong relationships to increase user loyalty, and using weak relationships to develop new users. The e-commerce team should actively seek operational strategies and marketing methods to optimize its impact.

Objective: Subjective cognitive decline (SCD), the self-reported experience of worsening cognitive abilities (Jessen et al., 2014), is associated with increased risk of developing Alzheimer's disease and Mild Cognitive Impairment. Modifiable factors such as purpose in life (PiL), the experience of living a meaningful life where one's life goals are attainable or being achieved (Boyle et al., 2009), and loneliness, an individual's perceived social isolation (Luhmann & Hawkley, 2016), are known to be associated with SCD. These relationships are understudied among ethnically diverse groups. Using an online survey, we examined associations between PiL, loneliness and SCD in older ethnically diverse individuals living in the US. Participants and Methods: 870 older adults (126 Latino,74 Black,33 Asian,and 637 White;average age=67.0 [7.6]) completed an online survey including the Life Purpose Questionnaire, the Gierveld Loneliness Scale, and the Everyday Cognition scale (ECog), which measures subjective cognitive concerns in memory, language, executive function, and divided attention. Chi-square tests and analyses of variance were conducted to assess group differences in SCD and demographic/lifestyle predictors. Multiple regressions and correlations were conducted to assess the relationships between ethnicity and PiL with SCD, and the moderating effect of race/ethnicity. Multiple regressions and correlations were conducted to identify sociodemographic and lifestyle predictors of SCD in each study group. Results: White participants were older (p<.001), and White and Asian groups had higher levels of education (p=.009) compared to Latinos. The White group had a higher proportion of female (p=.016) and middle-income (p=.019) respondents. Black participants had higher PiL (p=.035) and lower loneliness (p=.047) compared to White participants; there were no group differences in ECog ratings (p=.143). Regression results indicated that higher PiL associated with lower SCD in the whole sample (β=-.435, p<.001). The interaction between PiL and ethnic group was significant (β=.078, p=.025), suggesting the relationship between PiL and SCD was strongest in White participants, followed by Asian, then Latino, and finally Black participants. In Latinos, female sex (β=-.281, p=.004) and higher PiL (β=-.240, p=.034) predicted lower SCD ratings. In White participants, higher PiL (β = -.394, p < .001), and lower loneliness (β = .128, p = .003) predicted lower SCD ratings. Correlation analyses revealed no significant associations with SCD in the Black group, although the correlation between loneliness and SCD was trending (r=.222, p=.063). In the Asian group, greater PiL was associated with lower SCD ratings (r=-.439, p=.011). Conclusions: Our findings suggest that PiL may be protective against SCD, particularly in Latino, Asian, and White adults. Differential predictive factors of SCD were also identified for our study groups, suggesting certain groups may benefit from specific targeted interventions. Overall, findings suggest that interventions geared toward increasing PiL and/or mitigating loneliness may help reduce SCD and the risk of cognitive decline in older adults in the US. As the current study was cross-sectional and faced sample size limitations in Asian and Black groups, future studies should include longitudinal assessment of these associations with larger and more representative samples to confirm our findings. Objective: Depression is a common problem among older adults and is further exacerbated by poor treatment response. The vascular depression hypothesis suggests that white matter hyperintensities (WMH) and executive dysfunction are main contributors to treatment non-response in older adults. While a previous meta-analysis has demonstrated the effects of executive dysfunction on treatment response, similar techniques have not been used to address the relationship between WMH and treatment response. Multiple commonly-cited studies demonstrate a relationship between WMH and treatment response, however, the literature on the predictive nature of the relationship is quite inconsistent. Additionally, many studies supporting this relationship are not randomized controlled studies. Critically examining data of well-controlled treatment response outcome studies using meta-analytic methods will allow for an aggregate evaluation of the relationship between WMH burden and treatment response. Participants and Methods: A MEDLINE search was conducted to identify regimented antidepressant treatment trials contrasting white matter hyperintensity burden between remitters and non-remitters. Only regimented treatment trials for depressed outpatients aged 50 and older that had a pre-treatment measure of WMH burden and remitter/non-remitter comparison were included. Hedge's g was calculated for each trial's treatment effect. A Bayesian metaanalysis was used to estimate an aggregate effect size. Results: Eight studies met inclusion criteria. The log odds ratios average was significantly less than zero (.25, SE=.12, p=.019), suggesting that there is a significant effect of WMH hyperintensity burden on antidepressant remission status. Conclusions: The purpose of this metaanalysis was to rigorously evaluate randomized controlled trials to determine the relationship between WMH burden and antidepressant treatment response. Findings revealed that WMH burden predicted antidepressant remission, that is, individuals with high WMH burden are less likely to meet remission criteria compared to individuals with low WMH burden. Results suggest that it may be important to

The brain integrity composite was comprised of bilateral entorhinal cortex volume, bilateral ventricular volume, and whole brain leukoaraiosis. Results: Over and above age and cognitive reserve, hierarchical regressions showed FSRP-10, inflammatory markers, and brain integrity explained an additional 13.3% of the variance in command TCT (p< 0.001), with FSRP-10 (p= 0.001), IL-10 (p= 0.019), and hsCRP (p= 0.019) as the main predictors in the model. FSRP-10, inflammatory markers, and brain integrity explained an additional 11.7% of the variance in command digit misplacement (p= 0.009), with findings largely driven by FSRP-10 (p< 0.001). Conclusions: Overall, in non-demented older adults, subtle behavioral nuances seen in digital clock drawing metrics (i.e., total completion time and digit misplacement) are partly explained by cardiovascular burden, peripheral inflammation, and brain integrity over and above age and cognitive reserve. These nuanced behaviors on digitally acquired clock drawing may associate with an emergent disease process or overall vulnerability.

45,979 Americans died by suicide from 1.20M suicide attempt. 4 Suicide is a neglected, under attended and underreporting public health issue in Bangladesh having no standard reporting system, no nationwide survey, with few research and paucity of literature. Report suggested that every day almost 32 people commit suicide in 2019 which was 29 and 30 in 2015 and 2017 respectively. The mortality rate of suicide found 39.6 per 100,000 in Bangladesh. 5 Like Pakistan, Afghanistan, Nepal, Bangladesh relies mostly on police data which are likely gross underestimations of actual rates. According to Bangladesh Police, which publishes a report annually on suicide incidents, over 11,000 people committed suicide in the country in 2017 which was 9,665 in 2010. In 2016, the total number of suicide incidents in Bangladesh was 10,600 while 10,500 in 2015 and 10,200 in 2014. 5 Study showed suicide attempt rates are 10-40 times higher than rates for completed suicides. 6 The methods used for suicidal attempts are usually different, ranging from self-poisoning to hanging, self-cutting etc. This may be related to the differences in the accessibility of certain methods. In the WHO Multicentre Study, 64 per cent of males and 80 percent of females used self poisoning. 7 And more than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt 6 . There is also socio demographic risk factors in relation to repetition, which belong to the age group of 25 to 49 years, being divorced, unemployed, and coming from low social class 7 . In contrast to most Asian countries, more Bangladeshi women commit suicide than men. The most prevalent age group is age under 40 years. The mean age of male and female were 28.86±11.27 years and 25.31±7.70 years respectively. 5 The most common associated factors of suicide are younger age, lower education, students, nuclear family, family history of suicide, use substance, problem in workplace, financial constraints, affair, domestic violence, divorce, and physical illness. Nowadays Suicide has become a daily occurrence event in Bangladesh, becoming the fourth leading cause of overall injury-related deaths and second important cause of injury-associated death in age groups of 20-39 years in Bangladesh. 5 While suicidal behaviour is influenced by several interacting factors -personal, social, psychological, cultural, biological and environmental -depression is the most common psychiatric disorder in people who die by suicide. 5 So it is crucial to understand the predisposing factors behind the suicide attempts among the population for preventing it. In this study we aimed to assess the socio-demographic status and psychiatric morbidity of suicide attempters through a standardized instrument and structured clinical interview. --- Method: This cross-sectional observational study was conducted at Rangpur Medical College Hospital, Rangpur, Bangladesh during the period of May to September 2017. Sample was taken purposively from the patients with suicidal attempt from different departments of the hospital (Medicine, Surgery, Head-Neck & Otorhinolaryngology). A total of 101 patients were selected as the study sample. In the present study, suicide attempt was operationally defined as a non-fatal act, whether physical injury, drug overdose or poisoning, carried out in the knowledge that it was potentially harmful and in the case of drug over-dosage the amount taken was excessive 8 . After obtaining the informed written consent from all patients, the interview was conducted once the patient was considered fit for a psychosocial assessment using a semi-structured questionnaire and clinical interviews. Medical officers attached to the psychiatry unit trained in interview techniques assessed these patients. Diagnosis was made by consultant psychiatrist according to DSM-IV. Data was entered and analyzed using SPSS version 24 and results were expressed as proportions and percentages. --- Results: Socio-demographic data A total of 101 patients were studied. In our study, majority of the sample was below 20 years old (41.59%). Female constituted 53.47%, half the sample was unmarried (51.49%), 72.28% lived in rural area, 38.62% were students, majority (95.05%) belonged to Islamic faith, 28.72% completed higher secondary school, 42.57% had a monthly income of 10001-20000 BDT and most (59.41%) lived within a nuclear family (Table-I). --- Suicide attempt evaluation Majority of the attempts (58.42%) were impulsive, followed by planned attempt (25.74%). 63.37% patients had no prior suicidal thoughts. 17.82% of patients had history of previous attempts, however, 13.86% of the respondents reported previous suicide attempts for more than once (Table-II). Out of the 101 patients majority (58.42%) had high suicidal intent on Beck's Suicide Intent Scale (SIS). In the study, 56.44% resorted to poisoning as the mode of suicide attempt, 23.76% tried to hang themselves, 14.85% overdosed with drug and only 4.95% used self-cutting as the method. Among all, 6 patients used more than two method to suicide. On narrative analysis, reasons that had the most influences in attempting suicide were Domestic Quarrel (48.52%), Relationship issues (20.79%) and Financial problems (8.91%). Out of 101,12 patients reported having more than one reason behind their suicide attempt (Table-II). --- Psychiatric evaluation: 1.96% of the patients had a family history of psychiatric illness and 4.95% had history of attempted/complete suicide in the family. Substance abuse was reported in families of 3.96% of patients, 8.91% had previous history of psychiatric illness, 6.93% admitted about substance abuse in their lifetime (Figure -1). Evaluation of psychiatric disorders revealed 3.96% suffering from substance related disorders, 6.93% suffering from Personality disorder, 11.88% from conversion disorder, 17.88% from major depressive disorder and 31.69% from other condition that may be a focus of clinical attention (Figure -2). --- Table-II: Socio-demographic characteristics of Suicide Attempter Discussion: Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008.9 However, globally, the availability and quality of data on suicide and suicide attempts is poor. As the largest continent in the world, Asia accounts for about 60% of world suicides, and there has been a lack of systematic exploration of suicide methods in Asian countrie. 10 This is indifferent in the perspective of Bangladesh as well. There is no surveillance for suicide and nationwide study on suicide is yet to be conducted. 11,12 In our present study, we gathered the data on socio-demographic and suicide attempt profile, and psychiatric morbidity of the subjects with history of attempted suicide presenting to a tertiary care hospital. The study group consisted of one hundred and one subjects. The data obtained in our sample was consistent with few earlier studies. --- Psychiatric Diagnosis in percentage The under 20 age group had the majority of suicide attempts in our study with 41.59% possession and this is well in co-ordinance with the study of Shah et al13 and Feroz et al. 14 In many Indian studies individuals below 30 years of age were found to be more vulnerable for attempting suicide.15-18 Female accounting 53.47% had the highest presence in our study and in the review article of SM Yasir Arafat 11 comprising 9 original articles, 3 review articles and 1 other type (thesis) also stated the same. The male-female ratio is slightly inclined towards the females is possible due to passive gender role, early marriage, lack of economic freedom low literacy and such cultural factors predominant in the Asian countries. 10,11,19 The rural people attempted suicide most in the current study (72.28%) and this is similar to other studies in perspective of Bangladesh 11,19 Unmarried subjects were also found to be slightly more than married (51.49%) which can be explained by the study from Denmark which reported cohabiting or single marital status was a significant risk factor for suicide. 20 Being separated or divorced was noted to be significantly associated with a suicidal act in another study. 21 And to add, Jordans et al 22 and Patel et al 23 found that the male-to-female ratio is smaller in Asia than in other parts of the world. For occupation and educational literacy, students (38.62%) were the highest attempters and overall most subjects showed a good literacy of above higher secondary level (28.72%). As opposed to this, unemployment was found to be significantly associated with suicide in previous literature from India and the West. 8,20, Financial status belonging mostly to lower-middle class (42.57%) in the study with 59.41% of nuclear families, was also in relation to that of previous study. 11,12 56% of our cases belonged to poisoning as the form of suicide attempt and the finding correlates with other global findings. 11,27,28 In one of the other studies, hanging was found to be the commonest method of suicide, 11,13,14 but the 2nd commonest (24%) in our study. This can be explained by the agriculture based society Bangladesh has and since majority of our subjects belonged to the rural community. Sato et al, found a relation between occupation (agriculture) and method used for attempt. 29 Easy availability of compounds within the home or premises rendered them the first preference for attempting suicide. 30,31 An associa-tion is observed between method availability and method specific suicide rates. 32,33 Impulsivity was commonest among our study group (58%), which resembles the report of B.A.J van Spijke, 34 Mann et al 35 reported that 46.7% were planned attempters in his study but only 26% were found in our study. Only 37% of our study subjects had prior suicidal thoughts which coincided with the statistical figure (about 23%) of the study conducted by Ponnuduraiet al. 16 Domestic quarrel (49%) and Relationship issues (21%) accounted the most behind suicide attempts among the study group and this confirms the trend of other studies. 11,16,26,35 While assessing psychiatric disorders we found 65% of the suicide attempters suffered from a psychiatric disorder; major depressive disorder (18%) and conversion disorder (12%) were found to be the most common diagnosed disorders. However 35% of the subjects who passed the GHQ-12 and considered for psychiatric evaluation didn't show any clinical morbidity and was grouped under condition that may be a focus of clinical attention. And while only 1% had more than one psychiatric disorders, such co-morbidities was also reported. 36 --- Conclusion: Despite the global concern, suicide is still a neglected and under attended public health problem in our country. The time demanded step of establishing a national suicide surveillance is depended on scientific studies. In light of present study our aim was to assess the morbidities and demographic influence, however the study had some limitations. Our sample size was small and this study had only 5% representation from higher socio economic status. Even with this limitations this study served the purpose treating the psychiatric morbidity as well as other causes of attempted suicide in the study population. Taken together all the findings, our results lead us to the conclusion that the variables enhancing the risk of suicide among the vulnerable groups if identified and the predictive items associated with suicidal risks are enlisted, it would effectively help in early detection and prevention of suicide attempts.

Suicide is the act of intentionally causing one's own death. An estimated 703 000 people die by suicide worldwide each year. 1 Over one in every 100 deaths (1.3%) in 2019 were the result of suicide. 1 The global suicide rate is over twice as high among men than women. 1 Over half (58%) of all deaths by suicide occur before the age of 50 years old. 1 Globally, suicide is the 17 th leading cause of death and fourth leading cause of death in 15-29-year-olds. 2 Suicide occurs across all regions in the world, however, over three quarters (77%) of global suicides in 2019 occurred in low-and middle-income countries. 2 60% of these occur in Asia as estimated. 3 In 2020, Suicide is the12 th leading cause of death in the US, an estimated

Introduction The movement to reorient the Brazilian care model for mental health has been extensively discussed and defended. In practice, however, the guidelines of psychiatric reform and advancements in science have not guided practice. Although the quantity of services has significantly increased, re-hospitalizations have also grown considerably and the average duration of hospitalizations is longer, while intervals between readmissions of a relative large number of patients are small (1)(2)(3)(4) . The quantity of outpatients' visits does not necessarily mean effective resolution. Many of these services are not very efficient, generate demand and contribute to conditions to become chronic (5) , consequently leading to re-hospitalizations. When a medical diagnosis is defined in psychiatric care, it guides the therapeutic plan of patients with mental disorders, which includes pharmacological, social and psychological interventions and nursing care. Rev. Latino-Am. Enfermagem 2010 Jul-Aug; 18(4):800-8. Concomitantly, emerging family conflicts, guilt, social isolation, lack of knowledge concerning the disease and difficulties in coping with a situation that results from financial overload and difficulty in interpersonal relationships should be detected (6)(7) . Integration between the health system and families should occur when the first manifestations of the mental disorder start, in order to avoid rupturing the relationships between the individual with a mental disorder with his/her family and the community. Many families and even individuals with mental disorders believe that hospitalization is still the best treatment available (8) . Taking these factors into account, we conclude that psychiatric hospitalization may reflect the clinical conditions of patients and also the support provided by families and the community and the efficiency of the psychiatric facilities. These are, in a certain way, an epidemiological warning and indicate the need to initiate appropriate follow-up strategies that are integrated between the sectors involved instead of isolated measures (4)(5)9) . The decision-making power of patients with mental disorders is limited during hospitalization and all their actions are controlled according to the facilities' standards, where there is not always a concern for each individual's uniqueness nor for family members (10) . Extrahospital services, in turn, perhaps do not have conditions to widely examine the issue of exclusion and care for individuals in crisis, as is the case of Psychosocial Care Centers (CAPS) and psychiatric emergency departments in general hospitals (11)(12)(13) . From the perspective of care coverage, the majority of community services have limited coverage, especially for patients with more severe and chronic clinical conditions. Hence, the responsibility to care for these patients in the daily routine lies with the families (6)(7)14) . Therefore, appropriate treatment implies the rational use of hospitalization, consisting of pharmacological, psychological and social interventions, which should be clinically significant, balanced and integrated with better quality care (15) . This perception of illness eliminates the reductionist view of mental problems and aggregates biopsychosocial factors and new ways of addressing, treating and organizing the psychiatric care network. A higher incidence of readmissions has been observed in a hospitalization unit for acute female patients of a psychiatric facility. We observe that patients are readmitted not only because of clinical relapses but also due to a lack of family and social support, lack of adherence to treatment or abandonment of treatment, lack of medication available in the network and even interruption of treatment due to the lack of physicians and lack of knowledge concerning the particular disease and treatment. These observations justify the analysis of some characteristics of individuals with mental disorders and relate them to readmissions with a view to present data to support more effective care both in closed facilities and the entire community health care network in order to reduce the frequency of psychiatric hospitalizations. This study identifies sociodemographic variables, clinical conditions, medical diagnoses and treatments and analyzes their relationship with psychiatric readmissions. --- Method Study design This study uses an exploratory-descriptive methodology based on secondary data: information contained in the medical files of patients hospitalized in a psychiatric hospital between 2006 and 2007. --- Study's setting The psychiatric Hospital Santa Teresa de Ribeirão Preto (HST-RP) currently has the following sectors: Acute Female, Acute Male, Chemical Dependents and Permanent Residents. Its mission is to provide humanized and individualized care to patients 16 years old or older, belonging to the XIII Regional Health Department (DRS XIII), with mental disorders and who present imminent risk to themselves and others. It also aims to re-insert permanent residents into the community and family life (16) . --- Sampling and data collection procedures --- Ethical Procedures The project was approved by the Ethics Research --- Results Based on analysis of data obtained in this study and despite blanks found in the consulted documents, it was possible to make associations between psychiatric readmissions and patients' sociodemographic variables and clinical conditions upon admission and hospital discharge, medical diagnoses and treatments provided. Of the 681 readmitted individuals, 30% were between 40 and 49 years old. A significant difference was found between the frequencies of individuals in age groups according to gender (Fisher's test=0.007). --- Sociodemographic variables and psychiatric readmissions Among the 627 files where information was provided regarding race, we observed that 66% were white, 10% black and 16% mixed. The level of schooling recorded in 67% of files revealed that 8% were illiterate; 157 men (38%) and 156 women (59%) did not complete primary school; 34 men (8%) and 44 women (16%) began secondary school but only 21 (5%) and 30 (11%) respectively concluded it. Six men and seven women began higher education but only three acquired a bachelor's degree. It was possible to observe in the files that recorded marital status that the number of singles who were readmitted was higher among men (66%) than among women (45%). There were more widowed (16) and separated (38) women than men in these conditions. The Chi-square test showed a significant result (P=0.000) in the comparison between gender and schooling indicating that women readmitted had more years of schooling than men. A significant difference was found in the association between marital status and gender; most of the readmitted men were single (Fisher=0.000). --- Discussion Overall, the results correspond to those found in the psychiatric literature, especially to those of an epidemiological study carried out in Ribeirão Preto, SP, Brazil (4) . Rev. Latino-Am. Enfermagem 2010 Jul-Aug; 18(4):800-8. Information concerning place of birth (571) was found in patients' files and three quarters were born in the Southeast region, predominately individuals from the state of São Paulo followed by Minas Gerais. There is a predominance of men in all regions. Most of the readmissions originate from cities in the DRS XIII, which complies with the principles of regionalization and hierarchy according to law nº 8.080 (16) . The city of Ribeirão Preto accounted for the majority of readmissions, followed by Sertãozinho and Jaboticabal, SP. Ribeirão Preto currently has 504,923 inhabitants and despite the fact it is the center of the region, it still is deficient in community services (17) . In this respect, it is worth questioning whether neighboring cities are assuming the mental health care as recommended by psychiatric reform. The deficiency of these services can hinder integration of services, so necessary to psychosocial rehabilitation, which allow people functional psychiatric recovery (13)(14)18) . Among the reasons that determined the last hospitalization in the different age groups, the youngest Men presented a higher proportion of readmissions due to treatment abandonment (216) than women (107), which was associated with poor family support in 85 men and 48 women. A large number of patients who did not take the prescribed medication were observed. It is known that failures in treatment are important causes of relapse, as observed in this study. A consequence of interrupted psychiatric treatment is the risk of relapse with a negative impact on the patients' balance and disease overload on the family (6)(7)9) . We verified in this study that three patients had psychiatric hospitalization mandated by court. These cases have increased. The facility received 26 patients from January to September 2007 mandated by a court order (17) . This demand interferes with the true reason of hospitalization (medical evaluation) and also destabilizes the structure and dynamics of inpatient units. In and social support, adherence to community service, residual symptoms and social skills (9,14) . Concerning the manifestation of mental symptoms upon admission and hospital discharge, calm patients stood out and 85% remained so upon discharge; among the agitated ones upon admission, 79% were calm upon discharge and 11% were delirious upon discharge. Women presented better physical conditions at discharge. Most of the time an individual with a mental disorder needs to be hospitalized in order to have his/her clinical condition stabilized due to symptoms such as delusions, hallucinations, agitation or speech disorders and suicidal thoughts or even to meet the needs of families with relational difficulties and emotional overload (4,6,8,15,19) . This study revealed that most of the mental is restricted as observed in the different psychiatric services (13) . Despite the existence of nursing notes taken daily in all periods, we observed that nursing care is not disorders, including medical and nursing services, social work, psychological and occupational care, and leisure among others (1,5,11,14) . Non-physicians need to better define their role in the care provided to patients with mental disorders and find appropriate strategies for interventions to justify the importance of their contribution to psychiatric care. The nursing team has the opportunity to detect needs presented by patients with mental disorders under its care during the entire period of care delivery. Through different technical care procedures and personal interactions, nurses can help hospitalized patients to better understand their disease, treatments and utilize other psychosocial resources, enabling patients to become active participants in the process (20) . The frequency and duration of psychiatric hospitalizations is still a concern due to social exclusion and personal loss that it causes. A recent study carried out in Brazil with 307 adults with a history of three or more hospitalizations and a control group of 354 individuals hospitalized for the first time showed that psychosocial variables play an important role in the prevention of multiple readmissions (19) . The psychiatric nurse, as a member of multiprofessional teams, needs to advance within the mechanisms that promote changes in practices through the aggregation of new knowledge and competencies. --- Conclusions This --- Data collection instrument A form was used to guide data collection from patients' files: "Survey of Psychiatric Readmissions"

Segregated individuals with mental disorders, families without support or guidance concerning disease and treatment, and unprepared professionals are some of the factors that can contribute to re-hospitalizations. This study identifies sociodemographic variables, clinical conditions, diagnoses and treatments in order to identify their relationship with psychiatric re-hospitalizations. This is an exploratory and descriptive study. A form was used to search data in patients' files from 2006 and 2007 in a regional psychiatric facility. A total of 681 re-hospitalizations were identified, the majority due to treatment abandonment. Length of hospitalization was higher for women between 40 and 49 years of age. Positive associations of sociodemographic data with previous hospitalizations were found, such as type of discharge, and physical and mental condition, which is in accordance with the literature. Readmissions are associated with sociodemographic and clinical indicators. These findings can guide care and public policies regarding mental health.

As cases and deaths mount after the government's summer shift to a "normalisation" policy, tension is growing because of discrepancies between the official counts and reports from professionals on the ground. Tension is growing too between the government and the medical profession. This month, as doctors around the country wore black ribbons to commemorate colleagues lost to the pandemic, President Recep Erdoğan's coalition partner Devlet Bahçeli, leader of the Nationalist Movement Party, called for the Turkish Medical Association to be outlawed and its leadership prosecuted. "The Turkish Medical Association is as dangerous as coronavirus and is disseminating threats," said Bahçeli on Twitter. "The medical association which claims the name 'Turkish' should immediately be shut down. Legal action must be taken against its executives." Doctors held a week long protest from 13 to 20 September to commemorate Turkish health workers who died from covid-19, carrying placards criticising the government's pandemic response. One said, "You can't handle it. We're burning out." Bahçeli called the protest a "treacherous plot." The authorities have targeted local leaders in the medical association since the pandemic began, with several ordered to surrender their passports and check in regularly at police stations. In March Özgür Deniz Değer, co-chair of the medical chamber of the eastern city of Van, was summoned by police after he criticised the government in an interview for not including political prisoners in a pandemic release scheme for detainees. In May, after tweeting his doubts about the government's health worker death toll, he was charged under a law that carries up to a four year sentence for "creating fear and panic among the people." The charges were later dropped, but the threat led Değer to self-censor, he told Science magazine. The co-chair of Şanlıurfa Medical Chamber, Ömer Melik, and its secretary general, Osman Yüksekyayla, have twice been detained and questioned by police. The first time, Melik had posted the number of local cases on the chamber's Twitter account. The second time, the chamber had raised concerns over deaths of health worker and lack of personal protective equipment. In April, Kayıhan Pala, a public health expert at Uludağ University, in the city of Bursa, was charged under the law against spreading panic, after a complaint from the governor of Bursa province. In a local media interview Pala had accused the government of understating covid-19 cases and deaths. The charges were eventually dropped after a public outcry. Scepticism over official covid-19 figures is widespread among Turkey's doctors. "The numbers of just one city, or just one or two medical chambers, are almost equal to the [official] numbers for the whole country," physician Halis Yerlikaya told Reuters at a hospital in Diyarbakir. The government does not release regional figures and has removed cause of death from public death registers. But the health minister, Fahrettin Koca, denied hiding cases at a press conference earlier this month, noting that official numbers were now rising fast. The Turkish Medical Association has long been a target of Erdoğan's government. Its entire central committee was arrested in 2018 after it criticised a Turkish military incursion into Syria. Eleven members, including its chair, Sinan Adıyaman, received prison sentences of 20 months or more. 1 These remain under appeal, and the doctors are currently at liberty. More than 3300 doctors were forced out of their jobs under a decree promulgated after the 2016 coup. The government later passed a law requiring all new medical graduates to obtain security clearance before working. 2 The law was struck down by the courts but is being rewritten. The harsh environment has fuelled an increasing medical brain drain to other countries, according to the medical association. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Doctors in Turkey who post information about local covid-19 cases on social media are facing harassment and criminal charges from authorities anxious to hide the extent of the pandemic's spread in the country, the Turkish Medical Association has said.

INTRODUCTION Health is one aspect of community and quality of life is an individual perception overall about happiness and satisfaction in life and the environment in which he lives. Public health status of a country is influenced by of health status of its citizens. Health's facilities reviewed in this study are health care services and health education institutions owned by the government and private state. Health service facilities that are being discussed in this section consist of: health centers, Hospitals, and Community Based Health services. The researcher conducted this study to come up with community mapping of the health status and health-seeking practices among the residents of Lampung, Indonesia. the status of the following demographic data regarding Lampung Province as illustrated in a community mapping initiative , A geographical condition, Population, Territory and population size, Crude birth rate, Trend net death rate, and Trend gross death rate The area of Lampung Province covers an area of 35288.35 km² of plains and islands located in the northern part of the southeastern most tip of Sumatra Island. Topographic areas are hilly. The mountainous area of Lampung Province consists of slope -steep slopes and steep with a slope of about 250 with an average altitude of 300 m above the surface of the sea. The area includes the Bukit Barisan with protrusions and the peak of Mount Gross Death Rate (GDR) is the total death rate of hospitalized patients per 1,000 patients. As with NDR, this indicator does not adequately provide quality assessment of hospital services in general, although the GDR is affected by the mortality rate less than 48 hours in general cases of emergency or acute. Lower GDR means better quality hospital services, but these figures can assess the quality of service when the mortality rate is less than 48 hours. Gross Death Rate (GDR) in Lampung Province in 2014 amounted to 30.86 per 1000 outpatient. This number is below the target of less than 45 patients death in less than 48 hours per 1000 outpatient. --- METHODS The literature suggested that Community Mapping and Health Seeking Practices among Residents of an Indonesian Village was an important data that described the most common causes of diseases and common causes of death among in resident of an Indonesian village. In this study, the researcher seeks to discover whether this was also true for the Lampung population. Community mapping and health seeking practices was of great interest because the data can be used to determine the ten most common causes of morbidity and mortality based on health belief, eating culture, and seeking practices the resident of the village. This study used the approach testing this theory. It also describes the theoretical approach and the methods employed. The researcher used also a self-made questionnaire, to get data about health belief, health eating culture, and health seeking practices among the residents of Pringsewu city. Random sampling was done. Validity and reliability test was conducted on twenty respondents. The correlation technique used to test product moment correlation for validity and test and Kuder Richardson formula 21 to test the reliability. The research design used in this study was descriptive survey design; detailed survey is devoted to gathering of information about prevailing conditions or situations for the purpose of description and interpretation. This type of research method is not just amassing and tabulating facts but includes proper analyses, interpretation, comparisons, identification of trends and relationships. Significance of the descriptive survey method concerned not only with the characteristics of individuals but with the features of the whole sample thereof. It provides information useful to the solutions of local issues (problems). In this study, the researcher utilized descriptive survey design. The participants in the study are chosen by random sampling. The dependent variable is geographic most common cause morbidity and natural mortality alongside with health belief, healthy eating culture, and health seeking practices (http://www.Studymode.com/essay/descriptivemethod) The research sample size is influenced an important factor such us homogeneity of the target population, the type of sample methodology, and the level of precision desired when sampling from a small and finite population of N individuals, the sample size may be obtained from the Slovin formula. The researcher used 100 sample for this study. --- RESULTS AND DISCUSSION The area of Lampung Province, covering an area 35288.35 km ² plains and islands located in the northern part southeastern most tip of Sumatra island, bounded by: Based on Table 6, the morbidity rate in the province of Lampung is 13.089%. Hypertension gets the highest, followed by URTI (upper respiratory tract infection), common cold, ear disease, diarrhea, diabetes mellitus, gastritis, rheumatoid arthritis, dyspepsia, and the lowest pharyngitis. Based on Table 17 above, the mortality rate in the province of Lampung is 0.088%. Heart disease as the number one cause of death followed by stroke, hypertension, COPD, diarrhea, diabetes mellitus, traffic accident, dengue fever, tuberculosis, lung cancer and others. --- CONCLUSIONS AND SUGGESTIONS The purpose of the study was to do community mapping and know the health-seeking practices among residents of an Indonesian village. Health-seeking practices is an important modifiable behavior which can be enhanced through knowledge by describing the most common causes of mortality and morbidity among the residents of an Indonesian village. The study utilized descriptive survey design to investigate the health beliefs, healthy eating culture, and health seeking practices among residents of Lampung Province. 1. What are the health beliefs, healthy-eating culture, and health seeking practices of people in Regency of Pringsewu based on the geographic mapping? Based on the data, the community health belief value of Lampung Province is 2.750 with the category of moderate. The value of health eating culture is 2.945 (moderate). Based on this data the people have a healthy-eating culture which is categorized as moderate. The value of health-seeking practices was 2.95 (moderate), meaning that people in Lampung have health seeking practices that is categorized as average. 2. Based on the rates of morbidity and mortality as well as health belief, healthy eating culture, and health seeking practices what is the geographical mapping that shows general health status of the people across the province of Lampung? Based on Table 6, the population in the province of Lampung had 13.089% morbidity rates. Hypertension gets the highest, followed by URTI (upper respiratory tract infection), common cold, ear disease, diarrhea, diabetes mellitus, gastritis, rheumatoid arthritis, dyspepsia, pharyngitis. Based on Table 17. The mortality rate of 0.088% in the province of Lampung has heart disease as the number one cause of death followed by stroke, hypertension, COPD, diarrhea, diabetes mellitus, traffic accident, tuberculosis, dengue fever, lung cancer and others. Lampung province has 14 government hospitals, one psychiatric hospital, one hospital DRT, one hospital Bhayangkara police, in addition to the government hospitals. There are 42 private hospitals composed of 30 general hospitals and 12 special hospitals. The people have healthy household practices, and a healthy way of life that can be seen from the percentage of healthy homes and lifestyle. Healthy housekeeping met the ten indicators that include assisting in the delivery by health personnel, exclusively breastfed infants, having health care insurance, not smoking, daily physical activity, eating vegetables and fruits every day, provision of clean water and latrines, and housing spaces with suitable floor area based on the number of occupants. Coverage of clean and healthy lifestyle in Lampung Province in the year 2014 has resulted to 59.2%. A positive local outlook on life is essential to wellness and each fulfilled the indicators. A "well" person is satisfied in his work, is spiritually fulfilled, enjoy leisure time, physically fit, socially involved and has a positive emotional and mental outlook.

The purpose of the study was to do community mapping and know the health-seeking practices among residents of an Indonesian village. Healthseeking practices is an important modifiable behavior which can be enhanced through knowledge by describing the most common causes of mortality and morbidity among the residents of an Indonesian village. The study utilized descriptive survey design to investigate the health beliefs, healthy eating culture, and health seeking practices among residents of Lampung Province. Based on the data, the community health belief value of Lampung Province is 2.750 with the category of moderate. The value of health eating culture is 2.945 (moderate). Based on this data the people have a healthy-eating culture which is categorized as moderate. The value of health-seeking practices was 2.95 (moderate), meaning that people in Lampung have health seeking practices that is categorized as average. Coverage of clean and healthy lifestyle in Lampung Province in the year 2022 has resulted to 59.2%. A positive local outlook on life is essential to wellness and each fulfilled the indicators. A "well" person is satisfied in his work, is spiritually fulfilled, enjoy leisure time, physically fit, socially involved and has a positive emotional and mental outlook.

Interpersonal Factors First and foremost, interpersonal factors are wellestablished risk factors for suicide, including social isolation, 5,6 loneliness, 6 lack of belonging, 7 and perceived burdensomeness. 7,8 Residents of rural communities are more likely to experience social isolation, relative to those living in urban communities. 9 As rural areas tend to be less densely populated, social support can be more difficult to obtain during acute suicidal crises. These interpersonal risk factors for suicide are likely to be exacerbated amidst the current pandemic, especially among vulnerable populations (eg, those who are elderly or immunosuppressed), who may experience greater physical isolation due to concerns about infection. 10,11 Life-saving physical distancing i policies aimed at "flattening the curve" 12 may also inadvertently exacerbate social isolation, thwarted belongingness, and perceived burdensomness. 13,14 For example, quarantine, mandatory teleworking requirements, and community-based closures may prompt social isolation, as well as decreased belongingness and increased burdensomness. 13,14 In addition, major stressors, such as housing instability, 15 unemployment, 16 and health-related concerns 17 characteristic of this pandemic may increase perceived burdensomeness and risk for suicide. 18,19 Another key interpersonal risk factor that also may be exacerbated during the COVID-19 pandemic is interpersonal violence (ie, physical or sexual violence, such a Intended to be used in conjunction with professional treatment. CBT-I, cognitive behavioral therapy for insomnia. as childhood abuse or intimate partner violence), 20,21 which is associated with increased risk for suicide. 22 This is particularly concerning for those living in rural communities, where intimate partner violence tends to be more severe, chronic, and is associated with worse health and psychosocial outcomes, 23 compared to urban settings. Unfortunately, resources for addressing interpersonal violence in rural communities are more limited, with more barriers to help-seeking (eg, confidentiality concerns, local politics, distance), greater areas of need for specific services, 24 and cultural norms that can deter disclosure and help-seeking. 23 Thus, it will be critical to address these interpersonal risk factors for suicide in rural communities during and following the COVID-19 pandemic. Finding alternate ways to decrease social isolation and maintain connectedness and belongingness while adhering to physical distancing is paramount. Although telephone and virtual communication can be used to maintain social connectedness, many individuals in rural communities lack reliable access to high-speed Internet. 25 Consequently, accomplishing and maintaining social interaction in rural communities may require nuanced and creative solutions. One potential strategy involves engaging in social interactions outdoors while adhering to physical distancing guidelines, which may be more feasible in rural areas since they often maintain open space. In addition to potentially increasing social connectedness, being outdoors also may help to bolster mood 26 and promote mental health. 27,28 Rural communities could also set up means of identifying individuals who are vulnerable or struggling to ensure that they feel connected and cared for. Helping individuals to derive a sense of purpose is also critical to offsetting the perceived burdensomeness that can accompany major financial stressors and health concerns. 17,29,30 "Pulling together" by collectively engaging into meaningful, value-driven activity during crises can attenuate the impact of perceived burdensomeness, while concurrently increasing belongingness. 31 It can also promote resilience, 32 and individual and collective sense of control. 30 Moreover, as individuals experience a greater sense of purpose, meaning, and connectedness, they are more likely to experience decreased risk for suicidal ideation and suicidal self-directed violence. [32][33][34] Thus, providing rural communities with the resources to come together to increase sense of purpose, while simultaneously protecting the most vulnerable community members from infection, is integral. One option for beginning to address this is for rural communities to create opportunities for remote volunteering (eg, fundraising or providing supplies for individuals who are unable to leave their homes) through local organizations or grassroots efforts. Of note, it may be particularly important for communities to come up with specific solutions themselves, both to increase efficacy in doing so as well as to increase feasibility and sustainability of different community-based efforts. To address interpersonal violence, rural communities can disseminate information regarding interpersonal violence resources, such as toll-free hotlines, chat lines, and community-based clinics and services. Rural providers can also increase efforts to screen their patients for interpersonal violence and ensure that those with histories of interpersonal violence have safety plans available. Beginning a conversation about interpersonal violence as a community also may be key to decreasing stigma and increasing the likelihood that rural community members who experience interpersonal violence will seek help for these experiences, whether formally or through other community supports (eg, family, friends). --- Access to Firearms Another key risk factor for suicide that may be exacerbated during the COVID-19 pandemic involves access to firearms, 35,36 the leading means of suicide in rural communities. 37 Individuals in rural communities are more likely to own firearms, including multiple firearms. 38 Recent media reports have described individuals acquiring firearms and ammunition as a result of fears regarding COVID-19. 39 Thus, previous firearm owners may have obtained additional firearms and ammunition, while the number of firearm owners overall has likely increased. This is particularly concerning given the stressful nature of the current pandemic, including exacerbation of key risk factors and potential decrease in protective factors. Thus, another key consideration for preventing suicide in rural communities during the COVID-19 pandemic entails increasing safe firearm-related behaviors. This would align with national suicide prevention recommendations more broadly, which include reducing access to lethal means, such as firearms, for populations at increased suicide risk or during periods of elevated risk for suicide. 40,41 Moreover, this is a critical time to ensure that knowledge regarding the risk associated with firearm access is disseminated to rural communities. It may be particularly important to implement public health messaging that communicates the benefits associated with safe firearm storage (eg, locked, unloaded), 42 as well as options for temporarily reducing firearm access for individuals at elevated risk for suicide. 43,44 --- Mental Health and Access to Care Finally, mental health symptoms and diagnoses are wellestablished risk factors for suicide, 45 and there is the potential for onset or exacerbation of mental health symptoms during the COVID-19 pandemic-whether due to fear and anxiety regarding infection, or the prolonged physical distancing, disruptions, and uncertainty created by this unprecedented and potentially lethal pandemic. [46][47][48][49] This may disproportionately affect individuals in rural communities, who already experience increased stigma regarding mental health, suicide, and help-seeking. [50][51][52] Furthermore, due to existing shortages of mental health providers in rural communities, many individuals in rural areas rely upon primary care providers to provide mental health screening, resources, and treatment. [53][54][55] However, concerns about infection and triaging the most medically severe patients during the COVID-19 outbreak may further strain primary care providers' ability to provide such services. Ensuring that individuals in rural communities have access to mental health care during and following the COVID-19 pandemic will be a challenge. Addressing this may include increasing dissemination of public health messaging regarding avenues for obtaining mental health care (eg, telehealth) and crisis support (eg, national and local crisis lines) in rural communities, as well as continued destigmatization of mental health care. Family and friends can encourage one another to seek treatment if experiencing emotional distress and can share their own experiences with seeking help. Increasing dissemination of free web-based applications may also help to facilitate coping for a broad range of concerns. In addition, this is likely a particularly important time for rural health care providers to screen for mental health symptoms (eg, depression, anxiety, posttraumatic stress disorder, substance use). For rural patients most at risk, ensuring continued access to mental health care (eg, telehealth) will be key. In sum, individuals in rural communities may be disproportionately impacted by the COVID-19 pandemic. 56 Many of these risk factors for suicide can interact with one another to further compound risk. Nonetheless, many of these solutions also may be synergistic in potentially mitigating these risks. Ensuring that rural communities are adequately equipped to prevent suicide while managing the spread and impact of COVID-19 is critical. --- Endnote i. While the term "social distancing" has been used to describe social isolation measures to limit the spread of COVID-19, we use the term "physical distancing" instead to describe recommended physical barriers (eg, sheltering in place and maintaining at least 6 feet of distance from nonhousehold members).

, mental health, psychology, social determinants of health, utilization of health services. Individuals in rural communities are at increased risk for suicide. 1,2 While the impact of Coronavirus Disease 2019 (COVID-19) continues to unfold, 3 it is likely that suicide risk factors among individuals residing in rural areas will be exacerbated and suicide rates may subsequently increase. 4 Awareness of these factors is essential to ensure that appropriate steps are taken to prevent suicide in rural communities, both during and in the aftermath of this pandemic. In this commentary, we delineate key considerations for doing so, with potential solutions summarized in Table 1.

Introduction Since its independence, the Uzbek government has put into several laws on concerning implementation of policy of high social defense. This attention was also adjusted to Orphan houses. But to educate fosterlings of orphan houses, to satisfy their needs and to be cared only by the government is considered not enough. For their destiny each member of the society has to be responsible for orphan houses. Thus, a main task of pedagogics is to provide increasing the function of public works along with the government in the process of preparing fosterlings of orphan houses to social life. --- Methods In the initial level of taking steps into independent life every youth usually needs so-cial aid. In that case the family satisfies their necessity but to bring up children and teenagers as an independent person is required a great power and attention from the government and society. The main purpose of orphan houses is considered social maintenance for fosterlings and this intention is completed when educational works and trainings are done reciprocal. In that case it is expedient to organize measures which include interaction of family. During such kind of measure the following should be acquired: adults should care about children, they should respect other people and parents, be on good terms with family members, understand to each other, and respect others' feelings and opinion. Several trial and experimental works were organized in order to use basic tenden- The European Journal of Education and Applied Psychology 2023, No 4 Section 5. High professional education cies and theoretical concepts of preparing fosterlings of orphan houses to family life in practice and to learn the results of them. As an experimental field five Orphan houses in Fergana, Andijan and Namangan regions which situated in Fergana valley were chosen. The respondent-fosterlings who were enlisted to experimental works were 494 altogether in five orphan houses. Developing practice of family life is considered one of orphan houses, According to it, following themes were chosen as an intensive factors: "Bases of family life", In the threshold of coming of age." (conversation), "Specific peculiarity of coming of age" (meeting with gynecologists), "Secret sentences" (meeting with urologists), "Can you manage family effectively?", "The ways of preventing family problems" (question-answer), "The terms of organizing good relationship in the family", "AIDS: the reasons and results of this illness" (a mini-lecture), "Are you ready to marry?" (competition among girls), "Dear men, you are superior of a family" (Competition among boys), "Faults in the coming age", "What is more important in the family: love and belief?", "Reproductive health: how can it be saved?" (Discussion and debate), "A modern family: how it should be imagined?", "In my opinion: a prosperous and lucky family is… (Debate)", "Five important factors of good relationship in the family". "The main rules of spending and saving money" (Training). Different technological projects, interactive methods which were organized in order to introduce family life to fosterlings of orphan houses guaranteed their effective results as they based on participation of fosterlings and their ability of thinking independently. --- Result and discussion Several measure`s structures were used which help to prepare fosterlings to family life and projects' schemes were formed which were based on theoretical concepts of family life. --- Table 1. Theoretical concepts of family life --- No The name of project Schemes of project Amount of respondents were enlisted to experimental and superintendence group as a result of casual choice, in order to organize actions as based on above projects, using special methods in practicing which is concern family life and to check its results and convenience for practice. To have initial knowledge about family life helps to understand what is family, its importance, to respect family, to have practice about managing family economy, to learn how to create family budget, to feel responsibility for bringing up children and to create spiritual and mental healthy environment in the family. Although the degree of developing practice about family life in consciousness of fosterlings in orphan houses showed positive degree such as(high and average degree is 57%) but according to superintendence groups, more than 50% of respondent-fosterlings don`t have enough knowledge about family life, their practice to manage family economy is very low and they cannot create family budged independently. According to affirmed experiment the dynamical changes of experiments were learned in order to show real summary of special project which was considered appropriate for practice in the process of preparing fosterlings of orphan houses to family life. By the indexes of the table the good result of project which applied in order to give conception about social life to fosterlings of orphan houses are comprehended. --- Conclusion The proof of foresaid information can be confirmed by re-counting two results by mathematic-statistical date. So, we did statistical analysis based on preparing orphanage children for family life. As a statistical analysis showed the result of the fosterlings were received. These indexes were analyzed according to Student-Fisher`s method. According to its essence this method is observed that the degree of theoretical knowl-edge and practical concepts of fosterlings of "Orphan houses" are in higher degree than respondents of superintendence groups. The republic fund of "Mahalla", scientific and practical center "Oila" with the help of community, "Family day" was organized in orphan houses and also it is arranged that bringing fosterlings to families during their holidays in order to approach them to family life. Consequently, approaching to organize trial and experimental works showed expected results. As projects were based on, certain technologic plans resulted in increasing of their advantages and also providing fosterlings interests to their activities.

In the article, teaching of family life skills and practices to students of mercy homes is analyzed in detail. also, at the end of the article, there are suggestions and recommendations for developing family life skills and practices in the students of mercy houses.

With an aging US population, more people than ever live with serious illnesses. Although palliative care (PC) can improve outcomes in serious illness, there are inequities in PC utilization. People with low socioeconomic status (SES), men, and Black and Hispanic people are less likely to receive and benefit from PC services. Despite these established demographic differences in PC utilization, there is a dearth of relevant survey research on preferences for PC in the general population. To address this gap, we surveyed a random sample of 1,500 NJ adults. Respondents were given a brief definition of PC and asked to indicate how likely they would be to schedule, attend, and routinely attend PC visit(s) if they were diagnosed with a serious illness. Predictors included in logistic regression modeling were SES indicators (income, educational attainment, insurance status, employment status), gender, and race/ethnicity. Data were weighted to be representative of the population of NJ. Modeling results revealed that lower income and lower educational attainment were associated with significantly lower odds of endorsing willingness to schedule, attend, and routinely attend PC visits in the event that one would become seriously ill. Unexpectedly, there were no gender or race/ethnicity differences in preferences for PC. These findings highlight the importance of public health education for what PC is and its benefits for an aging population, especially among those with lower SES. Future research efforts are needed to understand discrepancies in reported PC preferences versus real-world PC utilization for men and Black and Hispanic individuals. Abstract citation ID: igad104.1651 --- NO PENSION, NO HAPPINESS?-FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS Chengming Han, and Nan Zhou, Case Western Reserve University, Cleveland, Ohio, United States Objective. This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The analytical sample included 10641 respondents who were older than 45. Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others. Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou). Results. More than half of the sample reported that they would rely on their children when they became too old to work. Those who reported that they would rely on themselves (b=-1.72, p=0.000) or pensions (b=-1.23, p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children. When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms. Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms. However, the hukou status inhibited the mediating effect of pension and health insurance. Introduction Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Which frailty tool is ideal for risk stratification remains unclear. We calculated three frailty scores from the Million Veteran Program (MVP) and examined their association with mortality and CVD in older Veterans. Methods Participants were from MVP -a large, contemporary Veteran cohort study -and aged ≥50 years at baseline (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). The frailty scores used were: MVP-FI (36-item questionnaire deficit accumulation frailty index), VA-FI (31-item EHR index), and modified Study of Osteoporotic Fractures (mSOF; a physical frailty score). MVP-FI and VA-FI scores of ≤0.10 were robust, 0.11-0.20 pre-frail, and ≥0.21 frail; mSOF scores of 0 were robust, 1 pre-frail and ≥2 frail. Primary outcomes were all-cause and CVD mortality. Secondary outcomes were incident stroke, myocardial infarction (MI), and heart failure (HF). Cox regression was used to evaluate the association of frailty with outcomes. Results Among 190,688 participants, mean age was 69 ±9, 94% were male. By MVP-FI, 29% were robust, 42% pre-frail, and 29% frail. Hazard ratios (HR, 95% CI) for all-cause mortality were 1.66 (1.61-1.72) and 3.05 (2.95-3.16) for pre-frailty and frailty, respectively. For CVD mortality, HRs were 1.76 (1.65-1.88) and 3.65 (3.43-3.90) for pre-frailty and frailty. Hazards of stroke, MI, and HF also increased with greater frailty. VA-FI and mSOF yielded concordant results. Conclusion Irrespective of measure, frailty is associated with increased all-cause mortality and CVD event risk. Clinicians and researchers may consider the most convenient tool for available data to incorporate frailty into practice. Abstract citation ID: igad104.1654 --- DEVELOP AND EXTERNALLY VALIDATE A RISK PREDICTION MODEL FOR SCREENING COGNITIVE FRAILTY IN OLDER ADULTS Wenting Peng, Yuqian Luo, Cen Mo, Kehan Liu, and Minhui Liu, Central South University, Changsha, Hunan, China (People's Republic) Cognitive frailty, the combination of physical frailty and mild cognitive impairment, is a growing public health concern in aging populations. We aimed to develop and validate a risk prediction model for screening cognitive frailty in community-dwelling older adults without probable dementia (aged ≥ 65 years). We used Year 2011 data from National Health and Aging Trends Study (NHATS), with participants randomly divided into the training set (N=4,222) and internal validation set (N=2,111). We used Year 2015 data of NHATS as the external validation set (N=3,380). Cognitive frailty was assessed with the Fried phenotypic criteria and cognitive performance in three domains (memory, orientation and executive function). Independent risk factors were screened by multivariate logistic regression analysis. Model performance was assessed by discrimination (area under the curve [AUC]) and calibration (Hosmer-Lemeshow test). The final model included 13 key predictors (age, gender, education, smoke, walking for exercise, vigorous activity, self-rated health, depressive symptoms, balance impairments, arthritis, hospitalization, activities of daily living, and instrumental activities of daily living score). The model showed good discrimination with

that 1.) between-person levels, not within-person fluctuations, matter, and 2.) between-person levels matter across all ages. Openness to Experience, Conscientiousness, and Extraversion predicted earning a higher yearly income; Neuroticism predicted earning a lower yearly income. Effects sizes for traits were comparable to that for parental education. Our results shed light on how people navigate social structures across the lifespan.

INTRODUCTION Child labour is a persistent social phenomenon of public health concern, found in most developing nations, and to a lesser extent in developed countries. 1 According to the International Labour Organization (ILO), child labour is defined as "work that deprives children under the age of 18, of their childhood, their potential and dignity and that is harmful to their physical and mental development". 2 It obstructs their access to education or interferes Family; Household; Practices; Rural; Urban with their ability to attend regular school, and the acquisition of skills. 2 This could potentially negatively impact the achievement of Sustainable Development Goals (SDGs) 3 and 4 (good health, well-being and achieving quality education). However, certain chores such as sweeping and washing dishes done by children cannot be categorized as child labour because such tasks are typically considered age-appropriate and part of a child's learning and development process. 2 It has been estimated that the number of children aged 5 to 17 years engaged in hazardous work -defined as work that is likely to harm their health, safety or morals has risen by 6.5 million to 79 million since 2016. 3 According to the Multiple Indicator Cluster Survey (MICS) by United Nations Children's Fund (UNICEF) in 2018, about 50.8% of Nigerian children, ages 5 to 17 years, were involved in child labour. 4 Child labour exists in urban and rural areas, but it is found to be more prevalent in urban areas due to rural-urban migration in search of economic opportunities. 5 Child labour in urban areas frequently involves work in the informal sector. For example, children may be engaged in street hawking, garbage picking, or working in small workshops. 6 Also, domestic labour is a significant concern in urban areas worldwide. 7 In sub-Saharan Africa, hawking and street trading appear to be the most popular forms of child labour. 8 In urban cities, a prevalent child labour practice involves children working as house-help under the care of affluent individuals. These children are often promised access to education but frequently end up as domestic servants responsible for tasks such as laundry and kitchen duties. 9 In Enugu metropolis, the prevalence of child labour among junior secondary school children in the 9-17 years age range was 71.7%, with the most common type of child labour being domestic housework. 10 In rural communities, the mainstream work is agriculture and the vast majority of all child labourers are unpaid family workers. 11 Child labour in agriculture such as farming, fishing, aquaculture, forestry, and livestock is a global phenomenon found in all regions of the world including Nigeria and it accounts for 60% of all child labourers ages 5 to 17 years. 12 Other forms of child labour include children in armed conflict, commercial sexual exploitation, trafficking and so on. 13 Poverty serves as both a cause and a consequence of exploitative child labour. 3.14 This complex issue is further exacerbated by a strong correlation between illiteracy and child labour. Additionally, it is often observed that female children bear a heavier burden of child labour compared to their male counterparts, highlighting the intersection of gender disparities in this challenging context. 14 Child labour not only deprives children of their right to education but also places them at significant risks. 15 Many child labourers are unable to attend school regularly, resulting in lower literacy rates and diminished opportunities for future employment. Also, working in hazardous conditions exposes these children to various health risks, including physical injuries and exposure to harmful toxins, which may lead to long-term health problems. 16 Beyond the physical toll, child labour can exact severe psychological and social consequences. Children often suffer from stress, anxiety, and social isolation due to their working conditions. 17 In Nigeria, although laws and policies have been enacted to combat child labour, parents in both urban and rural areas continue to involve their children in labour. 3 Local Government Areas (LGAs) of which 16 are urban and 4, rural. 19 The study locations were Ikeja (urban) and Epe (rural) Local Government Areas respectively. Ikeja is the capital of Lagos State and it occupies a land area of 9.92km square with a population of 437,400 in the 2016 estimate. Ikeja is an industrial area with the largest international airport in Nigeria and many local and international companies, educational and health institutions. 20 LGAs. The mean age was higher in the urban group and the urban women were better educated than their rural counterparts. The index child involved in child labour was older in the urban than in the rural group (p<0.001). --- Facts and figures by the ILO indicate that child labour is mainly a rural issue and is often invisibly hidden in remote farms. 25 The results from this study indicated that more than half of the rural respondents agreed with the statement that child labour was an alternative to education higher than their urban counterparts. This finding is similar to a Ghanaian study in which some parents did not consider basic education to be the right of a child. 26 More rural respondents supported that child labour made a child responsible in line with the economic and cultural context of child labour as a means of socialization in society among the respondents in the Ghanaian study. 26 The majority of respondents in both the urban and rural groups expressed agreement with the statement that children were vulnerable to exploitation by employers. This points to a concerning aspect of child labour practices. Among the factors driving the demand for child labour is the perception that children are more compliant, less knowledgeable about their rights, and generally easier to exploit. 25 This perception encourages a cycle of exploitation, as employers may exploit children's vulnerability for their own benefit, leading to a continued prevalence of child labour in both urban and rural areas. A higher proportion of rural mothers expressed the view that child labour was primarily a product of poverty, identifying it as the most notable force pushing children into the workplace. 27 This perspective aligns with findings from other studies, which consistently show that child labour is more prevalent in economically disadvantaged communities. [27][28][29] A substantial majority (65.0%) of respondents in the urban group believed that child labour should be abolished in contrast with rural respondents where only 28.0% shared this viewpoint, while a considerable 65.5% remained undecided on the matter. This high proportion of undecided rural respondents may be indicative of the cultural acceptance of child labour as a means of supplementing family income in these areas. 27 The urban child labourers who received a salary were more than half and higher than those in the rural setting. This finding is similar to that of children who worked in the urban cities and towns in Cross River State who were paid for their services, unlike their counterparts in rural areas. 31 Other kinds of payments received by about one-fifth of children in both urban and rural settings are provision of accommodation and upkeep. Another study found that children in rural areas work for their families, and hence most are not paid in cash for the services. 32 Those against the ban on child labour argue that if children are not allowed to work, they and their families will end up worse off and these children often work to help impoverished families meet basic needs. 30 The commonest form of child labour among the rural respondents was hawking followed by working as a house help and a similar trend was seen in their urban counterparts. These findings were similar to the study in Lagos State. 33 In Cross River State, engaging as a house-help was the highest child labour practice followed by hawking in the urban region. 31 Other studies in Nigeria also reported house-help as the most common child labour practice in urban areas. 1,9 However, some studies found farming as the most prominent child labour practice in the rural area. 31 This difference may be a result of the cosmopolitan nature of Lagos State. In conclusion, it was observed that children

Background: Child labour is a social phenomenon of global concern with serious consequences for child development, education and well-being. This study compared the pattern, attitude and child labour practices in urban and rural areas of Lagos State.This was a descriptive comparative cross-sectional study among mothers of children ages 5 to 17 years. A multistage sampling technique was used to recruit 400 participants. The data was collected using a pre-tested, standardized questionnaire on child labour for household surveys. The data was analysed using Statistical Package for Social Sciences IBM (SPSS) version 20 software and the level of statistical significance was set at p<0.05. Results: Urban mothers were older (43.811.8 years) compared to rural mothers (41.9 12.7 years), and a higher percentage of urban mothers (52.5%) had secondary education in contrast to rural mothers (25.5%). Child labour was more prevalent among children aged 5 to 10 years in rural areas (55.5%) compared to urban areas (44.5%). Within the past year, 33.8% of urban children and 66.2% of rural children were involved in labour and hawking was the most prevalent work in 31.0% and 69.0% of urban and rural children. The majority of rural child labourers (68.4%) and 31.6% of urban child labourers worked 8 to 10 hours daily, with a statistically significant difference (p <0.001), primarily due to family support.There is a need for increased and continuous awareness campaigns aimed at educating communities, parents, and children about the detrimental effects of child labour on their overall well-being.

brain -from palpation of bumps on the scalp (phrenology) in the 19th century, through electroencephalography in the 1970s, and magnetic resonance imaging (MRI) today. These technologies have striking material differences, giving the impression that neuroscience has progressed in big strides. But they share a fundamental assumption: that abnormalities of brain form and human function are closely and predictably related. This assumption may be accurate when, for example, linking a blood clot in a particular part of the brain to the sudden paralysis in a limb. But as Part 2 of the book explains, neuroscience does not stop there. MRI scanning is also used to examine the brains of children who have experienced social disadvantage, on the assumption that it will be possible to a) identify 'damage' caused by physical and emotional neglect in early childhood, b) conduct scientific studies to find ways of 'repairing' that damage, and c) intervene early to prevent long-term sequelae. The infant brain is depicted as 'precarious', necessitating a science of 'early intervention' and 'perfecting people' through interventions directed at the growing brain. Enter epigenetics with echoes of Lamarck's pre-Darwinian notion, long thought to be discredited, that acquired characteristics can be inherited. Your genome is (broadly speaking) the genes that sit (mostly) on your chromosomes and (a little) on your mitochondrial DNA. Your epigenome is everything else needed for those genes to be expressed. Epigenetics -the study of how gene expression is modified by environment -is a shadowy character in scientific stories these days, because the link between 'environmental influences' (read: the social determinants of health) and adverse brain development is currently hazy. The important thing to discover, say epigeneticists, is how particular environmental influences alter gene expression at the molecular level. Notwithstanding various 'breakthroughs' reported in the popular press, discoveries to date are preliminary. But it would appear that adverse environmental influences lead -for example, through a biochemical process called methylation -to sections of chromosomes becoming so tightly coiled that the genes on those sections are never expressed either by the individual who has experienced the disadvantage or by his or her children (and, perhaps, their children's children). It would appear. Actually, as Wastell and White explain, experiments in this branch of science suffer from three recurring problems: small (and often uninterpretable) effects, lack of a plausible chain of causality, and lack of replication. Putting aside the contested nature of the findings, the stage is set for a heroic story of saving future generations from the effects of disadvantage by reversing the biochemical processes that mediate it. Differences in MRI scan findings between disadvantaged and non-disadvantaged children have been hailed as evidence that material and emotional neglect leads (via an as-yet ill-defined set of chemical reactions) to physical damage in particular parts of the brain. And given that it occurs, it can surely be fixed by scientists. To that end, animal models are bred and studied (inducing and repairing lesions in carefully targeted anatomical sites) '… to produce findings which seem to transfer so convincingly from the laboratory cage to the disadvantaged housing estate' (page xii). Meanwhile, in the parallel universe of the social sciences and humanities, a substantial evidence base has been accumulating for decades on the social determinants of health, the intergenerational cycle of disadvantage, the ethics of human rights, and the efficacy and acceptability of social and political interventions to address these issues -all of which are briefly covered. But as these authors point out, the neuroscienceepigenetics story is currently enjoying more legitimacy, attracting more grant funding, and beginning to cut more policy ice than the tired old structure-agency-identity and discourse-ideology-critique stories. This book depicts the neuroscienceepigenetics train straying onto the social science track at rapidly accelerating speed. Will this train come to rest alongside other dystopian scientific narratives (such as eugenics, Tuskegee, and Porton Down) in a shameful historical siding? Or will the powerknowledge nexus that links super-science with the bright stuff of policy dreams take this train and its reductionist view of humanity crashing into the future? Only time will tell. Trisha Greenhalgh, Professor of Primary Care Health Sciences, University of Oxford, Oxford. Email: trish.greenhalgh@phc.ox.ac.uk @trishgreenhalgh DOI: https://doi.org/10.3399/bjgp18X696065

Science is one big story. Or, more accurately, it is lots of stories: conflicting, contested, merging, evolving -and sometimes ossifying, constraining, and distorting. Wittgenstein referred to the 'railway tracks' of science: the unspoken assumptions and shared ways of thinking within a scientific community, without which science cannot progress, and Thomas Kuhn talked of research paradigms: shared and evolving ways of conceptualising, theorising, empirically studying, and arguing about scientific topics. In their critique of an emerging new paradigm, David Wastell (a cognitive neuroscientist) and Sue White (a social scientist) offer an interdisciplinary text in two parts: 'Getting to grips with the thought styles' (an overview of the shared assumptions, practices, and methodologies on which modern neuroscience is based) and 'Fixing real people' (a critique of contemporary empirical findings and applications of neuroscience, especially in relation to social disadvantage). In Part 1, the authors explain that neuroscience asks questions like 'Which part of the brain is responsible for which function?' and 'What happens when that part of the brain is damaged?' A core assumption, which many neuroscientists share but these authors emphatically do not, is that social disadvantage operates principally by causing organic damage and dysfunction of the central nervous system, especially during vulnerable periods in fetal development, infancy, and early childhood. Part 1 includes a historical review of technologies used for examining parts of the

Introduction The past 3 years have seen a record number of mass shootings that have long-lasting consequences for survivors, victims' families, and those who address the aftermath of the shooting. 1,2 There is increased awareness of the prevalence and persistence of traumatic stress for first responders and health care professionals responding to mass casualty events. 3,4 Typically, secondary or vicarious trauma is assessed with practitioners working directly with people experiencing a traumatic event. 5 There is scant research on the mental health well-being of professional staff at social service agencies embedded in the impacted communities. Staff may provide immediate and then ongoing social and educational services either directly or indirectly to families, survivors, and the broader community after a mass casualty event. This study comprises staff at human service organizations and educational institutions in the neighborhood where 11 congregants were murdered on October 27, 2018, at the Tree of Life synagogue in Pittsburgh, Pennsylvania. We describe the prevalence of positive screens for mental health disorders and substance use among employees and examine differences among staff working directly with the community, senior-level administrators, and support staff. --- Methods This cross-sectional study was approved by the University of Pittsburgh institutional review board as exempt from the need for informed consent because the survey was anonymous and the study posed minimal risk to the participants. Eleven months after the shooting at the Tree of Life synagogue, we emailed executives of 12 nonprofit social service agencies and educational institutions located in the impacted community. Eight agency executives agreed to email their staff (374 individuals) the study purpose and a survey link. A reminder was emailed 1 month later. The survey averaged 20 minutes to complete. Mental health measures (specific measures are listed in the Table footnotes) included screens for depression, suicidal ideation, generalized anxiety disorder, posttraumatic stress disorder, alcohol misuse, marijuana use, and drug use for nonmedical reasons. Furthermore, items related to employment burnout were included. A 1-sided Pearson χ 2 test was used to test primary work role differences in reports of positive screens, and statistical significance was set at P < .05. Data analysis was performed from December 2019 to March 2020 using SPSS statistical software version 25 (IBM). --- Results Ultimately, 167 staff members (44.6%) completed the anonymous online survey, and 156 (41.7%) provided the necessary information. Participants were primarily women (125 participants [80.1%]). a A variable was created for having any positive mental health screen that included assessing as positive for the Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, Primary Care for PTSD Screen for DSM-5, or suicidal ideation. b The Patient Health Questionnaire-2 was used to screen for the frequency of depressed mood and anhedonia over the past 2 weeks. The cutoff point is a score of 3 (range, 0-6). c Suicidal ideation in the past 2 weeks was ascertained by asking the ninth question on the Patient Health Questionnaire-9, which asks respondents whether they have had thoughts that they would be better off dead or of hurting themselves. The cutoff point is a score of 1 (range, 0-3) for having suicidal ideation (several days, more than half of the days, or nearly every day). d Screening for generalized anxiety disorder in the past 2 weeks was assessed via the Generalized Anxiety Disorder-7. The cutoff point is a score of 10 (range, 0-21) for having moderate or severe symptoms. e The Primary Care PTSD Screen for DSM-5 is a 5-item screen to identify respondents with probable posttraumatic stress disorder in the past month. The cutoff point is a 3 score of (range, 0-5). f Current alcohol misuse was identified with the Alcohol Use Disorders Identification Test, a 3-item alcohol screen, to identify respondents who are hazardous drinkers or have active alcohol use disorders. The scores are summed from 0 to 12. The cutoff point is a score of 4 for men and 3 for women. Those whose score was over the cutoff but whose scores were from item 1 only were not considered as having a problematic drinking issue. g Marijuana use in the past year was assessed by the question, "How many times in the past year on average have you used marijuana for non-medical reasons?" Respondents were defined as users of marijuana if they self-reported use more than once per month. h Defined as respondents who in the past year self-reported using an illegal drug or a prescription medication for nonmedical reasons more than once per month. i Defined as respondents answering sometimes or often about their current work situation experiences in the past month. --- JAMA Network Open | Psychiatry --- Discussion The extent to which there are positive mental health and substance use screens and no differences by work position suggests that a mass shooting is a collective trauma and that professionals within an organization are not immune from the effects, regardless of position. These findings suggest that agencies should assess their organizational capacity for addressing secondary trauma and related mental health concerns among their staff. 6 Prevention and intervention strategies should focus on all levels of the organization to promote staff wellness. 6 This study has some limitations. Because it is a cross-sectional study, the data only capture a specific point in time, other unmeasured factors might account for these findings, the findings are not generalizable, there was a low response rate, and nonrespondents may differ from respondents. Studies of similar organizations in other communities following a mass trauma event are necessary to examine other factors, such as coping and social support, that might mitigate negative outcomes. --- Drs Engel and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Introduction The number of new HIV infections remains a concern in Spain. The latest data published in November 2013 by the Service of Epidemiological Surveillance of HIV/AIDS (Ministerio de Sanidad, Servicios Sociales e Igualdad, 2013) indicates that transmission among men who had sex with other men (MSM) is the most important affected population. Among men, the MSM transmission accounted for 61% of new HIV diagnoses in Spain in 2012. Among women, however, heterosexual transmission is the main category, with 85% of newly diagnosed. This report highlights that the main route of transmission is sexual risk behaviors. In addition, MSM is the collective of priority intervention followed by heterosexual women (Ministerio de Sanidad, Servicios Sociales e Igualdad, 2013). One of the personality variables associated with health behavior in sexuality is Sexual Sensation Seeking (SSS). This dimension was defined by Kalichman et al. (1994) as the tendency to obtain optimal levels of sexual arousal and engaging in novel sexual experiences. People who score high in SSS usually take part in situations which are considered harmful and risky by people who score low. In adolescents and young Westerners, the SSS is related to a broader range of risk behaviors for HIV/STIs as a higher number of sexual, less use of condoms and other forms of protection during their last sexual intercourse (Voisin, Hotton, Tan & DiClemente, 2013) which are prevalent among Spanish young (Ballester, Gil, Giménez & Ruiz, 2009), or risky use of cybersex and more online sexual compulsivity (Ballester, Castro, Gil & Giménez, 2013). In particular, regarding SSS there are some comparing studies between men and women. Among the studies focused on heterosexual population, the research by Flanders, Arakawa and Cardozo (2013) and the research by Gaither and Sellbom (2003) stand out. Both of them were based on American people who revealed higher Sexual Sensation Seeking for young men than for young women. As well as the study by Erol (2007) with Turkish population, who revealed higher SSS among Turkish young men comparing with women. In this sense, Ballester, Gómez, Gil and Salmerón (2012) found more sexual compulsivity in Spanish young men than in Spanish young women. In addition, there is a comparing study between men and women in homosexual population from Spain (Morell, Gil, Ballester & Castro, 2013). These studies agree the higher sexual sensation seeking for men compared with women. That is, heterosexual and homosexual men reveal higher levels in SSS than heterosexual and homosexual women. As regards the comparing studies of SSS, between heterosexuals and homosexuals, there are also few studies. The first one based on men (McCoul & Haslam, 2001) evaluated sexual sensation seeking in heterosexual and homosexual adult men from New York. This revealed more scores of SSS Scale for homosexual men than heterosexual men. Later, Bancroft et al. (2004) concluded trough different studies that sexual disinhibition would be a predictor for heterosexuals and homosexuals, connecting sexual risk behavior and SSS. The second study, based only on women (Farely, 1993), showed higher scores in SSS for homosexual women, as well as more disposition toward sexual fantasy, stronger sexual desire and higher frequencies of sexual activity. Therefore, there is still unknown if heterosexual women will reveal more or less SSS levels than homosexual men. This is because there is a lack of comparative studies between heterosexual and homosexual population in men and women (Flanders et al., 2013). For that reason, because of the gap of knowledge about this topic, the main contribution of this research is to analyze the role of sexual orientation, in men and women, on sexual sensation seeking. --- Method --- Participants Participants were 382 young people, 52.36% (n = 200) were male and 47.64% (n = 182) were women. The 52.46% of the sample (50 men and 42 women) self-reported being heterosexual whereas 47.64% (50 men and 40 women) self-reported being homosexual. The limited number of participants who self-reported bisexual made difficult the comparative analyses (6 men and 4 women), consequently we had to eliminate them. education and 27.89% had primary or secondary education. --- Outcome measure Escala de Búsqueda de Sensaciones Sexuales (Sexual Sensation Seeking Scale, Kalichman et al., 1994). In this study, the Spanish adaptation of this instrument carried out by Ballester, Gil, Ruiz, Giménez and Gómez (2008) was used. This scale consists of 11 items such as "I enjoy the sensation produced sex without a condom" or "I'm interested in trying new sexual experiences" that evaluate the SSS using a Likert scale of four possible answers ranging from <<uncharacteristic to me >> to << very characteristic of me>>. The scores range from 1 to 4 will give a minimum score of 11 and maximum of 44. The internal consistency of the original questionnaire, evaluated by Kalichman and Rompa (1995) through Cronbach's alpha coefficient was .79 in homosexual men whereas in the Spanish adaptation is .70. In the present study Cronbach's alpha is .811. --- Procedure This study was developed from 2012 to 2013. After obtaining the necessary permission of the Ethic Committee of Research, the team research made contact with participants. Firstly, to recruit the sample of homosexual orientation, we went to meet various Spanish associations linked to the LGBT (Lesbian, Gay, Bisexual and Transgender) and belonging to the FELGTB (State Federation of Lesbians, Gays, Transsexuals and Bisexuals) that implement programs to improve the sexual health of these populations. They agreed about the interest of this study and acknowledge their cooperation. In particular, they participated through their social networks (Facebook and Twitter) and / or their websites. Secondly, in order to recruit heterosexual participants, information on the study was disseminated through outreach activities included in a HIV awareness campaign. This was organized by the Research Unit on AIDS and Sexuality (UNISEXSIDA) which belongs to the Jaume I University and the University of Valencia. In these activities, participants were informed about the study. If they were interested, researchers provided with the same link that referred to the online questionnaires. In both cases, participants agreed the informed consent that included the voluntary participation, the nature of the research and its objectives and confidentiality of the data. The questionnaire lasted for 20 minutes. --- Results T tests were made, in order to analyze potential significant differences based on sexual orientation or gender on the dependent variable. --- Table 1 about here In Table 1, the t-test shows significant differences between heterosexual and homosexual (t = 3.277, p <.001), and heterosexuals obtained significantly higher scores. T test shows significant differences between men and women (t = 4.916, p <.001) with men who obtained higher scores. Analyzing the sample by the intersection between gender and orientation (see Table 2) there are significant differences among the four groups (heterosexual men, heterosexual women, homosexual men and homosexual women) (F=14.412, p<.001). Post hoc analyses show significant differences between heterosexual men and heterosexual women (p<.026) and between heterosexual men and lesbian women (p<.001). For all cases, men obtained higher scores than women. Homosexual men were more sexual sensation seekers than lesbians (p <.001) but there are not significant differences between homosexuals and heterosexuals, for men (p<.872) and for women (p<.892). --- Table 2 about here There is no correlation between age and Sexual Sensation Seeking in the global sample (r=-.07, p=.286) or the different groups, that is, women (r=-.08, p=.193), men (r=-.06, p=.364), heterosexual participants (r=-.01, p=.872) and homosexual participants (r=-.06, p=.421). --- Discussion The results do not support the hypothesis that homosexual men have greater SSS than heterosexuals. The findings contradict the previous study by McCoul and Haslam (2001) which compared the SSS in heterosexual and homosexual population. This study was carried out in the North American context and was only focused on men. The difference between the results of McCoul and Haslam (2001) and those obtained in the present study could be due to cultural differences. Men had significantly higher SSS scores than those obtained by women. This result is consistent with studies examining this variable in Spanish population and different contexts such as American young people (Erol, 2007;Flanders et al., 2013;Gaither & Sellbom, 2003;Morell, et al., 2013). Heterosexual men scored higher in sexual sensation seeking than heterosexual women. Similarly, homosexual men score higher in SSS than lesbian women. These results are in line with the conclusions found in the literature among young from Western countries such as US (Gaither & Sellbom, 2003) or Spain (Morell et al., 2013). Our results show that heterosexual women scored higher on SSS than homosexual women, reverse the expected result. This result does not coincide with Trocki, Drabble and Midanik (2009) who found higher scores of Sensation Seeking for homosexual than for heterosexual women in a generic construct of sensation seeking. The differences suggest that although general sensation seeking (a personal inclination to pursue new, stimulating and intense experiences in general) and specific sexual sensation seeking personality (a personal tendency to obtain higher levels of sexual arousal, as well as novel and exciting sexual experiences) are two related variables, they behave differently. Consequently, they cannot consider two aspects of the same construct. Unlike women, heterosexual and homosexual men did not differ in SSS. This result contradicts research carried out by McCoul and Haslam (2001) with exclusively male U.S. population which concludes higher SSS by gay men. Note that authors such as Berg (2008) and Chng and Géliga-Vargas (2000) state that the SSS in homosexual men, correlates with increased sexual risk behaviors (Folch, Casabona, Muñoz, González & Zaragoza, 2010) and increasing incidence and prevalence of HIV infection in men who have sex with men (MSM) (Centro Nacional de Epidemiología, 2012). These findings may be considered in light of some limitations. Homosexual participants were recruited by LGTB associations and this might influence this study. However, this was the most feasible place to access this type of population, who are usually diverse. In addition, social desirability could mediate on the validity of data which was collected through the self-reported questionnaire. Despite these limitations, the research provides data that increase existing knowledge about the relationship of sex-based differences and sexual orientation on the SSS. Regarding MSM, the SSS has been associated with this group although less extent than in heterosexual men. Our study was unable to have a sufficiently large sample of bisexual individuals. It would be interesting in future studies to examine SSS in the bisexuals whether the results obtained in this study shed light on SSS differences. With regard to women, our study suggests that prevention programs should focus more on heterosexual women. This could contribute to a lower frequency of sexual risk, in line with what is stated elsewhere (Hendershot, Stoner, George & Norris, 2007;Spitalnick et al., 2007). (1)-( 3) p<.872 (1)-( 4) p<.000 (2)-(3) p<.892 (2)-( 4) p<.001 (3)-( 4) p<.001

This study analyzes the relationship of sexual orientation and gender to Sexual Sensation Seeking. 382 participants completed the Sexual Sensation Seeking Scale, 200 men and 182 women between 17 and 29 years old. 52.46% of them self-reported heterosexual orientation while 47.64% self-reported homosexual orientation. The results showed differences with Sexual Sensation Seeking being more frequent among heterosexuals and men. There were no differences between heterosexual and homosexual men. Heterosexual women had higher Sexual Sensation Seeking scores than homosexual women. These results and their possible implications for the effective development of prevention and intervention programs in affective-sexual education are discussed.

particularly in care coordination with other healthcare providers. Therefore, in the present study, we assessed the EHR adoption among ADSC and its associated organizational characteristics using the 2018 National Study of Long-Term Care Providers (NPALS). The sample included 4,035 ADSC from a national representative sample. Directors or managers of ADSC completed the survey that included questions on organization characteristics, staffing, practice procedures, services, technology use, etc. Findings reveal that the adoption rate of EHR among ADSC was less than thirty percent and less than twenty percent of ADSC used EHR for health information exchange with either physicians or pharmacists. In addition, we found that an ADSC located near other healthcare providers, with Medicaid authorization and a higher percentage of Medicaid patients, and various computer capabilities such as recording participants' demographic information, clinical notes, medications, service plans, and lab results were related to a higher likelihood of EHR use and EHR exchange. However, possibly due to privacy concerns, the capabilities to record participant problems and view lab results, negatively predict EHR exchange with physicians or pharmacists. The findings are discussed in terms of challenges and strategies to promote EHR adoption in ADSC. were physically closed but serving participants at places of residence (i.e. virtually, meal delivery, home-visits), 20% served participants onsite and at places of residence, and 13% were temporarily closed and not serving participants. There was statistically significant variation in operating status by region, policy-relevant organizational and participantlevel characteristics, and in the types of services provided. Discussion of results will highlight how NPALS data can be used to assess disparities in ADSC availability during the pandemic. Additional information from the forthcoming 2022 survey data will also be discussed, focusing on potential differences in operating status and ADSC characteristics between the two survey waves. --- SESSION 1100 (SYMPOSIUM) Abstract citation ID: igad104.0105 --- NURSING HOME SOCIAL WORK: CONFLICTING VALUES AND ETHICAL PRACTICE WITH RESIDENTS, FAMILIES, AND STAFF Chair: Mercedes Bern-Klug Discussant: Denise Gammonley People who live in nursing homes and those who spend weeks or months there recuperating from a hip replacement or stroke have a broad range of needs, many urgent and others enduring. Despite the high needs of residents-which have increased over the past decade as resident acuity has increased--the settings are typically under-staffed both in terms of the number of direct care staff and the preparation of direct care staff (NASEM Report, 2022). Social workers and others in the social service role (i.e., those without a social work education) step into or are tapped to intervene when resident rights conflict with family wishes and/or staff rights and wishes. In this session using findings from both qualitative and quantitative studies, we will describe how and what type of conflicts social workers are involved with and the training they report they need to be better prepared to serve as a resource in this important role. Drawing from a nationally representative survey of social service directors (N=922), this presentation will provide an overview of nursing home staffing trends and describe the ways in which social service staff routinely interact with residents, families, and staff. Social workers are involved in many aspects of care, including the admissions process, planning and providing care, care transitions, and general supportive services. As members of the interdisciplinary team, social workers advocate for resident rights, and support decision-making and care planning in times of family crisis and high conflict situations. Summary statistics will be presented to identify the directors' frustrations with the role -including their perceptions of major barriers to care, and draw attention to the changes that would improve job satisfaction (e.g., higher salary/wage, 51%; lower staff turnover among direct care staff, 47%; and more time to focus on the social and emotional concerns of residents, 45%). The presentation will conclude with an overview of directors' interest in training topics that may help to mediate conflicts among residents, families, and staff. Specifically, we will share how prepared directors feel to train other staff in conflict-resolution skills (e.g., working with the resident/family and team to balance resident self-determination with the nursing home's responsibility to minimize risk), and the use of an ethical framework to guide action. Abstract citation ID: igad104.0107 --- SOCIAL SERVICE DIRECTOR PRIORITIES IN RESOLVING CONFLICTS IN NURSING HOMES Nancy Kusmaul 1 , Amy Roberts 2 , and Mercedes Bern-Klug 3 , 1. University of Maryland Baltimore County,Baltimore,Maryland,United States,2. Miami University,Oxford,Ohio,United States,3. University of Iowa,Iowa City,Iowa,United States Social workers in nursing homes serve many critical roles such as assessing for residents' unmet psychosocial needs, providing support to residents and families at end of life, and resolving conflicts between residents, families, and staff. In their roles, they often need to balance conflicting priorities and determine whose rights or needs should take priority. Little is known about how these conflicts affect the social workers in their jobs. This presentation will report the results of a content analysis of the answers to two open ended questions, "What do you like about your job?" and "What would you change about your job?" in a nationally representative sample of nursing home social service directors. The results illustrate directors' views of what they value in terms of helping residents, families, and staff navigate change, difficult conversations, and conflicting interests. Social service directors report that their priorities are residents and their families, specifically advocating for resident needs. They also report needing to advocate for the role of social work on the interdisciplinary team. They report that family dynamics are messy, but do not discuss how they prioritize within and between residents, their family members, and nursing home staff. More research is needed to understand the decision making process that social workers employ in decision-making about priorities. Conflicting rights arise often in nursing homes among residents, staff, and family. Nursing home social workers sit at a unique nexus of these rights, given their macro, mezzo, and micro-level training. This study employs a multi-method qualitative design with semi-structured staff interviews (n=90) (direct care, mid-level professional, top management), content analysis of long-term care facility policies (n=376), and ethnographic observation of two facilities (n=8 months) for a multi-layered cross-comparative in-depth case study. While social workers represented only a very small number of the overall nursing home workforce, data revealed the overwhelming reliance on social workers to resolve conflicting rights that arose among residents, staff, and family. Certified nursing assistants, nurses, directors, and administrators regularly deferred to social workers via written policies and unwritten practices to resolve a variety of issues, including discrimination concerns by staff, residents, or family, concerns about quality of care and workforce shortage, and concerns about conflicting rights to resident autonomy, dignity, medical decision-making, and safety (e.g., bed rails). Staff at all levels and professions described the emotional labor and unique professional experience that these conflicts required and felt ill-equipped to resolve these issues. While social workers resolved most of these conflicts, they, too, reported feeling ill-prepared for this role and worried about out-of-scope practice. Ultimately, they relied on their social work training in systems-level change, case management, and interpersonal communication to resolve conflicting rights. This presentation will discuss social worker challenges as informal legal intermediaries and opportunities for better support and training.

the system is now available to more than 500 ADSCs serving more than 12,000 participants. This session will describe the data points and outcome measures as well as the uniform tools to be utilized for collection and introduce the data portal to the greater academic community. This longitudinal data will be available to NADSA academic partners to provide greater avenues of research into the benefits of adult day services use to participants, caregivers, payors, and the community.

INTRODUCTION The new global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly altered our everyday lives. People face the virus from uneven starting points. Existing health inequalities in noncommunicable diseases such as hypertension and diabetes increase the severity of COVID-19 infection and likelihood of death. The wider societal measures introduced to control the spread of the virus and save lives now, are exacting a heavier social and economic price on those already experiencing hardship. Societal lockdown's have varied worldwide, significantly impacting physical activity behaviour. Whilst some countries (eg, United Kingdom (UK), Australia) have not restricted people's ability to exercise outside daily, others (eg, Spain, Italy) restricted this for several weeks. Despite a likely increase in sedentary behaviour for some, other studies suggest lockdown may have led to increases in population-level interest in and engagement with physical activity. 1 A disproportionate increase in loneliness during lockdown can increase the risk of poor health behaviour, especially in groups living in areas of multiple deprivations. However, medical and government initiatives have largely focussed on health protection and managing COVID-19 related disease with little emphasis on health promotion. The boundaries placed on physical activity have been felt disproportionately by the elderly; comorbid; those with caring responsibilities; those without access to outdoor space; and simply those less literate in exercise, thus widening further, inequalities in physical activity. Understanding the musculoskeletal and metabolic sequelae of physical activity and how they disproportionately affect certain groups, is an important element in designing population approaches that respond to the needs of different cohorts. As we tentatively enter the next stage, recovery and rehabilitation, are we able to mitigate some of these disparities? Physiological sequelae of physical inactivity Physical inactivity has a rapid and profound negative effect on musculoskeletal and metabolic health. Bed rest models, used to mimic the extreme unloading on the body experienced by astronauts, show a loss of quadriceps muscle volume of 18% after 90 days, 2 with greater decrements in muscle power. There is a rapid reduction in peripheral insulin sensitivity, largely at the muscle level. 3 More pragmatic-reduced step count models (under 1500 steps per day) in healthy volunteers demonstrate a 17% reduction in peripheral insulin sensitivity and a 7% reduction in VO 2 max 4 and these changes are amplified when participants are also overfed. 5 These changes are more marked in the elderly due to the loss of muscle mass and quality with age, which is associated with a loss of functional independence. The mechanism is due to the relative 'anabolic resistance' to dietary protein and exercise in muscles of older individuals. 6 Previously independent elderly people may emerge from lockdown dependent due to functional strength loss. Muscle volume loss and insulin resistance are also accelerated where inflammation is present, such as secondary to sepsis or in pro-inflammatory chronic disease states. Intensive care patients with multiorgan failure lose 15% rectus femoris cross-sectional area by day 7, and face a prolonged recovery. 7 Worldwide, higher diagnosis rates, hospitalisations and death rates from COVID-19 are more common with increasing age as well as those living in deprived areas. In several countries, including the UK, USA and South Africa, those in Black, Asian and Minority Ethnic (BAME) groups were more likely to be infected and have worse mortality rates, thought to be secondary to structural and cultural disparities. Inequality in physical activity behaviour, as well as rates of and morbidity from infection are prevalent therefore. --- Physical inactivity and mental health The effect of physical isolation on our mental health also cannot be overlooked. Loneliness is particularly affecting those living alone and without children, and is strongly associated with depression, generalised anxiety and poor health behaviour. 8 Higher exercise levels in older adults during the COVID19 pandemic has been associated with more positive psychological well-being. 9 Controlled experiments have found that regular physical activity protects mental health in those undergoing 8 months of prolonged social isolation. 10 In the UK, data from Sport England indicate 65% of adults were using activity to manage their mental health during a time of increased stressors including fear of contagion, job insecurity, and a lack of normal social support. 11 The most vulnerable are probably likely to be those on the lowest income, and they will be disproportionately impacted by physical inactivity. The shift to increased home working for many people further reduces the social contact of the normal work environment. --- Recommendations for action Strategies to diminish these changes can be at an individual, a community, or a national public policy level. Public health campaigns should outline simple, affordable advice for engaging in physical activity. Targeted physical activity campaigns may be required for older age groups or vulnerable groups of society. A recent international white paper supports regular low/medium intensity high volume exercise and a 15-25% reduction in caloric intake to prevent physiological decline following sedentarism. 12 As group exercise opportunities become more limited, and outdoor exercise becomes less attractive approaching winter months, there may be a natural shift to online resources. With greater home working, employers should be proactive in incentivising physical activity. Businesses could be innovative by organising group exercise classes or challenges which reinforce the lost sense of connection and community. Regular breaks and short bursts of efficient physical activity at home should be promoted including resistance exercise requiring minimal equipment, such as bodyweight exercises. A need for simple and safe ways to stay physically active in a limited space has been highlighted as a priority among older adults living at home during the pandemic. 13 For those without access to the internet, there is a potential role for telephone volunteer services to support those isolated, especially in communities where these are less likely to be established by communities themselves. However, solely relying on interventions that focus on individual change may be limited due to disparity in accessibility and capability. 14 As we re-open society, can we do so in a way to influence the environment in which we live? Health inequalities are due to a complex interplay of environmental and social factors which impact a local area. 15 Strategies should be place-based approaches and build physical activity and health into local and national government decisions. Active travel via government subsidised vouchers to those of lower socioeconomic status, has previously shown to be successful in early years nutrition. 16 As health services re-open, physical activity could be incorporated into new models of care. Post-COVID 'recovery' clinics using a multidisciplinary approach are currently sporadic or non-existent, but important as it is estimated that 10% of people experience prolonged illness after COVID-19. 17 Studies to evaluate intervention strategies for long-COVID are urgently required to prevent long term morbidity. Those with persistent or progressive symptoms need integrated physician-led care models with a strong musculoskeletal and prevention focus. Grant programmes to evaluate the effectiveness of new models are needed. Health promotion is as important as health protection in reducing morbidity and mortality and demands immediate prioritisation. Linking medicine and public health with evidence-based community physical activity programmes is a priority. The United Nations and International Olympic Committee, recognising the physical and mental health benefits of physical activity, has advocated the incorporation of sport into international COVID-19 recovery plans. 18 Sporting organisations should also identify ways to engage with vulnerable groups who normally participate in sporting programmes in low-income communities who are currently unable due to restriction to movement. Outreach activities to promote physical activity and widen resources in specific disadvantaged cohorts is successful in previously targeted interventions. 19 Engagement in sport has many mental health benefits and promotes social cohesion at a time when social interaction is minimised. Finally, consideration of prioritising vaccination to those most at risk may become increasingly important as the months to come. --- CONCLUSION The current changes in our physical activity behaviour disproportionately impact certain groups of society. This may lead to a second wave of health inequality driven by disparities in access and availability to be physically active during a period of restricted movement. COVID-19 has likely further influenced how these different factors interact, multiply and reinforce each other. Acting on only one part of this complex system is likely to only ever provide a partial and incomplete response. Not only is a holistic, collaborative and integrated public health approach required to reduce the negative impact of high amounts of sedentary behaviour in the population during the current pandemic, but specific strategies using a placebased approach targeting at risk and disadvantaged groups from national to grass roots level need to be considered if we are ever to reduce the further widening of physical activity health inequality.

Government-restricted movement during the coronavirus pandemic in various countries around the world has led to rapid and fundamental changes in our health behaviour. As well as being at a higher risk of contracting and being hospitalised with COVID-19, the elderly, those with chronic disease and lower socioeconomic groups are also disproportionately affected by restriction of movement, further widening the physical activity health inequality. In this viewpoint we discuss the physiological sequelae of physical inactivity, and the additional burden of ageing and inflammation. We provide recommendations for public health promotion and interventions to try to mitigate the detrimental effects of physical inactivity and rebalance the health inequality.

Introduction The SARS-Cov-2 virus has caused a worldwide pandemic. By September 7th 2020, the total number of confirmed cases in Spain were 525,549 (1). The highest severity and mortality rates of the coronavirus disease 2019 (COVID-19) are seen in older people (2). To deal with this health crisis, the Spanish Government declared the state of alarm from March 14th 2020 to June 21st 2020 (3). During the first part of this lockdown, until May 2nd 2020, people were only allowed to leave their homes to buy food or medicines, attend to a medical center, go to a bank or insurance company, go to work, care for vulnerable individuals or complete other activities considered essential (3). After that, a four-phase plan for easing restrictions towards the so-called "new normality" was asymmetrically applied across Spain. A prolonged stay indoors alters lifestyle habits, with individuals potentially reducing their physical activity, eating a less healthy diet and/or experiencing a lack of social contact (4). Consequently, the health of the population may be affected. Relatively few studies so far have explored the changes in health status and lifestyle habits during a period of confinement in different age groups (5)(6)(7). The objective of this study was to assess the health status and lifestyle habits of vulnerable, community-dwelling older adults during the first COVID-19 lockdown in Spain, comparing results with data collected at a previous time point. --- Methods --- Design and study population This study was carried out on a sample of individuals who participated in a previous study (8). The initial sample included community-dwelling people aged ≥70 years, living in Guipúzcoa (Basque Country, Spain), with a Barthel index ≥85 (9, 10) who met one of the following criteria: frailty, based on the Timed up and go test ≥20 seconds (11,12) or a high risk of falls (12). --- Data collection For this study, a telephone assessment was performed by a nurse and a social worker between April 27th and May 14th 2020. In addition, we used data that had been collected 9 months earlier through face-to-face interviews, conducted by another nurse and social worker in a primary care center and at the participants´ home. During the interviews, information was collected on individuals´ health status, lifestyle habits, social life, and home and environment conditions. --- Variables The variables assessed during the telephone interviews were the following: age, sex, ability to perform basic (Barthel index (9,10)), and instrumental (Lawton test (13)) activities of daily living, body mass index, frequency of consumption of white meat, fish and eggs (adequate: daily and ≥3 times/week; inadequate: 1-2 times/week, <1 time/week and never or almost never), Mini Nutritional Assessment-Short Form (MNA, score 0-14 points) (14), physical activity (based on the question, "Do you regularly do at least 30 minutes of physical activity each day or 4 hours a week?"), hours of sleep per day, living arrangements and family support (based on the question, "Do you have enough family support?"). The previous assessment collected information on the aforementioned variables, and also level of education and cognitive status (Memory Alteration Test, score 0-50 points (15)). Furthermore, the telephone interview included two questions from the FRAIL scale (16): "How much of the time during the past 4 weeks have you felt tired?" and "By yourself and without using aids, do you have any difficulty walking up 10 steps without resting?". Participants were also asked to report any falls experienced in the previous 4 weeks; self-perceived health (assessed with one item, grouping response options as, poor [fair, poor and very poor] and good [very good and good]; diet in relation to frequency of fruit, vegetable and legumes intake; and sleep habits, with two questions: "Do you take pills for sleep?" and "How many times in the last 4 weeks have you had difficulties falling asleep?". Lastly, health related quality of life was explored with the EuroQol EQ-5D-5L scale (17) and overall loneliness with the six-item De Jong Gierveld Loneliness scale (not lonely: 0-1; lonely: 2-6) (18,19). --- Statistical analysis Categorical variables were described as frequencies with percentages and continuous variables as means with standard deviations (SD). Paired comparisons were carried out using McNemar´s test for categorical variables and Student´s paired t-test for continuous variables. Statistical analyses were performed with the free statistical software R, version 3.4.0. --- Ethical aspects The study was approved by the Comité de Ética de la Investigación con medicamentos de Euskadi (CEIm-E, 12/2020). Verbal consent was requested for participation in this research. --- Results Of the 48 individuals (69% women, mean age: 82.0 years, SD=5.8) previously assessed, 10 were excluded from this study due to: death (n=1), hospitalization (n=1), refusal to participate (n=8).The final sample consisted of 38 individuals (71% women). During the latter part of the lockdown, a 35% of the individuals reported having felt often tired in the previous 4 weeks, and most had difficulties in walking up 10 steps without resting (Table 1). Although a high percentage woke up rested in the morning, 46% took sleeping pills and 66% had had difficulties sleeping in the previous 4 weeks. Forty-two percent of participants reported poor self-perceived health. The majority reported slight or moderate pain or discomfort but they were not anxious or depressed (71%) and did not experience loneliness (60%). Functional capacity declined over time, for both basic and instrumental activities of daily living. Based on the Barthel index, fewer were able to walk independently without assistance (92% vs. 74%, p=0.008) or climb stairs (92% vs. 71%, p<0.001) after the confinement. Regarding nutritional status, the participants´ BMI decreased (p<0.001). At the same time, the normal MNA seen in all cases (100%) during the first assessment worsened to a risk of malnutrition and malnourishment in 32% and 3% of the sample, respectively. Participants also reported having fewer hours of sleep (p=0.001). At the same time, family support was higher than in the pre-lockdown period (p=0.005). --- Discussion The assessment of a group of vulnerable, communitydwelling older individuals in the latter part of the first COVID-19 lockdown period revealed several issues that merit discussion. Our data show more sleep and mobility problems than in a recent previous assessment. Most of the individuals also experienced a certain level of pain, but they were neither anxious/depressed nor lonely. Similarly, in Losada-Baltar et al. (5), older people reported lower levels of anxiety than middle aged adults and younger group. The lowest loneliness levels were reported by middle aged adults, followed by older adults and younger participants. The older population seems to have greater resilience and capacity to adapt to this kind of situation (5). Nonetheless, overall, the health status of the participants had worsened, compared to the first assessment. The decline in functional capacity, both for basic and instrumental activities of daily living was particularly striking. This deterioration may be associated with a higher risk of adverse events, such as hospitalization or death. Furthermore, we observed changes in dietary patterns, with a lower consumption of protein. As a result, nutritional status worsened from normal to at risk of malnutrition or malnourished in some cases. Regarding the Mediterranean diet, Rodriguez-Perez et al. (7) found that adherence in people >51 years, slightly increased during the confinement in Spain, while in Di Renzo et al., detected a higher adherence in 18-to 30-year-olds than in younger and older populations during the first COVID-19 lock-down in Italy (6). This study highlights the risk that a long period at home may pose for vulnerable populations. Maintaining the health status of such individuals and helping them to avoid rapid deterioration under the current pandemic situation is a challenging task. There is a clear necessity for programs specifically designed to meet their needs. Promoting physical activity and helping individuals maintain healthy dietary and sleep patterns should be the focus of such programs. In particular, a multicomponent exercise routine, with aerobic, resistance, balance, coordination and mobility training exercises, easily performed at home, would be recommended for older people (11,20). Regarding diet, efforts should be made to ensure an adequate protein intake (21). Sleep problems could be addressed by a combination of non-pharmacological treatments, such as sleep hygiene education and relaxation techniques (22). These and similar interventions would be useful in the current context, as well as in case of new lockdowns. The main limitation of this study is that it is not possible to know whether the changes observed were due to the impact of the confinement or the time elapsed between the assessments. Frailty is a dynamic process, with functional status commonly worsening (23,24). The sample studied was composed of initially independent but vulnerable individuals, with frailty or a high risk of falls. Therefore, the decline observed could have been spontaneous. Nonetheless, the lockdown situation is unlikely to have a positive impact on the condition of the participants. Another limitation is that the sample size is very small. Moreover, weight at the time of the telephone assessment was self-reported. This may have introduced some bias. On the other hand, during the telephone interview participants were also asked about their weight in the previous year, and values reported were similar to those measured at the initial assessment. Self-reported weight has been used in other studies (6,7). --- Conclusions Functional and nutritional status and sleep patterns worsened during a COVID-19 lockdown in a group of vulnerable older individuals. The needs of this population should be considered and incorporated into interventions designed to avoid rapid decline under the current pandemic situation, and especially during any future period of confinement. --- Conflict of interest: The authors have no conflicts of interest to declare.

This study evaluated the health status and lifestyle habits of vulnerable, community-dwelling older adults during the first COVID-19 lockdown in Spain. A telephone assessment was carried out in 38 individuals (71% women), with a Barthel index ≥85 who were frail or had a high risk of falls. Data were compared with those from an assessment performed 9 months earlier. In the latter part of the lockdown, a high percentage of the studied individuals showed difficulties in walking up 10 steps and reported sleep problems (66%) and pain (74%). On the other hand, participants were not anxious/depressed (71%) and the majority did not report loneliness (60%). Compared to the earlier assessment, we identified a decline in functional capacity and worsening of nutritional status, but an increase in family support. Efforts should be made to implement intervention programs seeking to avoid accelerated decline under the current pandemic situation, and especially during possible new lockdowns.

I. INTRODUCTION According to the central and state budgets, the total amount spent on 'Social Services' like family welfare, health, education and water supply and sanitation and 'Rural Development' (i.e. related to anti-poverty programmes) is known as the "Social Sector." Expenditure particularly on education and health contributes to human development of country (Government of Telangana, 2017) [3]. An effort was made to change the focus of development policies and programmes from only economic considerations to tackling human welfare concerns in the inaugural human development report of 1990. Encouraging people to live long and healthy lives should be the primary goal of all development reports because people are real wealth of any nation. To assure continued human progress, economic growth alone might not be enough (Chaurasia, 2019) [1]. Human Development is basically concerned with human rights, including those to life, health and wellbeing. The Human Development Index represents Amartya Sen's "capabilities" approach that underline the value of ends (like a decent standard of living) over means (like per capita income) (Stanton, 2007) [11]. Sen has argued that the growth of a nation depends not only on its economic development but also quality of life offered to its citizens as well (Kumar et al., 2016) [5]. Rao (2000) has attempted to measure the inequalities in human development status across six major states of India by using Human Development Report 1997 [10]. The study has pointed out the regional and inter-district differentials in human development prevailing within the state. The quality of life of the Indians as indicated by education, GDP and HDI has been found to be lower than that of the developing countries. The high human development group consists of Mexico, Colombia, Thailand, Malaysia and Mauritius acquiring ranks ranging from 50 to 61. Brazil, Jamaica, Cuba, Sri Lanka and Indonesia falls in the medium human development group and their ranks range from 68 to 99. India falls in low human development group. In terms of all human development indicators such as life expectancy, literacy, mortality rate Kerala has performed well while Bihar's performance recorded as worse. The level of human development can be improved only if the beneficiary areas and population participate actively in implementing the development programmes and government spent more funds on education, health, nutrition and other factors of human development. Verghese and Damayanthi (2006) have applied Principal Component analysis, Factor analysis and Squared Euclidean Dissimilarity Index to examine the human development disparities among states of India [12]. In 1981, states like Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan and Orissa have an HDI value around half that of Kerala. Kerala and Punjab are in better position with respect to social sector expenditure and per capita net state domestic product whereas Bihar, Orissa, Utter Pradesh and Rajasthan have been situated at worse off position with respect to both indicators. Kerala has also been situated in a better position in terms of health indicators during early 90's. Other states like Uttar Pradesh, Madhya Pradesh and Bihar have been at worse off position at that time. Study results reveal that human development among Indian states shows a converging tendency and inequalities have also been declining over these two decades i.e., from 1981-1991 and 1991-2001. There is need to control the inter-state disparities in human development, otherwise, it will leads to various economic, social and political problems. Pradhan (2007) has highlighted the trends of human development in the Indian economy during the globalization regime of 1990's [9]. The study has found that though India has been progressing in sphere of human development, its progress remained low when compared with other countries particularly China. The performance of states of India with respect to various social indicators i.e. adult literacy, Infant Mortality Rate (IMR), life expectancy has found to be diverging in nature. Since 1990's India's social sector expenditure on education has substantially higher except in 1999-00. In educational front, India gets a fairly better position in contrast to all other countries like Nepal, Sri Lanka, China, USA and UK. The study has found that most of resources remained underutilized in the globalized era. In order to improve human development, there is need to be emphasized on social sector expenditure and this requires policy decisions on underutilization of resources, qualitative public expenditure and their effective utilization. Mohapatra (2013) has discussed trends in social sector development in field of health and education and also analyzed that how social sector will help in enhancing the human capabilities and augmenting self-sustaining economic growth [6]. There has been found that human development and social sector development are positively correlated with each other. The social sector expenditure in India has grown tremendously during the period 1990-1991. In our country, households spend 72% of total expenditure upon their health while public sector expenditure on health has been only 20.3% in total. Socio-economic development will be possible only as the literacy gap between male and female declining. Public health expenditure must be increased as a result of which the efficiency and productivity of individual as well as country as a whole will be enhanced. It can be concluded that both health as well as education have been an important determinant for progress of any country. Maximum social welfare and better quality of life can be attained only through social sector development. --- II. LITERATURE REVIEW Pattayat and Rani (2017) have explained association between economic growth and social sector development in Haryana during 1985 to 2016 [7]. Recently, public expenditure on education, healthcare, housing, sanitation and social security has been increased in Haryana. Study found a positive impact of increased social sector development expenditure on growth of Net State Domestic Product (NSDP) in short-run as well as in long-run. No doubt, government of Haryana has make huge investment for development of social sector but it remains beyond the reach of poor section of the people. There is need to emphasize on increasing public investment in human capital to encourage the growth of the economy. --- III. DATABASE AND METHODOLOGY This study looked at the relationship between India's social sector and human development from 1992-93 to 2019-20. The study is based on secondary data. The statistical techniques like correlation analysis and factor analysis have been used in the present study. --- IV. SOCIAL SECTOR DEVELOPMENT INDEX AND HUMAN DEVELOPMENT INDEX (HDI)

The development of social sector relies on structure of public expenditure on housing, public health care, education, water supply and sanitation and welfare of weaker sections (SCs, STs and OBCs) etc. The definition of human development is the increase in people's freedom to lead long, healthy and creative lives. Present study examines the relationship between social sector and human development across Indian states. The association between India's social sector and human development from 1992-93 to 2019-20 has been examined using Pearson Correlation. The study found a positive relationship between social sector development and human development across Indian states. Human development dimension should be taken into account during formulation and performance of social sector programmes. Level and structure of government policies must play a crucial role in ensuring a high level of human development among the people.

Objective As survivors of historical trauma, the Northern Arapaho and Eastern Shoshone tribes sharing the WRIR in Wyoming reportedly die 30 years earlier than whites in the state (1). However, only 2 peerreviewed studies with WRIR health data have been published, both of which focused on children (2,3). This research is the first to share data on adult health status in the WRIR. We analyzed biometric, whole-blood, and survey-based data that were collected on 176 adults from 96 families who enrolled in Growing Resilience, a randomized controlled trial to assess the effects of home food gardens on health. --- Methods Families were eligible to enroll in Growing Resilience if they 1) lived in the WRIR, 2) had at least 1 participating family member identifying as enrolled in a federally recognized tribe, 3) had at least 2 adults (or 1 for single-adult families) willing to participate in 2 years of gardening and health data collection, and 4) were interested in receiving and maintaining a home food garden but had not had a food garden over 30 square feet the previous year. Project partners aimed to recruit 100 families over 3 years, 2016-2018, and administered screening forms for eligibility. Recruitment and promotion activities included newspaper advertisements, flyers, open houses, and word of mouth. Overall, 119 interested families were eligible and were invited to enroll in the study. Of those, 96 families (81%) enrolled in the study immediately before their first health data collection. We report results for the 176 adults (aged ≥20 y) in those families. We collected biometric, blood draw, and survey (up to 46 questions) data. Researchers measured height and weight for body mass index calculations using a Seca 213 Mobile Stadiometer (Seca) and a Tanita SC-331S Body Composition Analyzer (Tanita); assessed blood pressure using an Omron 10 Plus Series upper arm blood pressure monitor with ComFit Cuff (Omron Healthcare); and measured waist circumference using a Gulick II tape measure (Gulick). Whole blood analysis included hemoglobin A1c (HbA1c), vitamin D, and low-density lipoprotein (LDL) cholesterol (conducted by LabCorp). We tested for sex differences in all health indicators using a 2-sample Kolmogorov-Smirnov test for equality of distributions. The survey included demographic questions, and heads of households were administered the US Department of Agriculture household food security 6-question module (adapted to report on previous month) (4). Study protocol details are available elsewhere (5). The Growing Resilience study was approved by the University of Wyoming institutional review board. --- Results Of the 176 adults, 63% were female and 37% were male. Participant ages were evenly distributed (19%-25% per category) with the exception of adults aged 60 to 69 years (12%) and those aged 70 or older (<3%). Of the 170 adults who identified their tribal affiliation, 44% identified as Northern Arapaho, 40% as Eastern Shoshone, 3% as both, and 13% as another tribe. Most adults (91%) were overweight or obese, and more than one-third (37%) were categorized as obese class II or III (Table ). Just over threequarters had high blood pressure, more than half of whom had stage 2 hypertension. Blood measures indicated that a little more than half of adults for whom LDL cholesterol results were collected (n = 163) had normal levels, and nearly 80% of adults had deficient vitamin D levels (≤20 ng/mL; n = 167). Almost half of adults had normal HbA1c levels, one-third had levels that indicated prediabetes, and 19% had diabetes (n = 167). Of those with diabetes, 4 were undiagnosed (ie, did not self-report as diabetic, but had HbA1c ≥6.5%; these participants were notified). Nearly all women (95%) and most men (80%) had waist circumference measures associated with higher risk of obesity-related disease. The only measure in which a difference by sex was found was blood pressure; men had higher systolic (D = 0.368, P < .001) and diastolic (D = 0.278, P = .002) blood pressure than women. At the family level, 65% of the 94 responding heads of household reported being food insecure during the previous month. Of those, 20 households (21%) had very low food security, and 15 households (16%) had marginal food security. --- Discussion These members of the Northern Arapaho and Eastern Shoshone living on the WRIR in Wyoming suffer worse average health status than adults at state and national levels, including among American Indians/Alaska Natives (AIs/ANs) at large (Figure). Their obesity rate is 70% higher than the national AI/AN average (6), hypertension rates are more than double (7), and high LDL cholesterol rates are one-third higher (8). The diabetes rate is 2.3 times the Wyoming average and 23% higher than AI/AN averages (6). Their 65% food insecurity rate is more than 10 times the national 30-day rate (9). --- Figure. Rates of obesity, hypertension, and diabetes among adult Growing Resilience participants before any intervention compared with state and national rates. State and national data are from the Behavioral Risk Factor Surveillance System (6,7). Abbreviation: AI/AN, American Indian/Alaska Native. Our study has limitations. The small sample size constrains analyses by sex or age, and data were not taken from a random sample. WRIR-wide estimates reported by tribal health affiliates (10) and findings in this sample did roughly align for obesity (71% reported vs 64.4% here) and diagnosed diabetes (12% reported vs 16.2% here). Although our results may not be fully generalizable to the WRIR adult population, the severity of poor health in this sample suggests that WRIR communities are living with enormous health challenges, many of which can result in death if left untreated (11). These data also currently comprise the most complete set that is publicly available about adult health status in WRIR. To begin addressing these challenges and reducing these health disparities, Native American families need access to multiple and effective means to control and enhance health (12,13). The Growing Resilience study is assessing to what extent home gardening provides one such means. Although this nation's traumatic colonization history suggests health promotion interventions alone cannot remedy such large health disparities, access to effective interventions should be available to every Native family. --- PREVENTING CHRONIC DISEASE --- Author Information Corresponding Author: Alyssa M. Wechsler, MA, Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave, Department 3196, Laramie, WY 82071. Telephone: 307-399-3247. Email: alywex@uwyo.edu. Author Affiliations: 1 Division of Kinesiology and Health, University of Wyoming, Laramie, Wyoming. 2 Wyoming Survey & Analysis Center, University of Wyoming, Laramie, Wyoming. 3 Department of Economics, University of Wyoming, Laramie, Wyoming. --- PREVENTING CHRONIC DISEASE

As survivors of historical trauma, the Northern Arapaho and Eastern Shoshone tribes sharing the Wind River Indian Reservation (WRIR) in Wyoming have significant health disparities, but very little data on this population have been published.

Introduction Master volunteers are critical partners in helping advance the mission of Extension (e.g., Feather, 1990). Extension master volunteer programs include master naturalist, master gardener, master composter, master food volunteer, master family and consumer sciences volunteer, and master clothing volunteer, to name a few. Master volunteers receive specific and detailed education in a content area that prepares them for directed and often specialized volunteer opportunities, sometimes on behalf of Extension and often embedded within other agencies and organizations. Extension training and support for volunteers can be complicated. In prior studies, researchers have explored volunteer motivations and attractors (Wilson & Newman, 2011;Wolford, Cox, & Culp, 2001), strategies for assessing the need for programs (Savanick & Blair, 2005), and ways to connect volunteers to communities (Bennett, 2012). No matter the motivation to serve, a volunteer may have trouble finding and/or getting involved in rewarding opportunities (Sheier, 1981). The volunteer also is likely to face challenges in service, ranging from following procedures such as registrations and background checks to burnout (Coles, 1993) --- Master Volunteer Life Cycle Model The master volunteer life cycle model presented here describes the ideal scenario of what happens across three phases of a volunteer's experience in the Minnesota Master Naturalist Program, a natural resourcesfocused master volunteer program. We created the model to provide program managers with a tool for improving ongoing programming so that it prepares, retains, and motivates volunteers across the span of their experiences with the program. Development of the model was grounded in our experience with more than 2,000 Minnesota Master Naturalist Program volunteers, supported with a literature review, and refined through extensive peer feedback from leaders of similar volunteer programs across the country. Many master volunteer programs are focused heavily on the initial education component of the program and only slightly, if at all, on factors that contribute to the success or failure of the participants' volunteer experiences. With our model, we attempt to zoom out from that micro view on the volunteers' preparation and focus on larger outputs and outcomes of the program, putting each aspect of the total experience in the context of the whole. An effective, comprehensive master volunteer program includes the components that are depicted in Figure 1 and explained in detail in the paragraphs following the figure. --- Master Volunteer Life Cycle Model --- Recruiting Phase Prospective volunteers enter a master volunteer program with a variety of personal motivations. Some motivations are intrinsic, such as the drive to make a difference (Pink, 2009); other motivations are extrinsic, such as the goal of earning a title or certification (McClelland, Atkinson, Clark, & Lowell, 1953). When Extension personnel recruit for a program, they can appeal to these motivations when encouraging potential master volunteers to join the program by taking a course. Participants take a 40-hr educational course in which they experience active hands-on learning, exposure to content experts, network building with likeminded peers, and a capstone service project. After completing the course, some participants choose to exitthe program and discontinue participation; others seek to identify a match for their volunteering skills and interests. In some cases, volunteers approach an agency or organization with a service project in mind. In other cases, organizations advertise their volunteer needs for any master volunteer to fill. Note that in Figure 1 the arrow between "Match" and "Volunteer" includes a partial dotted line. This dotted line represents the idea that the Extension program prepares a volunteer for service and even helps connect the volunteer with community needs but that the volunteer must recognize his or her own capabilities, confidence, and competence (or, self-efficacy, as described by Bandura in 1990) and take the initiative to begin a volunteer role. Extension program managers can help volunteers gain confidence in recognizing where their skills might meet community needs. --- Volunteering Phase The core program outcome is participant volunteerism that supports the mission of the master volunteer Volunteers are more likely to sustain their volunteer service when they feel connected to the organization for which they are volunteering and to content experts. Many volunteers find a community of others with whom they share interests and specialized volunteer roles. After the initial preparation course, volunteers benefit from more focused training that orients them to the goals and culture of the organization for which they are volunteering and provides specific guidance related to the job they will be doing. Additional advanced training often is beneficial to and desired by master volunteers for both continuing their educations and strengthening their social connections. Such in-depth training allows these individuals the opportunity to learn more about a desired topic, moving that person toward self-actualization (Maslow, 1954). Volunteer recognition conveys appreciation for and knowledge of work contributed by volunteers and should be suited to the culture of the master volunteer program and preferences of the volunteer (Culp & Schwartz, 1998). --- Assessing Phase Program managers should reflect on whether a volunteer's work continues to meet the needs of the program and at the same time encourage participants to reflect on their personal volunteer service needs. Volunteers who are meeting these mutual needs may continue in their chosen volunteer roles. In some cases, volunteers look for new roles to learn new skills or meet new people. Some volunteers take a break from volunteering due to changing personal circumstances and re-engage with the program when they can. Some participants volunteer for a while and then exit, or drop, from the program to pursue other interests. Throughout all phases of the volunteer cycle, program managers solicit feedback from volunteers and apply this input toward improving the program. Managers conduct formal evaluations after each educational offering and when specialized questions arise, and they also may receive and consider anecdotal input and observations. --- Conclusion The processes of developing and managing Extension volunteer programs typically involve much attention on the initial volunteer education component. attention on the many factors that contribute to successful volunteer experiences. Zooming out the focus to a wide-angle view of the full master volunteer life cycle highlights points in each phase of the cycle (recruiting, volunteering, and assessing) when program managers should support volunteers so that they can be successful and sustain their volunteer service. ed@joe.org. 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Extension master volunteer programs, such as master naturalist and master gardener, often focus heavily on volunteer education. The model presented here describes the full life cycle of a master volunteer's experience in the program, putting education in the context of other essential program components. By zooming out to a wideangle view of the master volunteer experience, the model provides guidance for improving the program by highlighting the many points in the cycle at which program managers can support volunteers so that they can be successful and sustain their volunteer service.

A graffiti-style mosaic invites viewers to consider this 2-sided face as a means of contrasting hope and pessimism about the futures of Black Americans in the United States. The painting offers several color-based contrasts to illuminate possible touchstones for conversation about and exploration of relationships between past and present, between our ancestors and us, and between those among us whose families suffered slavery's affronts and those among us who are legacy beneficiaries of slavery. Purple-orange and black-white contrasting sites illuminate popular culture and media references that offer yet another layer of interpretation by which viewers might consider these topics. Additionally, viewers can compare blackface and its racist use to portray Black people in entertainment and media (at left) to a caricature of the actor Chadwick Boseman, who played iconic Black figures such as Jackie Robinson, James Brown, Thurgood Marshall, and the fictional character of Marvel's Black Panther (at right). The left side of the face is scarred and expresses past and present fears of Black people in America. The right side of the face suggests possible sources of Black joy, despite systemic and psychological oppression. This mosaic suggests numerous ways to interpret relationships among our pasts, our present-day experiences, and health equity. Viewers are invited to reflect upon the historical situatedness of present-day racism as perpetuated by mass incarceration, police violence, and clinician bias in evaluating patient's health care experiences, for example. Anthony U. Onuzuruike is a third-year medical student at Cleveland Clinic Lerner College of Medicine in Ohio who will graduate in 2023. He grew up in Kansas City and went to the University of Missouri, where he earned undergraduate degrees in chemistry and biology. He has always been somewhat of a Renaissance man, with interests in many aspects of life such as sports (football and basketball), history, music, medicine, and art (digital painting). Citation AMA J Ethics. 2021;23(2): E196-197. DOI 10.1001E196-197. DOI 10. /amajethics.2021.196. .196. --- Conflict of Interest Disclosure The author(s) had no conflicts of interest to disclose. --- The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA. Copyright 2021 American Medical Association. All rights reserved. ISSN 2376-6980

This graffiti-esque mosaic considers legacies of slavery and segregation as manifested in present-day health inequities. Racist American structures and practices are maintained by social policies and cultural attitudes informed by old stereotypes.Media Procreate for iPad.

I. INTRODUCTION The rise of social media and the availability of big social data, in particular in the form of User-Generated Content (UGC), represent nowadays a challenge in the fields of data analysis and data science. The multiple kinds of contents (i.e., textual, acoustic, visual) that people share within the Social Web can be employed to different purposes and analyzed under different perspectives to tackle several issues related to society. On the one hand, the focus of the SeCredISData Special Session 1 is given to the study and the application of affective computing and sentiment analysis [1], [2] to social data, which can impact on monitoring, analyzing and counteracting discrimination and hate speech, which are increasingly spreading phenomena in our countries also in combination with the pervasiveness of social media [3]- [5]. A further aspect to be taken into account in the automatic analysis of sentiment is the use of figurative language [6]- [9], also considering that often, sarcastic messages are the ones that spread more virulently. Furthermore, also the applications of sentiment analysis and emotion detection in social media for the development of education, entertainment, cultural heritage, health, e-government, and games is considered as interesting object of investigation [10]. On the other hand, by considering the process of 'disintermediation' that affects social media, characterized by the absence of traditional trusted intermediaries in the process of information generation and diffusion [11], [12], the Special Session will also investigate the problem of assessing the credibility of UGC spreading among and across virtual communities [13]. The diffusion of fake news, hoaxes, rumors, fake reviews, inaccurate health information, can have a negative impact on society with respect to different aspects [14], from influencing political elections, producing harmful effects if connected to the health of patients, to generating hate and discrimination phenomena. For all these reasons, the study and the development of approaches that can help people in automatically assess the level of credibility of information is a fundamental research issue in the last years [13]. --- II. SCOPE AND TOPICS OF INTEREST The aim of the SeCredISData Special Session is to cover different aspects related to data analysis applied to big social data, by addressing to a heterogeneous community of researchers who has data science as a common denominator. Big social data analysis is interdisciplinary by its nature, and combines disciplines such as natural language processing, social network analysis, multimedia management, social media analytics, trend discovery, information retrieval, computational linguistics. Therefore, areas of interest to SeCredISData in particular, and to DSSA 20182 in general include, but are not limited to: • Subjectivity, sentiment, and emotion detection; • Sentiment-based indexing, search, and retrieval; • Sentiment topic detection and trend discovery; • Multimodal emotion and sentiment detection; • Irony and sarcasm detection; • Affect in natural language and multimodal interaction; • Emotion models and ontologies of emotions; • Hate speech detection and ethical issues in affect and opinion detection; • Summarization of affective data; • Sentiment analysis and emotion detection in social media applications; • Opinion spam, group spam, fake news detection; • Credibility/reliability of health-related information; • Multimedia content credibility; • Information/misinformation diffusion; • Trust and reputation in virtual communities; • Retrieval of credible information; • Credibility gold standard datasets generation; • Fact-checking and crowdsourcing credibility. --- III. SUBMISSIONS AND ACCEPTED PAPERS The SeCredISData Special Session has received a good number of submissions, i.e., eleven, which demonstrates the interest of the scientific community about the problems related to the analysis of the sentiment, the emotion and the credibility of information that diffuses on-line, in social media in particular. Of the eleven submissions, six were accepted to be presented at the conference and published on the Proceedings of DSAA 2018, with an acceptance rate of about 55%. The accepted articles deal with interesting issues that are fairly evenly distributed among the topics of interest of the Special Session. A first paper, entitled: "Willingness to Share Emotion Information on Social Media: Influence of Personality and Social Context", presents a user study, carried out on 190 subjects, exploring the willingness of Web users to share emotion information either through selfreporting or through facial expressions. The study tries to find correlations between sharing and feedback mechanisms, as well as sharing and personality traits. In the paper entitled: "Utilizing Information from Tweets for Detection of Sentiment-based Interaction Communities on Twitter", the authors investigate the task of detecting semanticallymeaningful communities on Twitter, by proposing a set of modifications to the traditional way edges are built and weighted between interacting nodes of a Twitter graph. The idea of introducing semantics in standard analytical metrics and tasks is promising. Another paper, entitled: "An Empirical Analysis of the Role of Amplifiers, Downtoners, and Negations in Emotion Classification in Microblogs", presents the impact of amplifiers, downtoners, and negations on emotion words and on document classification, by considering tweets. One of the interesting aspects of the paper is that modifiers have been studied in sentiment analysis but rarely in emotion analysis. The paper: "Portability of Aspect Based Sentiment Analysis: Thirty Minutes for a Proof of Concept" introduces an unsupervised method for the detection of finer-grained sentiment aspects of product/services in reviews, by integrating graph-based extraction rules over dependency trees and distributional semantics techniques, and addressing the interesting issue of domain portability. In: "'Behind the words': psychological paths underlying the un/supportive stance toward immigrants in social media environments", the authors aim at studying supportive and unsupportive attitudes in social media, with particular reference at exploring psychological paths underlying social media stances toward immigrants in the state of need, a problem of sad actuality. Finally, the paper entitled: "A Methodological Template to Construct Ground Truth of Authentic and Fake Online Reviews", discusses an interesting research issue, i.e., the way of building ground truth datasets in the area of on-line credibility assessment, where the problem of collecting labeled data with respect to the credibility of information has not been solved yet in the literature. This would help researchers to better evaluate ongoing research, which constitutes one of the major issues in opinion spam detection [15]. --- IV. CONCLUSION The SeCredISData Special Session had the objective to promote the development of methods and approaches for the analysis of big social data that can have positive repercussions on society. In particular, the Special Session was addressed to all those researchers who employ data science as a common denominator to tackle issues related to the analysis of the sentiment, the emotion and the credibility of on-line information, in social media and virtual communities in particular. The success of the Special Session demonstrates the interest of the scientific community in these aspects, and the need to continue research in this area. --- ACKNOWLEDGMENT The SeCredISData Organizers would like to thank the members of the Program Committee for their valuable contribution: Snehasish Banerjee, Valerio Basile, Stefano Cresci, Rossana Damiano, Rino Falcone, Carlos A. Iglesias, Giovanni Livraga, Mihai Lupu, Stefania Marrara, Marcelo Mendoza, Stuart E. Middleton, Véronique Moriceau, Malvina Nissim, Nicole Novielli, Symeon Papadopoulos, Barbara Poblete, Paolo Rosso, Giancarlo Ruffo, Manuela Sanguinetti, Michael Sirivianos.

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

INTRODUCTION According to the Association of American Medical Colleges (AAMC), approximately 11% of US physicians are from minority groups that collectively represent 31% of the US population. 1,2 Underrepresented in medicine (URiM) are those racial/ethnic groups that are underrepresented relative to their numbers in the US population. Groups identified as URiM include Black/African American, Hispanic, Native American (ie, American Indian, Alaskan, Hawaiian), and mainland Puerto Rican. Among academic medicine faculty, approximately 7% to 8% are physicians from URiM groups, and further disparities exist in leadership positions in medicine. [3][4][5][6][7][8] Mentorship is critical to physician recruitment, career development, and retention. 9 A mentor advises, supports, and shares knowledge through a longitudinal relationship with a mentee. [9][10][11][12] Unfortunately, many URiM physicians experience minority taxes that can adversely impact their career. 13,14 Minority taxes are burdensome extra duties, experiences, or responsibilities unfairly assigned to physicians from minori-tized groups (Figure 1). 13,14 Use of cross-cultural mentoring skills to navigate differences between non-URiM and URiM physicians can make mentorship relationships with URiM physicians more effective. 15,16 Our study had three objectives. The first was to obtain information on current demographics, URiM physician collaboration, and academic promotion among US military family physicians. The second was to assess their confidence and skills in discussing structural, systemic, and/or interpersonal racism in cross-cultural mentorship relationships. The third was to identify whether they could recognize and address specific challenges described in literature as minority taxes. Study questions assessed cross-cultural relationships between non-URiM mentors and URiM mentees. --- METHODS This survey was part of a larger 2021 Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting Omnibus Survey conducted by the Clinical Investigations Committee (CIC) of USAFP. The CIC iteratively evaluated We collected data from participants anonymously via a link supplied at the meeting. We sent three follow-up email survey invitations. Respondents self-reported demographics, crosscultural mentorship relationships, confidence and skills in discussing racism, and ability to recognize and address minority taxes. We categorized survey questions with 4-point and 5-point scales into two response categories. We categorized questions regarding confidence and skills as confident/not confident and skills/no skills, respectively. Similarly, we cat-egorized questions regarding understanding and ability to recognize minority taxes as understand/do not understand and recognize/cannot recognize, respectively. We performed descriptive statistics and bivariate associations using SPSS Statistics (IBM) software. Summary statistics included mean and standard deviation for continuous variables and frequencies with percentages for categorical variables. Group comparisons were conducted using χ 2 tests, independent samples t tests, Fisher's exact tests, and Wilcoxon's rank sum tests, as appropriate. Two-sided statistical tests were conducted assuming α=0.05. --- RESULTS Of the 487 attendees who met inclusion criteria, 258 responded to the survey. Ten percent of respondents were from URiM groups, and 54.3% of respondents identified as male. Additional respondent characteristics are shown in Table 1 . Fifty-three percent of respondents did not have a URiM physician mentee, and 55% had not collaborated with a URiM physician colleague on a scholarly activity within the last 3 years. Most respondents felt that they understood the historical context of racism (75.2%), had the skills to discuss racism (62.8%), and had the confidence to discuss racism (60.5%). Family Medicine, Volume 55, Issue X (2023): 1-5 However, only 54.7% felt that they could recognize and address minority taxes. Table 2 shows the overall survey responses of all respondents, URiM versus non-URiM responses, and responses from those with and without a URiM mentee. URiM physician respondents were more likely to have a URiM physician mentee (65.4% vs 44.4%, P=.042), more confident discussing racism (84.6% vs 60.3%, P=.015), more likely to recognize and address minority taxes (84.6% vs 51.3%, P=.001), and more likely to feel more skilled to discuss racism (80.8% vs 58.2%, P=.026). Sixty-five percent of URiM physicians responded that they had been affected by racism in their medical career. Respondents who had a URiM physician mentee were more confident discussing racism (70% vs 56.5%, P=.025), more likely to recognize and address minority taxes (62.5% vs 47.8%, P=.018), more likely to have collaborated with a URiM physician in the last 3 years (62.8% vs 28.3%, P=0.0), and more likely to feel more skilled to discuss racism (70.8% vs. 51.4%, P=.001). --- DISCUSSION Within our data set, URiM military family physician demographics are consistent with civilian data in regard to overall URiM composition 1 and academic promotion (Table 1). 7 Only approximately 50% could recognize and address minority taxes. Furthermore, more than half of respondents did not have a URiM physician mentee and had not collaborated with a URiM physician colleague on a scholarly activity within the last 3 years. The lack of statistical significance between URiM and non-URiM physicians' scholarly activity collaboration with a URiM physician may be representative of the impact of minority taxes on scholarly activity. To our knowledge, this is the first study to evaluate cross-cultural mentorship practices among military family medicine physicians. The first limitation to this survey was that the survey demographics questions combined Asian, a non-URiM physician group, and Pacific Islander. This was not considered to have a significant impact on outcomes given the overall low population of the Pacific Islander minority group in medicine, approximately 0.1%. 1 Second, although USAFP represents more than 3,000 military physicians, the survey was available only to registered conference attendees, less than 20% of membership. 18 Lastly, while our study demographics mirrored civilian data, unique military factors such as pay equality, esprit de corps, and an interconnected global professional network built through duty reassignments may limit study generalizability because nonmilitary physicians may not have these experiences that influence their career trajectory. Military family medicine has had a tradition of producing physician leaders who have responded to addressing disparities in physician retention and career development. The Military Health System (MHS) Council for Female Physician Recruitment and Retention and the annual MHS Female Physician Leadership Course (FPLC) were implemented to address higher attrition rates of women physicians and the lower percentages of military women physicians serving in leadership positions. 8,19 Like gender disparities, addressing racial/ethnic disparities in medicine will require similar programs. 20 Mentors involved in these programs must have the skills to recognize, address, and mitigate the negative effects of minority taxes. 15,16 Some specific skills are listed earlier in Figure 1. This initial study suggests that, while some cross-cultural URiM physician mentorship is occurring, it could be significantly improved. Furthermore, our study results are timely and aligned with the Society of Teachers of Family Medicine's key initiatives of antiracism and supporting the professional growth of URiM physicians. Additional studies are needed to implement programs and identify opportunities to improve URiM physician pathways in medicine. --- PRESENTATIONS --- CONFLICT DISCLOSURE The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, the Department of the Navy, the Uniformed Services University of the Health Sciences, Fort Belvoir Community Hospital, the US Department of Defense, or the US government.

Background and Objectives: Mentorship is critical to physician recruitment, career development, and retention. Many underrepresented in medicine (URiM) physicians experience minority taxes that can undermine their professional objectives. Use of cross-cultural mentoring skills to navigate differences b etween non-URiM and URiM physicians can make mentorship relationships with URiM physicians more effective. This survey examined military family physician demographics and mentorship practices. Methods: Design and Setting: Cross-sectional study using voluntary, anonymous data from the 2021 Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting Omnibus Survey. Study Population: USAFP Members attending 2021 Virtual Annual Meeting. Intervention: None. Statistical analysis: Descriptive statistics and χ 2 tests.The response rate to the omnibus survey was 52.9%, n=258. More than half of respondents did not have a URiM mentee and had not collaborated with a URiM colleague on a scholarly activity within the last 3 years. Only 54.7% of respondents could recognize and address minority taxes. URiM physicians were more likely to have a URiM mentee (65.4% vs 44.4%, P=.042) and to recognize and address minority taxes (84.6% vs 51.3%, P=.001). They also were more confident (84.6% vs 60.3%, P=.015) and more skilled in discussing racism (80.8% vs 58.2%, P=.026). Conclusions: Structured programs are needed to improve knowledge and skills to support cross-cultural mentorship. Additional studies are needed to further evaluate and identify implementation strategies.

OTHER MULTIDISCIPLINARY P.133 Women in Canadian neurosurgery: an update C Veilleux (Calgary)* EL Figueroa (London) N Samuel (Toronto) H Yan (Toronto) G Rosseau (Washington) M Hodaie (Toronto) G Zadeh (Toronto) G Milot (Canada) doi: 10.1017/cjn. 2023.221 Background: Women continue to represent a minority of the neurosurgery workforce in Canada. We herein aim to provide an update of the current Canadian landscape to gain a better understanding of the factors contributing to this disparity. Methods: Chain-referral sampling, interviews, personal communications, and online resources were used as data sources. Online survey results obtained from women attending neurosurgeons across Canada were also utilized. Quantitative analyses were performed, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding. Results: We observe a positive trend in the incoming and graduating of female residents across the country, although this trend is lagging compared to other surgical specialties. The proportion of women in active practice remains low. Positive enabling factors for success include supportive colleagues and work environment (52.6%), academic accomplishments (36.8%), and advanced fellowship training (47.4%). Perceived barriers reported included inequalities regarding career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Conclusions: Women continue to represent a small proportion of practicing neurosurgeons across Canada. Our work highlights several key factors contributing to the low representation of women in neurosurgery and identifies actionable items that can be addressed by training programs and institutions. --- OTHER NEUROSURGERY P.134 Neurosurgery research output in The Association of Southeast Asian Nations (ASEAN) region: a scientometric analysis P Rosales (Manila)* C Escuadra (Manila) doi: 10.1017/cjn.2023.222 Background: Various challenges and innovations have led to the evolution of neurosurgery in the ASEAN region. This has increased interest among neurosurgeons to publish research papers for the past years. The study aims to compare the publication trend, and topic trend on research in the region using scientometric techniques. Methods: Publications from Web of Science (WoS) using the keywords "neurosurgery" OR "neurological surgery." were obtained. Results only included English articles published from ASEAN countries. Publication, citation, collaboration, and text-co-occurrence analysis were done using WoS and VOSViewer. Results: 1951

higher median mRS at 1st [3(2-4) vs 1(1-2), p<0.001], and final [2(1-4 vs 1(1 (0-2), p<0.001] follow-up. Conclusions: Patients treated with DC fared worse at every endpoint, which was disproportionate to the difference in presenting WFNS grade. These data do not support the use of DC following microsurgical clipping of a ruptured aneurysm.Outcome prediction in patients with aneurysmal subarachnoid hemorrhage undergoing microsurgical aneurysm repair: analysis of a South Australian Cerebrovascular Registry TJ O'Donohoe (Melbourne)* C Ovenden (Adelaide) G Bouras (Adelaide) S Chidambaram (Adelaide) AS Davidson (Melbourne) T Kleinig (Adelaide) A Abou-Hamden (Adelaide)

Introduction Both more developed and less developed nations are experiencing rapid ageing of their populations with those age 65+ years expected to become 27% and 15% of these nations, respectively, by 2050 [4,6]. Although issues related to older adults are receiving substantial attention in other areas of research, the HCI community might contribute more. Aging is associated with a multitude of biological, cognitive, and social changes that impact the use of technology [5]. For mobile devices in particular, these can seriously hamper usability, for example through reduced visual acuity and less accurate fine motor controls that affect almost everyone as we age. However, age also brings new opportunities that well designed mobile apps could support: for example increasing spare time, strengthening family connections, and new learning/travel opportunities. The digital revolution has not adequately considered the needs of the ageing population. Although older adults constitute an increasing segment of the demographics, the majority of research on HCI focusses almost exclusively on younger adults, a trend reflected in industrial developments and in evaluation studies of mobiles. As a consequence, older adults may be losing the possible benefits and opportunities from this growing digital era (see Figure 1). In contrast to the youth focused mainstream of mobile research and development, there is a growing use of mobiles to support older adults with special needs and many of the lessons from this research could have wider implications for age-agnostic design and evaluation. --- Focus Areas This SIG focuses on mobile devices, perhaps the most challenging but potentially most available platform for the ageing population. We interpret "mobile device" broadly to include current and future forms of mobile computing, including phones, tablets and wearables. Mobile devices' ownership rates for older adults are increasing [3], yet there are few suitable concrete design principles [1,5]. Further, evaluating both the usability and the social/personal benefits of seniorcentred mobile interfaces is challenging and not well supported by existing HCI [7]. By providing easier access to information through mobile devices, older adults can be gain more benefits. --- Goals This SIG aims to reach three goals. --- Building a research repository Presently researchers working on this topic are scattered across different fields. The research outcomes, experiences, and practices are not disseminated across the boundaries of these fields. As a consequence, it is difficult for people in different communities to become aware of research progress in the field. A major goal of this SIG is to bring researchers from these fields together to synthesize and collate findings from different disciplines, and create opportunities to explore bridging between several field experts in order to develop efficient, effective, usable, and adoptable mobile technologies and more appropriate methods. The SIG will also be able to discuss critical issues cutting across fields that --- Community building Senior-centred research and development is currently conducted in academic and industry research labs in a rather disjoint manner. As such, this SIG's goal is to link the SIGCHI community with researchers and practitioners across academic disciplines (such as the Cognitive Neuroscience) and industries who are actively working or having interest toward understanding older adults' technology use, specifically mobile applications. For future collaborations, mailing lists and post-chi activity (e.g., workshop) will be established. --- Raising Awareness Interactive technologies for seniors is a significant market of interest for industries, expected to grow from US$ 2 billion to an estimated US$ 30 billion in the next few years [8]. This is a natural reflection of the size of this user group (16% of population [9]). Yet interest in HCI is still relatively small (less than 1% of all CHI 2015 accepted submissions across all tracks can be categorized as focused on older adults). This SIG aims to raise awareness of the challenges and research opportunities in this field. --- Suggested topics for group discussion The group discussion will be structured according to the topics below. --- Current issues Older adults face many problems while accessing mobile devices. This topic will focus on discussing issues related to human factors, perception, memory, and motor movement of older adults, and how these issues affect the accessibility of senior-based mobile interfaces. --- Theories and design Various theories and design principles have been proposed for older adults. This topic will focus on discussing the state-of-the-art theories and design principles for mobile interfaces of older adults, how effective is the current theories and design principles on improving the accessibility of senior-based mobile interfaces, and identify future research opportunities. --- Evaluation methodologies Evaluating senior-based user interfaces still face many challenges, particularly on accurately understanding the preferences, habits, and adoption challenges of older adults [10]. For example, there is growing evidence that offspring can be dis-encouraging to older adults and can lead to tensions in study design [11]. This topic will focus on discussing the state-of-the art evaluation methods, to discuss how suitable is the current methods, and identify future research opportunities. --- Applications Mobile devices open up many new possibilities and opportunities for older adults. This topic will discuss what some potentially useful applications for older adults are. For examples, text-entry methods can enhance the usability of messaging applications. Games and social applications have the potential to improve the wellbeing of older adults. We will conclude with a list of future opportunities for applications. --- Conclusion The older adults community is currently very active and regularly makes significant contributions to both the research literature and our society at large. However, our community is scattered across different research fields. In workshops at MobileHCI conference over the past two years organized by two of the committee members, it was attempted to unify the older people researchers scattered across different research fields into an interdisciplinary community centered at CHI. We want to open access our community further by hosting a SIG and pushing the boundaries of the field in a common direction. Trying to establish a set of best practices across our varied communities will position the field to learn from the past and present so that we can march forward together to address the older people interface design challenges of the future.

This SIG advances the study of mobile user interfaces for the aging population. The topic is timely, as the mobile device has become the most widely used computer terminal and at the same time the number of older people will soon exceed the number of children worldwide. However, most HCI research addresses younger adults and has had little impact on older adults. Some design trends, like the mantra "smaller is smarter", contradict the needs of older users. Developments like this may diminish their ability to access information and participate in society. This can lead to further isolation (social and physical) of older adults and increased widening of the digital divide. This SIG aims to discuss mobile interfaces for older adults. The SIG has three goals: (i) to map the state-of-art, (ii) to build a community gathering experts from related areas, and (iii) to raise awareness within the SIGCHI community. The SIG will be open to all at CHI.

Background The relationship between social network structure and performance has been a hot research topic for decades. Recent researches have showed there was significant relationship between social network indices and organizational performance. However, we found two issues in this area after reviewing the existing literature: (1) Most literatures only adopted one dimension to build up the social networks. And most of them only collected one performance indicator, which limited the possibility to differentiate the influence of different kind of networks on different performance. (2) Most existing literatures that focused on organizational performance were mostly based on inter-organizational networks. Since organizations could different from each other by structure, size, revenue, business and so on. The result they got might reflect these differences. To address the above two issues and get a better understanding on the relationship between informal networks and organizational performance, we collected multiple organizational performance from the 22 Chinese branches of Company A. Company A is one of the biggest Express companies in the world. Because all of the branches have the same structure and strategy, the network indices and performance are much more comparable. We also adopted 2 different dimensions to build up the informal social networks within Company A in China. --- Methods Both online and paper based (only for those who did not have an Email) Social Network Survey was sent out to all of Company A's 25 hundred employees in China in December 2009. They were asked to select a group of employees on each social network dimension from the predefined employee list in the online survey and to write down a group of employees' names for each social network dimension in paperbased survey. 1995 responses were collected after two weeks, so we got a response rate of 80%. We argue that there are naturally two kinds of relationships in organizations. The first one is functional relationship. People will use functional relationship to get information, work related material, and search for expertise help. Another kind of relationship is social and emotional relationship. People will use this kind of relationship to share personal issues, to make friends and so on. Based on the above argument, the following 2 dimensions mapping both functional relationship and social relationship were adopted in the survey (see table 1). Both 2009 and 2010's performance data was collected from all of the Company A's branches in China. 4 kinds of organizational performance were collected and they are customer satisfaction index (CSI), financial performance(FP), operational performance(OP), and turnover rate (TR). Customer satisfaction is the aggregated index from Company A's monthly survey, which includes 7 questions, that captures the most important dimensions, such as value for money, professionalism, complaint handling capability, overall satisfaction and so on. The financial performance is the percentage of the budget that each branch completes for that year. The operational performance is defined by the controllable operational errors for each branch. Turnover rate is the ratio of volunteer-leave employees for each branch. --- Result and Discussion We normalized all 4 kinds of performance data for both 2009 and 2010 and aggregated two years data together for data analysis. UCINet 6.289 and Pajek2.0 were adopted for network data analysis. The network density was calculated by UCINet for each branch on each network. Individuals' Indegree, Outdegree, and Constraint were calculated by UCINet on each network and then were averaged for each branch. All 5 kinds of brokerage for each individual were calculated by UCINet and added up and then averaged for each branch. Tradic census were run for each branch by Pajek and Tradic ratio was calculated as the ratio of the patterns that connect all 3 individuals without considering the direction of connection to all trads/dyads for each branch. Since the network indices varied much with the size of different network, partial correlation was adopted for data analysis. The number of people participating this program for each branch was taken as the controlled variable. 4 branches' data were excluded from the data analysis because of one of the following reasons. (1) Branch size were too small so there were less than 10 people participating this research program. (2) The turnover rate was more than 20%. So, there were 18 branches data were put into the calculation. Table 2 showed the correlations between the organizational performance and network indices. Table 2 showed that there is significant relationship between informal social networks and branch level organizational performance. Financial Performance(FP) and Turnover rate (TR) showed stronger relationship with all network indices and Operational Performance (OP) and Customer Satisfaction(CSI) showed weaker relationship with network indices. Even though some of the correlation (marked as a in table 2) did not achieve significant level (0.05 <p < 0.08), we are arguing that they do reflect the potential relationship between performance and network indices by considering the small sample size (18) and the magnitude of the correlations. As we argued, we assumed that different kinds of informal networks would show different level of predicting power for different kinds of performance. This assumption is also supported from the table2. Firstly, financial performance only showed significant relationship with network indices on information network and showed no significant relationship on energizing network. Secondly, operational performance only showed significant relationship with constraint on information network but not for energizing network. Thirdly, Turnover rate only showed significant relationship with brokerage on energizing network but not for information network. We believe that the financial performance and operational performance reflect more functional aspect of organizational performance and turnover rate reflect more social aspect of organizational performance. So, it clearly showed that the functional network (information network) can predict the functional aspect of performance (financial performance) better and the social related network (energizing network) can predict the social aspect of performance better. --- Conclusion In summary, through mapping both social related and functional related informal networks and collecting the performance data correspondingly, this paper showed: (1) There is significant relationship between organizational performance and informal network indices. Financial performance and employee turnover rate showed stronger correlation with network indices. (2) Emotional network showed stronger relationship with social aspects of organizational performance and functional network showed stronger relationship with functional aspects of organizational performance.

By mapping both social related (energizing) and functional (information) related informal networks and collecting the performance data correspondingly in one of the biggest Express Company in the world, this paper showed: (1) There is significant relationship between organizational performance and informal network indices, which means we can predict orgniztions' performance by the informal network patterns. (2) Emotional network showed stronger relationship with social aspects of organizational performance and functional network showed stronger relationship with functional aspects of organizational performance, which implies that we need to choose different informal networks to predict different kind of performance.

who dislike and reject their children are likely to inculcate low self-esteem and dislike towards themselves and others. Acceptance remains an important socio -genic need and its magnitude of satisfaction influences mental peace and growth of personality (Logdon and Stout 1951) [7]. The permissiveness / restrictiveness of parents appears to be most closely related to the development in child such traits as initiative, autonomy, independence and conformity. Parents who are extremely restrictive produce highly conforming and wellsocialized children. To love hostility and restrictiveness / permissiveness, will differ in making their impact upon the cognitive development of the child. They may also differ in their effect. upon child's social and personnel development. Due to the difference in cognitive development the competence level of child will differ and this will cause differences in the performance level of the child. It is to be noted that acceptance is not ' love ' or ' warmth '. Acceptance is more positive than tolerance but clearly lacks initiative in approaching others. Being rejected by parents causes physical neglect, denial of affection, lack of interest, disrespect, cruelty, and abusive treatment (Syamond 1939) [8]. Child rejection fosters insecurity, inferiority, and inadequacy. Rejection weakens ego, self-esteem, and isolation (Dhar, U. 1983) Several studies have investigated the factors that contribute to the self-actualization of physically handicapped adolescents. Mahmoudi-Gharaei et al. (2017) [9] found that parental acceptance positively influenced self-actualization in these adolescents, while O'Connor et al. (2018) [10] reported that parental rejection had a negative impact. The type of disability had no significant effect on self-actualization (Lasebae et al., 2019) [11], but positive family relationships, social support, a positive family environment, perceived control, and personal factors such as resilience, optimism, and self-efficacy were found to promote selfactualization (Chen et [12]. Parenting style was also found to play an important role in promoting self-actualization in physically handicapped adolescents (Mehta and Patel, 2019; Patel and Mehta, 2020). Gender differences were observed in the relationship between family relations and self-actualization, with the relationship being stronger in girls than boys (Saatchi and Kamkar, 2012). Additionally, females scored higher in self-actualization than males (Prabha et al., 2017), and social support was positively associated with self-concept in physically handicapped adolescents (Khatib and Khatib, 2018). These findings suggest that various factors, including family relationships, social support, personal factors, and parenting style, can promote the self-actualization of physically handicapped adolescents. The investigation presented in this paper is focused on effect of family relation on selfactualization of physically handicapped adolescent boys and girls. 240 boys and girls selected on the basis of family relation through multistage sampling in each group are compared through analysis of variance. --- II. METHOD Setting: The study was conducted in institutions for physically handicapped individuals located in the state of Madhya Pradesh, which is situated in the central region of India and comprises 53 districts. The study was conducted in physically handicapped institutions in two major districts, namely Jabalpur and Bhopal, encompassing both government and private educational institutions. The sample consisted of 800 subjects (400 boys and 400 girls) within the age range of 15-19 years. The Parental Acceptance-Rejection Questionnaire (PARQ) was administered to the sample, and different groups were formed based on the PARQ scores, including accepted and rejected boys' and girls' groups. Ultimately, a final sample of 120 boys and 120 girls was selected for the study. --- A. Hypothesis  The self-actualization of parentally accepted adolescent physically handicapped boys are higher than parentally rejected handicapped boys.  The self-actualization of parentally accepted adolescent physically handicapped girls are higher than parentally rejected handicapped girls.  The self -actualization of parentally accepted adolescent physically handicapped group (girls & boys) are higher than parentally rejected handicapped group. --- B. Objectives This --- C. Sample The total sample for the study consisted of 800 subject 400 boys & 400 girls between 15-19 years age group. The samples are selected in those group according to their family relation 240 students for final sample we are selected 120 boys and 120 girls. These data selected from educational institute of handicapped children in Jabalpur & Bhopal district. --- D. Description of Tools: For research we used the following tools. 1. Parental Acceptance Rejection Questionnaire (PARQ) -Mr.R.P.Rohnar The Parental Acceptance-Rejection Questionnaire (PARQ), developed by Mr. R.P. Rohnar, is a self report measure used to evaluate children's perceptions and adults' memories of their experiences of parental acceptance or rejection during childhood. The PARQ is composed of four subscales, including warmth and affection (or coldness and lack of affection when reverse scored), hostility and aggression, indifference and neglect, and undifferentiated rejection. The reliability of the PARQ was assessed using Cronbach's alpha, details available in table1. These findings suggest that the PARQ is a reliable instrument for assessing parental acceptance and rejection in childhood. --- Self -Actualisation Questionnaire (SEAI) -A.K.Sharma Inventory in construction of items in the form of statements on the basis of the fifteen characteristics of a self-actualized individual as given by Maslow, but the item had only Indian cultural load. Inventery comprises 75 items in total. A three point rating scale indicating 'equal to nil', 'some' and 'much' degree of S-A characteristics has been provided Infront of each of the statements. --- Validity of the scale: Since there is no test of self-actualisation available except POI which has its own limitation,criterion validation could not be done. However, the content validation of the item has already been made thoroughly. A correlation of .27 was found against Kakkar's Self-Acceptance Inventory, and .29 with NCERT'S Self-Perception Inventory. --- Reliability: The test retest reliability of the inventory on a small sample of 100 eight class students was found to be .85. --- E. Procedure PARQ are administrated of the sample of 800 students where some of the questionnaire were incomplete we have not included that questionnaire in Sample after that divided them in four groups on the bases of parental acceptance and rejection groups. The groups were as follows 1. Accepted Girls 2. Rejected Girls 3. Accepted Boys 4. Rejected Boys After that we applied the self-actualization scale of Dr. K.N. Sharma. After administration self-actualization scale we had done the statistical process to obtain result. --- III. RESULT --- IV. DISCUSSION AND ANALYSIS The findings presented in Table 2 indicate that the self-actualization of both accepted and rejected children is not significantly influenced by family relations or parental attitudes. Moreover, the results demonstrate that there is no significant difference in the self-actualization of physically disabled boys and girls who have been either accepted or rejected. These findings suggest that selfactualization is influenced by other social and psychological factors beyond family and parental support. It is noteworthy that this study was conducted on physically handicapped boys and girls, and the results suggest that selfactualization may represent an advanced stage of development for these individuals, who may struggle with meeting other psychosocial needs, such as feelings of insecurity, inferiority, frustration, social adjustment, future insecurity, and lack of confidence. Overall, the present study highlights the importance of considering a multidimensional approach when investigating selfactualization and underscores the need to explore other potential factors that may impact self-actualization among individuals with disabilities. These findings have important implications for the development of interventions aimed at enhancing self-actualization in this population. Future research could benefit from longitudinal designs that follow participants over time to further investigate the complex interplay between acceptance, rejection, and self-actualization among individuals with disabilities.

The investigation focused on effect of family relation on self -actualization of physically handicapped adolescent boys and girls. 240 boys and girls selected on the basis of family relation through multistage sampling in each group are compared through analysis of variance. Significant effect of parent child relation & personality variables is noted.

The number of people older than 65 in work has increased sharply in recent years and is now estimated at around 900 000 in England. 3 But because around half of all adult social care spending goes on care for older people (as opposed to disabled people of working age) this means that younger working people bear the bulk of care costs. The "triple lock" protecting state pensions has been temporarily suspended as part of the plan, but that does not fully mitigate the inequity. Unlike income tax, which is progressive, rates of national insurance paid fall as income rises, falling disproportionately as a share of income as pay increases, and placing a higher relative burden for the collective contribution to the cost of care on lower paid workers. 4 National insurance does not apply to income from dividends, pensions, investments, or rents. The government does not propose to levy tax on these to help increase funding for social care or healthcare and so it protects wealth from assets relative to income from labour. The planned cap on social care costs to be borne by individuals-£86 000 over a lifetime-means that people with savings and assets well above this amount, including equity tied up in owned homes, will be disproportionately protected when compared with those for whom £86 000 is most of what they have. Not only does this protect wealth (much of it accumulated only through house price growth) but it entrenches inequality by allowing that wealth to be passed on to family members without additional taxation. The funding mechanisms for local government services are inherently regressive and further entrench socioeconomic inequalities. 5 This matters, because the needs assessment, means assessment, funding, and provision of adult personal social care, whether at home or in long term care facilities, remain the responsibility of local government. Any expansion in numbers of people receiving social care will have to be funded by means of local government efficiencies or local fundraising (through council tax or local precept). Yet local authorities in richer areas with higher house prices and often with higher income from business rates can raise more income, despite the fact that areas with greater socioeconomic deprivation often have higher need. Around one third of income for local authorities comes from support grants from central government. 6 Cuts to those grants over the past decade have hit poorer areas harder. The Institute for Fiscal Studies showed in 2019 that reductions in local council revenue had fallen by the largest amount in the most deprived 20% of local councils. 7 The fact that social care remains means tested, rationed by eligibility, and delivered by a diverse network of small private providers, charities, social enterprises, and big corporate groups, and that the government has no plans to change any of this, means that healthcare and social care are not treated equally. People with medical conditions such as severe dementia, or progressive frailty or age related disability, are effectively treated as second class citizens in comparison with those with "healthcare" conditions such as cancer. It almost looks as if the government is actively trying to further inequality and unfairness in the system and in society. --- Competing interests: See bmj.com/about-bmj/freelance-contributors. Provenance and peer review: Commissioned; not externally peer reviewed.

In my last column I discussed the lack of detail or meaningful change in the government's Build Back Better plan for health and social care in England. 1 2 I did not, however, touch on the inherent inequality of the changes, between rich and poor, young and old. The "health and social care levy" is a planned 1.25 percentage point rise in national insurance contributions from April 2022. But this applies only to people in employment and younger than the state retirement age. From 2023 people still working beyond retirement age will also have to pay the levy.

and metals (Zn, Cu, Pb, Ti, Mn, Sn, V, Ba), while SMC children are exposed to high ozone concentrations and PM-associated with lipopolysaccharides. This is important because exposure to specific pollutants may lead to specific detrimental effects (Rivas-Arancibia et al., 2010;Villarreal-Calderon et al., 2010;Levesque et al., 2011). The neuropathology in MC mongrel dogs have shown DNA oxidative damage, Alzheimer's-type pathology, and accumulation of combustion-associated metals in olfactory mucosa, olfactory bulb, and frontal cortex, suggesting Alzheimerlike pathology and the resulting systemic and brain inflammation could be the consequence of air pollutant exposures (Calderón-Garcidueñas et al., 2002, 2003). In humans, the extensive respiratory inflammation targets the nasal epi-thelium first (Calderón-Garcidueñas et al., 1992). The pulmonary damage is equally severe and boys are more affected than girls, an observation likely related to their longer outdoor exposure hours (Calderón-Garcidueñas et al., 2003). Systemic inflammation, endothelial dysfunction, and high concentrations of interleukin-1β and tumor necrosis factor-alpha (TNF-α) with major impact in the brain (endothelial cells have receptors for these inflammatory mediators) are the norm in exposed are also exacerbated by domestic, school, and street violence (Cicchetti et al., 2010;Liu, 2011). These children are facing a significant rise in crime and violence in their neighborhoods (Davis, 2009) in a country where 52 million people have incomes below the poverty line. On the other hand, typically children from middle and high SES families have access to balanced nutrition and cognitively stimulating home and school environments. Have parents that can afford services and resources for their specific need, and attend schools with stimulating curricula, including teaching a second language. Middle or high SES children live in neighborhoods with lower crime rate and have access to private pediatric care. Thus, the factors accounting for chronic stress in low SES children are typically not present in the higher income cohorts. In keeping with Cicchetti et al. (2010Cicchetti et al. ( , 2011)), Rogosch et al. (2011), andSturge-Apple et al. (2012) the significant impact of high environmental stress is likely affecting predominantly low SES MC children. conclusIon Do we all breathe the same air in MC? Not quite. Low SES children are more likely to be live in environmental unjust communities, are exposed to second and third hand tobacco smog, and are more likely smokers themselves. They have higher chances of residing in high-density multiunit dwellings, with proximity to high traffic streets and factories, gas stations, mechanical shops, or share their living spaces with a home polluting business. Environmental justice/inequity studies suggest the level of pollution present in the environment in which vulnerable populations reside is higher than in more affluent areas (Jerrett et al., 2001;Morello-Frosch et al., 2002;Prochaska et al., 2012). Subjects in poor areas are more likely to spend time close to or in traffic, working on the street, walking long distances to find transport and commuting in congested, dangerous transport. Thus, there is an urgent need to investigate the role of air pollutants in the different MC neighborhoods and their association with children's cognitive and behavior responses. Epidemiological studies should be carried out to precisely determine the spatial distribution of air pollution health risks, Anderson et al. (2011) reviewed how both early plasticity and early vulnerability may reflect opposite extremes along a "recovery continuum" which, we argue, is pertinent to our children. The detrimental pollution effects likely start in utero and continue relentlessly as the child grows up. Children's brains are fully capable of plasticity and neural compensation, thus our MRI observations of increased white matter volume (Calderón-Garcidueñas et al., 2011a), in connection with a well defined vascular lesion associated with low blood flow (Foscarin et al., 2012), is not surprising. Neural compensation has been described in association with white matter lesions, infarcts, and in healthy subjects as a function of training and experience. Specifically, Duffau (2009) compensatory mechanisms following white matter damage included: unmasking of peri-lesional latent networks, recruitment of accessory pathways, introduction of additional relays within the circuit, and involvement of parallel long-distance association pathways. If the child's responses to a single insult depend on a complex set of factors (the nature of the insult, the severity, the timing, cognitive reserve, genetic makeup, nutrition status, family function, etc.), the responses of a child continuously exposed to a polluted environment may even be more complex. Her capacity to compensate and overcome the developmental disruption may be far more intricate given the neuroinflammation and the presence of pathological markers of neurodegeneration (Calderón-Garcidueñas et al., 2012). --- Why are loW ses chIldren more vulnerable than mIddle or hIgh ses chIldren In mc? Low SES children lack the support they need to develop what Diamond and Lee (2011) consider the four qualities required to be successful: creativity, flexibility, selfcontrol, and discipline. Accordingly, low SES children in MC attend public schools that are well known for deficient curricular programs, lack of creativity, flexibility or disciplinary practices, and teachers' unprofessionalism and absenteeism (Loret de Mola and García Bernal, 2012). Deficient schools do not help in the development of executive function skills and do not build cognitive reserves. Low SES children in MC have emotional and social needs, which children. These children exhibit high concentrations of endothelin-1, a potent vasoconstrictor that impacts the brain microvasculature (Calderón-Garcidueñas et al., 2008a). Therefore, it came as no surprise to see the pathological, structural, and cognitive effects of the MC exposures in otherwise clinically healthy children (Calderón-Garcidueñas et al., 2011a). SMC children carefully selected for unremarkable clinical histories and no known risk factors for neurological or cognitive disorders compared to clean-air-controls matched for age, gender, and socioeconomic status (SES), exhibited significant deficits in a combination of fluid and crystallized cognition tasks (Calderón-Garcidueñas et al., 2008b), and 56% of MC children exhibited prefrontal white matter hyperintensities (WMH) similar to those in young dogs (57%). Even more striking, their cognitive deficits matched their MRI volumetric changes in their right parietal and bilateral temporal areas. Thus, exposure to air pollution may perturb the trajectory of cerebral development and result in cognitive deficits during childhood (Calderón-Garcidueñas et al., 2011a). The MC children's neuropathology explain some of the clinical, electrophysiological, and brain MRI findings in our cohorts. The delayed brainstem auditory evoked potentials for example, correlate with the accumulation of α-synuclein and/or beta amyloid in auditory and vestibular nuclei (Kulesza and Muguray, 2008;Calderón-Garcidueñas et al., 2011b). In an autopsy cohort of 43 children and young adults (35 MC and 8 CTL), 40% exhibited frontal tau hyperphosphorylation with pre-tangle material and 51% had amyloid diffuse plaques compared with 0% in controls (Calderón-Garcidueñas et al., 2012). Hyperphosphorylated tau and amyloid plaques are seen in Alzheimer's disease and the development of neurodegenerative diseases must be contemplated as a potential long-term effect in exposed children. It is clear that MC children, regardless of SES, are not healthy and detrimental shortterm brain effects and potentially serious long-term effects are expected. Thus, in addressing the early cognitive and brain structural detrimental effects, we ask: do MC children have the capacity to recover from the observed negative neurological effects? components exposure in pediatric populations and social health outcomes, including measures of delinquent or criminal activity are also needed (Haynes et al., 2011). Childhood aggression and teen delinquency are increasing in Mexico City, establishing an early environmental health risk factor for violence prediction, and prevention (Liu, 2011) in populations at risk will be absolutely critical. Unfortunately while we wait for governmental sectors to address these endemic issues, there are no coverings for our children's noses, nor for their lungs, hearts or vulnerable brains. The body of knowledge gleaned from rigorous air pollution studies should be taken seriously by those concerned with health policy and public health. The unfortunate combination of poverty and air pollution are causing serious adverse, and often irreversible, health outcomes in our children. references followed by environmental protection measures and public health interventions. Research addressing low SES children's physiological regulatory capacities and cognition and developmental outcomes should also be carried out. To address the low SES children's detrimental responses to their physical and social environments (Jerrett et al., 2001;Morello-Frosch et al., 2002;Cicchetti et al., 2010Cicchetti et al., , 2011;;Rogosch et al., 2011;Prochaska et al., 2012;Sturge-Apple et al., 2012), efforts should be aimed to: 1) modify the current public school curricula to build executive function skills and cognitive reserves, which require trained supportive teachers and good quality school infrastructure; 2) provide access to free school lunch with balanced healthy diets; and 3) facilitate access to free good pediatric care, including mental health services. Furthermore, if early childhood air pollution exposures related to SES disadvantage can increase the neurodevelopmental and neurodegenerative risk in the exposed child, then the need for interventions aimed at breaking the cycle of childhood poverty, poor food security, high unemployment, air pollution, and the negative health consequences becomes heightened. We envisioned the protection of children to include cognitive interventions (Diamond and Lee, 2011), but it is important to remember that these approaches work if the children's emotional and social needs are also fulfilled. All efforts -nutritional, academic, extracurricular -are necessary, but insufficient if indeed the air children breath is not clean, and the environment is violent and stressful. We need environmental justice for Mexico City exposed children. As Cureton (2011) stated, "environmental injustice recognizes that economically disadvantaged groups are adversely affected by environmental hazards more than other groups." Low SES MC children urgently need a support system involving parents, teachers, the health system, and government initiatives to improve environmental health. Besides addressing shortterm brain outcomes, we need to investigate the long effects of neuroinflammation and if we are facing an Alzheimer's/Parkinson's epidemic in 30 years. Comprehensive epidemiologic investigations of air pollutant

Megacities around the world have significant problems with air pollution (Molina and Molina, 2004;Chen and Kan, 2008;Parrish and Zhu, 2009). Metropolitan Mexico City (MC) -an example of extreme urban growth and serious environmental pollution with 20 million people, over 40,000 industries and four million vehicles -exhibits marked regional differences in air pollutants concentrations including industrial and mobile sources of contami-

Importance of families PSP and HCW jobs involve shift work, heavy workloads, and exposure to trauma; by extension, these factors affect families who must adjust and adapt to the demands of this lifestyle. Families serve alongside these workers by taking on additional responsibilities in the home, accommodating work schedules, and sometimes making sacrifices regarding their own interests and careers. The FMRG adopts a broad concept of family, including all those who call themselves family, extending beyond the traditional configuration (i.e., nuclear family) to a more contemporary representation of families. Families form through emotional, physical, and social bonds between individuals who often (but not always) reside in the same household. These close interpersonal relationships are an important source of support, comfort, and security for PSP and HCW families. Conflicts between work and family can arise for PSP and HCW families due to the high-level demands of the job, which puts family well-being at risk. Some families adapt well to this lifestyle, but the cumulative impact of everyday stressors and workplace demands can result in negative outcomes. Work-family conflict emerging from this demanding lifestyle can create barriers to recruitment and impact decisions to leave these jobs. There is an urgent need for upstream resources to increase knowledge about the lifestyle's challenges and help PSP and HCW families develop strategies to manage the heightened demands. --- Family resilience(y) The capacity of families to resist, recover, and/or reconfigure in the face of normative and non-normative demands (i.e., crisis) is referred to as resiliency. It is not an inborn trait or ability, but an outcome that evolves through applying skills and capacities to situations and circumstances requiring adaptation, a process called resilience. Conceptualizations of family resilience(y) focus on the capacity of the family as a functional, interdependent system in overcoming significant life challenges. Making meaning out of crisis and challenge and maintaining a positive outlook are facilitated through connection, clear, open, and collaborative communication, flexibility, and access to social and economic resources. In particular, the level of support from friends, neighbours, and extended family members impacts the ability of the family to respond to issues that arise. The extent to which organizational programs and policies are family-friendly and the status of public perceptions regarding PSP or HCW are instrumental in developing and maintaining resilience(y). Resilience(y) in PSP and HCW families emerges through the bi-directional relationship between the families and the workplace. A disruption in the workplace (e.g., staff shortage) causes added stress for the PSP or HCW and an added burden for the family who tries to accommodate the shift change. This could be a minor inconvenience for some families and a breaking point for others depending on their unique circumstances (e.g., childcare or eldercare, dual-career households, health issues) and their capacity for resilience(y). The circumstances at home can correspondingly influence PSP's job performance and their response to work pressures. --- Supporting PSP families Research has shown that PSP families are unique due to logistics (e.g., nonstandard hours), risks (e.g., potential exposure to trauma), and identities associated with this lifestyle. Managing these cumulative and convergent factors combined with the everyday stressors of family life can be challenging for PSP families. Working with researchers Dr. Heather Hadjistavropoulos and Dr. Nathalie Reid, Dr. Cramm, and the FMRG developed an online resource to validate the experiences of PSP families, enhance awareness of aspects of PSP life, and support skill building. PSPNET Families is upstream, focusing on information regarding factors that can create tension in PSP families and pre-emptive strategies. Researchers are advancing awareness of the heightened demands placed on PSP and HCW families, reaching out to them through town halls and focus groups to learn more about their experiences. There is a need for both prevention (i.e., online psychoeducation) and resources for families already in crisis. Partnerships with mental health service providers and with PSP and HCW organizations can help further engagement with existing supports and understand where the gaps in service are. --- Challenge and conclusion Family relationships can be taken for granted, and the importance and well-being of the family unit neglected. Awareness of shared experience and the cumulative effects can support individual health and the quality of family relationships. Both PSP and their families are affected by the risks and requirements of the job. Rotating shifts and long hours require both the worker and the family to adjust to changes in daily routines. Workload-related stress and trauma exposure can translate into behaviours that disrupt family life. Family members can feel socially isolated. Though many aspects of PSP work are non-negotiable, PSP and their families can be proactive by recognizing the role and value of the family and the effects of the PSP career on the family. Making plans, adjusting to change as a family, and developing effective communication skills can protect families from some stressors. Thinking about how your family is impacted by PSP work and talking to life partners and children about concerns and worries that they might have about the work are ways to manage problems that can arise. Please Note: This is a Commercial Profile This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

focus on the families of public safety personnel and health care workers (PSP and HCW), plus how the risks and requirements of the job impact them Public safety personnel (PSP) and health care workers (HCW) are dedicated to serving our communities, and that commitment can take a toll on the mental and physical well-being of both the workers and their families. Cramm, Cox, and Norris work with the Families Matter Research Group (FMRG), a large team of researchers, educators, and trainees, some of whom are PSP and HCW family members themselves. The FMRG recognizes the commitments and demands associated with public safety and healthcare work and the effects these have on family life and relationships beyond the workplace. Their primary objective is to form partnerships with families, workplaces, and other service providers to understand better the experience and needs of PSP and HCW families and promote evidence-informed programs and policies to support their health and well-being.

INTRODUCTION Early marriage is globally highest in Sahara Africa, with 4 out of 10 women under the age of 18. Indonesia is ranked 7th in the world for the highest early marriage category around 1,220,900 Indonesian children experiencing early marriage, based on UNICEF data (UNICEF, 2019). The number of child marriages in Indonesia ranks 2 nd and among ASEAN countries after Cambodia (Rahmawati 2020). Based on data from the Central Statistics Agency (BPS), there was a decrease in marriage before the age of 18 in adolescent girls in 2018 by 11.21% down to 10.82% and in 2019-2020 there was a significant increase during the pandemic to reach 24 thousand (The Ministry of Women's Empowerment and Child Protection, 2021). Adolescent girls married at the age of <18 years as much as 63.08%, meaning that 1.95% first experienced pregnancy at the age of <15 years. For young women who get married at the age of <15 years old in their pregnancy is as much as 46.84% (Badan Pusat Statistik, 2020). The Head of the Office of Women's Empowerment, Child Protection and Population Control said that in the Special Region of Yogyakarta in 2021, the incidence of early marriage increased drastically due to a revision to the marriage age limit, that is the age of 19 years. Early marriage in the Special Region of Yogyakarta occurred at vulnerable ages 18-19 years (Agus Dwi, 2021). The analysis of the Office of Women's Empowerment Child Protection and Population Control showed that the number of children who married younger than 18 increased from 271 to 494 due to pregnancy and childbirth before marriage. In Sleman Regency, there are 343 applications for dispensation (Agus Dwi, 2021). The cause of adolescent girls marrying early is due to accidental marriage or the occurrence of pregnancies out of wedlock in young women, caused by lack of knowledge, curiosity, wanting to try and wrong associations. The low economic status in the families that are unable to meet the living expenses of their children and low education factors also contribute to make adolescent girls marry at an early age, such as elementary or junior high school graduates. The mental health impacts of early marriage can lead to anxiety, stress, and depression. It can happen because mental maturity is not optimal and stable yet. This situation can trigger the emergence of various problems in domestic life caused by unstable emotions (Minarni, Andayani and Haryani, 2014). According to Riskesdas data in 2018, the prevalence of mental health disorders is increasing from year to year by 9.8% (The Ministry of Health 2018). Indonesians aged 15-24 years old experience mental disorders in the form of stress, anxiety, and depression (Data and Information Center of the Ministry of Health of the Republic of Indonesia 2019). There is a prevalence of mental disorders in D.I Yogyakarta which includes depression, anxiety and stress, in the adolescent population aged 15 years and over by 8.1 ( Ministry of Health of the Republic of Indonesia (2018). The purpose of this study was to determine the relationship between early marriage and mental health in adolescent girls. In Table 1 it can be seen that most of the respondents are unemployed (51%), most of respondents do not know about marriage law (87.8%), and most of the respondents have a marital history of parents who are not divorced (89.8%), and most of the respondents' parents' marriage age was >19 years (77.6%). The average age of adolescents married was at the age of 16.78 years with the youngest age of 15 years and the oldest age of 18 years. The standard deviation is 0.941. Based on bivariate results on stress, the relationship between early marriage and stress has a significance value of 0.001 < 0.05. This means that there is a relationship between early marriage and severe stress in young women. Based on the cross-tabulation table, it was found that adolescents who married early experienced severe stress as many as 20 people. The result of the correlation coefficient is 0.484 which means that there is a significant relationship between early marriage and stress. The results of the study showed that 20 adolescents experienced severe stress due to early marriage (40.8%). Severe stress can last from several hours to several days. The inability of adolescents to adapt well to surrounding conditions (stressors) can be a trigger for other disorders such as biological, social and spiritual. Thus, a person who has a stressor needs individual maturity in any case and vigilance in everyday life. Immature age can affect the mentality of young women as young mothers who have assumed the responsibility of being parents and wives who are not supposed to be parents at the age of <19 years (Jamil, 2019). This is in accordance with research by Fatmawaty (2017) where the development of late adolescence means emotions that tend to be higher than childhood, this is because it exists under social pressure and faces new conditions. Meanwhile, during childhood, they are not prepared enough to face people's lives so that, with age, they learn to adapt to the situation and have a good tolerance for stressors. Destia (2016) also states that women who marry early have mental health disorders, cannot control emotions and manage stress, so that if they cannot adjust to the environment and with a new status, it can lead to stress. --- METHODS --- This According to Sarwono and Sarlito (2016), the occurrence of early marriage is due to the existence of a free environment between the sexes in adolescence which as seen in daily life is increasingly unnatural and has no limits. Marriage at an early age ultimately creates problems, and in no case does early marriage in adolescence ever benefit, adolescence should be a transitional period to adulthood. Solutions to solve stress problems experienced by young women are by providing support for their mental health as a whole through increasing psychological well-being, creating supportive living conditions and environments and early detection of mental health to reduce mental health disorders (Haines, 2019). The results of anxiety obtained that the relationship between early marriage and anxiety had a significance value of 0.001 < 0.05. This illustrates that there is a relationship between early marriage and extreme anxiety in young women. Based on the results of the analysis, it was found that the majority of adolescents who married early experienced very severe anxiety, as many as 21 people. The result of the correlation coefficient is 0.465, which means that there is a significant relationship between early marriage and adolescent anxiety. From the results of the study, it is known that 21 adolescents aged <19 years (42.9%) experienced very severe anxiety. This can happen because young women do not earn income, the existence of early marriage culture, an early marriage environment, last education and premarital education. This anxiety disorder causes feelings of excessive fear to damage the ability of adolescents to participate in daily activities (Livia Prajogo and Yudiarso, 2021). This is also stated by Syalis and Nurwati (2020) that the anxiety experienced by early marriage families can be interpreted as mixed feelings containing fears and worries in dealing with problems that arise in their family. Anxiety in adolescents who marry early is due to adolescents experiencing a faster process of physical maturity compared to their mentality. Young women are more prone to experience anxiety when facing problems. So that teenagers who marry early tend to experience anxiety (Rahayu, 2018). This is in line with the research of Efevbera et al. (2017) which explains that early marriage makes women experience pain, sadness, anxiety, and despair. This is in accordance with research of Mangande and Lahade (2021) in that the severe anxiety experienced by a woman as a wife in an early marriage can be interpreted as a feeling that describes the fear and worry of facing problems that will occur in her marriage. Mental health disorders in adolescents who marry younger than 18 years old are caused because adolescents cannot manage emotions properly, selfishness is still high, and there is unpreparedness in marriage (Alfina, Akhyar and Matnuh, 2016;Dwi Rahmawati, 2020;Nafikadini, Insani and Luthviatin, 2021). Based on bivariate results in depression, the relationship between early marriage and depression has a significance value of 0.004 < 0.05. This illustrates that there is a relationship between early marriage and severe depression in young women. Teenagers who married early mostly experienced very severe depression in the very severe category, which is 26 people. The result of the correlation coefficient is 0.406, which means that there is a low but certain relationship between early marriage and depression in young women. Based on the results of the study, it was found that 26 adolescents aged <19 years (53.1%) experienced very severe depression. According to Walgito and Bimo (2015), getting married at an early age has two quite severe impacts, namely in terms of physical and mental aspects. If teenagers marry at a fairly young age, their emotions are not yet stable. Emotional stability generally occurs at the age of over 20 years, because at this time a person begins to enter adulthood. Adolescence can be said to just stop at the age of 19 and where a person gets married at the age of 20-24 years, at that age they can be called a young adult or lead adolescent. In those times, the transition from adolescent turmoil to stable adulthood usually begins. In this case women are almost twice as likely as men to experience very severe depression. So, it can be concluded that women with early marriage have a heavy burden at their young age ranging from emotional adjustment, environmental pressures, lack of education, economy, and raising children. Handling mental health problems, especially severe depression, requires treatment with psychological therapy (interpersonal therapy, group counseling and social support, humor therapy, cognitive therapy) and changes in healthy lifestyles, such as exercising, thinking positively, managing diet, praying, recreation and having the courage to change yourself for the better at a young age as a mother and wife (Dirgayunita, 2016) people's lives, the need of family support, social needs and not being alone, staying away from relationships, socializing more, and doing activities with the surrounding environment (Dirgayunita, 2016). --- CONCLUSION From this research it would be concluded that, first, young women who had early marriages in Ngemplak District, Sleman Regency, had mental health disorders as many as 20 people (40.8%) and experienced severe stress with a p-value of 0.001. Among stress, anxiety and depression, stress has the highest correlation coefficient. So that early marriage greatly affects stress in young women. Second, young women who had early marriages in Ngemplak District, Sleman Regency, had mental health disorders as many as 21 people (42.9%) and experienced very severe anxiety with a p = value of 0.001. Third, young women who had early marriages in Ngemplak District, Sleman Regency, had mental health disorders as many as 26 people (53.1%) and experienced very severe depression with a p = value of 0.004. Fourth, subsequent research using a larger sample size should be wider in scope. Fifth, subsequent research will emerge the data on husband's characteristics, age, occupation and marriage. Last, religious offices can work together and collaborate with midwives and psychologists at the health service of the Ngemplak Community Health Center. They can conduct socialization and counseling with video media for early marriage education for young women to prevent early marriage, mental health disorders in young women, the impact of early marriage and is expected to improve cross-sectoral collaboration with PIK-R to conduct counseling as well as socialization regarding early marriage and mental health.

Early marriage occurs at the age of less than 19 years. The incidence of early marriage is caused by cultural factors of early marriage, married by accident, education, and low economic conditions all affect early marriage. The mental health impact of early marriage can lead to anxiety, stress, and depression. Aims: The purpose of this study was to determine the relationship between early marriage and mental health in adolescent girls. Methods: This study uses quantitative research methods using a cross-sectional research design. The total population is 49 people, and the sampling method used is total sampling. The study was conducted for 1 month. The research instrument used the DASS-21 questionnaire and data collection sheets. The data analysis of this research was univariate and bivariate analysis. Results: The results showed that the frequency of adolescents experiencing severe stress was 40.8%, very severe anxiety reached 42.9%, and very severe depression reached 53.1%. There is a relationship between early marriage and severe stress with a p-value of 0.001, there is a relationship between early marriage and very severe anxiety with a p-value of 0.001, and there is a relationship between early marriage and very severe depression with a p-value of 0.004. Conclusion: It can be concluded that early marriage has a relationship with mental health in adolescent girls in the Ngemplak Region and future research should involve husbands in in-depth qualitative research exploring in depth the causes of the mental health of young women who took early marriages.

Dear editor, In response to the latest correspondence on the topic of understanding and preventing hate crimes and social discrimination in the midst of the coronavirus disease 2019 (COVID-19) crisis. 1 This topic is very relevant to what is happening in Indonesia today. The COVID-19 crisis has changed the situation in Indonesia, which was previously hit by issues of conflict that are ethnicity, religion, race and inter-group relations. 2 It has now changed with various social and solidarity movements carried out by every level of society in various cities and provinces in Indonesia to fight the COVID-19 crisis together. 3 Indonesia is one of the largest archipelagic countries in the world. As a large nation, Indonesia has 17 504 islands, 4 has >300 ethnic groups; to be precise, there are 1340 ethnic groups. 5 In addition, the community adheres to quite a variety of religions, including Islam, Protestantism, Catholicism, Hinduism, Buddhism, Confucianism and others. 6 From the diversity and wealth possessed by Indonesia, Indonesia has a unifying motto of the Nation, namely 'Bhinneka Tunggal Ika' (which means: 'different but still one'). 7 This motto has a reasonably deep meaning, namely the socio-cultural diversity that forms a unity/country. In the last few years before COVID-19 hit Indonesia, Indonesia had internal conflicts related to ethnicity, religion, race and inter-group relations that colored daily life. 2 Even if this conflict continues, it can destroy the unity and integrity of Indonesia from within. On the one hand, Indonesia is currently experiencing a slump due to 'herd stupidity' 8 and a relatively high number of 'positive rate', 9 but on the other hand, there is something to be grateful for, namely the return of Indonesia to the motto 'Bhinneka Tunggal Ika'. In this COVID-19 crisis, there is no longer a gulf between everyone. There are no more differences in ethnicity, religion, gender, social status and interests. Today, everyone has the same interest: getting out of this national and global crisis. The hope is that after the COVID-19 crisis ends, the solidarity in the motto 'Bhinneka Tunggal Ika' will continue to take root in every pulse of every Indonesian so that this spirit does not only appear when in critical situations but in everyday life in society. 10 Hopefully, the Indonesian people can take lessons from every event that is currently happening. Maybe this is God's way to change Indonesia back to 'Bhinneka Tunggal Ika' as a motto that must be held forever as a state identity and the value of life in society. --- Conflict of interest The author declares no conflict of interest in this paper.

The coronavirus disease 2019 (COVID-19) crisis has changed the situation in Indonesia, which was previously hit by issues of conflict that are ethnicity, religion, race and inter-group relations. It has now changed with various social and solidarity movements carried out by every level of society in various cities and provinces in Indonesia to fight the COVID-19 crisis together. The hope is that after the COVID-19 crisis ends, the solidarity in the motto 'Bhinneka Tunggal Ika' will continue to take root in every pulse of every Indonesian so that this spirit does not only appear when in critical situations but in everyday life in society.

participants in clinic and outreach settings often become additional points of con-tact, complementing time spent with physicians, through which patients can learn more about their disease and its prevalence in their community. Individuals who are unaware that a condition is hereditary or lack knowledge about available treatment options acquire information during conversations with enrollers and share in-formation with family and friends. This diffusion of information can encourage at-risk community members to seek screenings and care, contributing to earlier detection of disease. Simultaneously, the enrollment process provides opportunities for health researchers to better understand the prevailing beliefs and specific needs of the community. Conversations, focus groups, and surveys can inform the development of culturally sensitive and practical methods of enrollment, as well as initiatives for increasing disease awareness and patient compliance. While recruiting for the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study, investigators at the University of Pennsylvania partnered with pastors, government representatives, leaders of community senior centers, African American media out-lets, and patients to collect more than 9000 African American genotypes in Philadelphia. An important component of the enrollment process was continuously considering why patients were choosing to enroll or decline. The POAAGG investigators 5 administered a survey to 307 patients asked to enroll in the genetics study and found that 45.9% of those who chose not to participate were uncomfortable sharing DNA, compared with 6.9% of patients who agreed to participate. Of those who participated, 36.2% said government involvement in the study would decrease their willingness to enroll. Knowledge about genetics research and educational levels did not vary between those who enrolled and those who declined. 5 In addition to mistrust of government, mistrust of clinical research is a real factor for many patients. This fear is often rooted in experiences with the health care system that remove control from the patient. 6 Although no quick fix to systemic inequalities affecting minority patients is available, health care professionals can create a safe environment where patients feel in control and able to make their own decisions. Physicians have the opportunity to elevate patients' feelings of agency by treating them as partners in their own care processes and in science that can ultimately provide improved screening and treatment options. The opportunity to contribute to research allows patients to take part in gaining knowledge of diseases affecting them and their families. When patients feel a sense of mutual benefit and partnership, the sacrifices they make to participate may be outweighed by the realization that this personal sacrifice will result in a larger good for their community. According to a recent study, messages that emphasize potential benefits to others are more persuasive in influencing certain health behaviors than those focusing on the benefit to self. 7 It is worth considering that 6.9% of patients participating in POAAGG enrolled despite their concerns with sharing genetic material. 5 This finding suggests that fear of enrolling in studies may be overcome by a desire to contribute. It may seem intuitive that physicians should build relationships with their patients, but these efforts can be even better supported by well-designed recruitment efforts. Initiatives to enroll in genetic studies, especially when well-funded and community-based, have the potential to formalize systems for listening to and engaging patient communities. Health centers should maximize opportunities to integrate large-scale recruitment efforts with community outreach and care. In this way, genomics research can benefit minority groups in the short term and the long term.

Genetic research has largely excluded ethnic minorities, contributing to a disparity that has far-reaching consequences for health, longevity, and quality of life in these populations. As of 2016, the percentage of genome-wide association study participants who were of African, Latino, Pacific Islander, Arab, Middle Eastern, or Native American descent was less than 3% combined. Most participants (81%) were of European ancestry. 1 Many hereditary diseases that chronically over affect minority populations, such as primary open-angle glaucoma, have mainly been studied in white patients. Primary open-angle glaucoma is 5 times more prevalent and appears 10 years earlier in African American than in European American persons, 2 yet the genetics of this dis-ease have been minimally studied in the most over affected group. The frequency of a condition that can cause blindness in midlife perpetuates a cycle of poverty affecting patients and their families. Excluding minorities from health research limits the ability to appropriately care for these populations and skews the scientific understanding of disease. However, organized initiatives to include minorities in health research have the potential to improve care in underserved communities.

Agents and Multi-Agent Simulation Associated with the GIS Environment An agent, within the realm of computing systems, operates autonomously in a specific environment, possessing the capacity to sense and exert influence on its surroundings. As articulated by Agar (2005), an agent is broadly defined as "anything that can sense its environment through sensors and act on that environment through effectors." Further elucidating this concept, Bandini, Stefania, Manzoni, Sara, and Vizzari, Giuseppe (2009), describe an autonomous agent as a computing system situated in a complex and dynamic environment, functioning independently within this setting to accomplish predefined goals or tasks. Expanding on this notion, Epstein (2002) characterizes an autonomous agent as a system intricately embedded in a specific environment, equipped with the capability to sense and operate autonomously over time. The agent diligently pursues its objectives, intending to impact its surroundings in alignment with its future perceptions. This perspective is reinforced by Espié (1995), Epstein and Axtell (1996), Johnston (2013), and Leykum (2012), collectively contributing to a comprehensive understanding of autonomous agents and their role in computing systems. --- Diagram 1. Architecture of agents in any environment Simulation is a purposeful endeavor wherein, utilizing an experimental method known as a simulator, the input data of a dynamic model undergoes manipulation, execution, and results in output data. This process aids in comprehending the functions and characteristics of the model [28], [32]. Consequently, simulation proves highly apt for modeling the process of disease spread. Multi-agent simulation entails a system comprising numerous entities, commonly referred to as agents. These agents evolve within a shared environment, which is specifically designed as a distinct entity for other agents to inhabit [29], [30], [31]. Each agent possesses distinct attributes, behaviors, as well as cognitive and communication capabilities. The collective set of attribute values for an entity at a particular instance constitutes the state of that entity. Behaviors, serving as rules, govern changes in state by intervening in the states of agents executing these behaviors and those of other agents involved in events, actions, communication, or interactions. In the realm of multi-agent simulation systems, the pivotal components are the environment, agents, and agent behaviors [Agar, M. 2005], [Edmonds, B. 2012]. --- Social Science with Models and Simulations In the social sciences, simulation offers the possibility of conducting controlled computer experiments. The purpose of simulation is not to build theories but to produce in a controlled manner analyzable data, typically coming from the experiments themselves rather than from system observation results. (iv) Ability to conduct testing procedures for small worlds or miniature environments. (v) The potential for applying a participatory approach, allowing sub-worlds to blend seamlessly. (vi) The capacity to represent diverse agents of heterogeneous nature. (vii) The option to utilize real spatial or statistical data for analysis and testing [Espié, S.1995], [Epstein, JM 2002], [Epstein JM & Axtell R L.,1996], [Agar, M.2005], [Bandini, 2009], [Edmonds, B. 2012], [Johnston, K.M., 2013]. This approach underscores the flexibility and universality of multi-agent models, positioning them as valuable tools in current and future research options. The ability to choose from a multitude of experiments represents a novel method in scientific research, particularly when generating data that may not originate from the real system but is intrinsic to system models. For addressing real-world issues, scenarios built on forecast results and models representing reality become essential, enabling the preference for solutions closer to the actual situation. --- Gis Integration for Agent -Based Projective Models Over the last two decades, the adoption of modeling methods has witnessed significant growth across various research disciplines and scientific fields, with a notable emphasis on the social sciences (Schurr et al., 2005;Sun & Naveh, 2004;Kaminka, 2004;Kubera et al., 2010). These methods provide a means to replicate and scrutinize intricate facets of the real world by conducting "in-silico" experiments or simulations in a computer environment, mirroring natural processes. Advancements in multi-agent modeling have paved the way for exploring and applying solutions to complex problems (Treuil JP, 2008). Several multi-agent simulation platform software options cater to modeling needs, including Repast, Netlogo, Cormas, and GAMA. Each platform has distinct strengths, with the GAMA software, in particular, offering robust tools for supporting visual multi-agent modeling (Taillandier P., 2014; Burrough, P. et al., 2015). Notably, GAMA stands out for its capability to work with agents derived from Geographic Information System (GIS) data, incorporating various processing and computing tools for geographic data (Taillandier P. et al., 2014) -a feature not strongly supported by other simulation software (Gignard A. et al., 2013). The software's objective is to construct intricate models enabling the integration of diverse data to capture the behaviors of agents and observe real-world scenarios. By integrating geographical data and employing a multi-level model development method, the software facilitates simplicity in managing and fostering interaction between levels of Agent-Based Models (ABMs). To enhance the complexity of models, the software incorporates mathematical, statistical, or artificial intelligence tools to harness the capabilities of agents. Decision algorithms and clustering play pivotal roles in the analysis of agent-based modeling. This approach is particularly apt for research on modeling with GIS data, a type of data integral to land management and agriculture. To address this issue, the research team employed NetLogo (Axelrod, R., 1997;Axtell RL, 2003) and integrated GIS into NetLogo. This software, known for its GIS extension, enables the reading of data files from GIS and facilitates the transfer of values from previous GIS results into the NetLogo environment for simulations. Loading the shapefile, along with the associated *.dbf and *.prj attributes, is accomplished using the following syntax: [syntax example may be provided here, code 1]: In ArcGIS, there is a tool called Polygon Neighbor. For polygons, the tool finds all polygons with matching edges and arranges the information in a table using the following important syntax: [syntax example may be provided here code 2]: The findings reveal that the total area of the island is 557 km². Within a span of just two years, the construction area on It is especially easy to spot a road about 15km long stretching from Phu Quoc airport to the central area of An Thoi in the south of the island. However, on the west side of the island (east of the main road), too dense construction has blocked the drainage path for rainwater, causing local flooding. The results of this simulation analysis are reproducible according to independent analysis by the P-GIS company 2 . These data are analyzed from Sentinel-1 radar satellite images obtained on August 10, 2019, by P-GIS. GIS in progress. Comparative practice shows that up to 63km of roads across the Phu Quoc island district were flooded with an average depth of 0.7m, and the deepest flooded place was up to 2m; as a result of this local flooding, 23 houses were damaged. Roofs were blown off, collapsed, cracked, and more than 8,400 houses were flooded. Nearly 2,000 people were Johnston, KM (2013), Kevin M. Johnston (2006). However, integration remains challenging, and compatibility issues with Repast have been complicated by changes in ArcGIS 10.x versions. On the other hand, some commercial software, such as AnyLogic (see photo below), a Russian-exclusive version of ABM, is also quite difficult to access for those who care about this issue due to copyright reasons. Therefore, for researchers and academics to study and exploit GIS data, NetLogo is still a good choice because of its simple simulation, straightforward programming, and diverse and powerful library. Many applications at small and medium scales are very suitable; especially for social scientists, learning a software with many complex functions is quite difficult. These simulation models also allow for concretization with adjustable algorithms, interdisciplinary, multidisciplinary, and even cross-disciplinary exchanges with the same research object, and the collection of quantitative and qualitative data from social science research disciplines into the same general model to test accuracy, thanks to the ability to express, through direct contact with the real world. In summary, choosing software to apply ABM in studies like the Phu Quoc case will help support more accurate decisionmaking. --- Conclusion In the last five years, over 1,500 hectares of forests and forest land from Phu Quoc National Park have been reallocated from special-use forests for the implementation of economic development plans. Forests and forest vegetation cover play a crucial role in regulating and maintaining fresh water resources, a pivotal factor in determining the island's capacity for tourism and services development. Phu Quoc Island boasts a favorable starting point, marked by a high economic growth rate, a substantial Gross Regional Product (GRDP) per capita, and numerous modern investment projects. The GRDP growth rate for Phu Quoc reached approximately 22% per year from 2011 to 2018, which is about three times higher than the national growth rate (5.9% per year). In 2018, the average GRDP per capita for Phu Quoc reached $5,569/person/year, surpassing the national average by more than 2.6 times. The island is experiencing rapid urbanization. However, the use of control tools to promptly provide effective solutions to decision-makers is crucial. To address these complexities, the application of experimental simulations using specialized software such as ArcGIS, NetLogo, and others becomes essential. These simulations, employing "agent" information technology entities (agents), are meticulously observed and analyzed down to the smallest detail. This approach aims to support more accurate decision-making, particularly in the planning and development strategy for Phu Quoc Island as it aspires to become a special administrative-economic zone of the country.

This presentation delves into information modeling methods within the realm of social sciences, specifically focusing on "Agent-based Modeling" (ABM). ABM involves the meticulous observation and analysis of computer entities known as "agents" in experimental simulations. The research emphasizes the application of ABM to study complex phenomena, using the example of tourism activities on Phu Quoc island. By scrutinizing the behavior of these agents, the study aims to enhance decision-making precision and quantify various aspects. Through simulations, cause-and-effect relationships can be identified, allowing for the testing of multiple scenarios and validation of initial hypotheses.

P34: How does active ageing policies and practice reconfigure cognitive impairment? Findings from an ethnographic study. --- Author: Christine Carter Objective: Active ageing is the maintenance of positive subjective well-being, good physical, social and mental health in later life. It aligns with the 'successful ageing' narrative where obligation to undertake activities is deemed beneficial to health status (Swallow 2019). How this narrative plays out for people with mild cognitive impairment (MCI) which is not dementia has not been considered. Methods: I adopted an ethnographic approach, undertaking participant observations and semi structured interviews with participants. I followed two 20 week programs, undertaking 65 field notes and conducting 16 interviews with participants. I used reflexive thematic analysis to analyse the results through Nvivo. Results: Four themes with sub-themes were identified. • Arrival into the intervention -learning, listening, knowing, and doing active aging. Participants navigated fears and uncertainties of MCI with their expectations of active ageing. • Being an individual in a group experience -retaining a sense of self whilst embracing the collective unknown. Participants reconfigured their MCI through a tension between individual responsibility and a collective group experience. • Managing uncertainly and attempting to create certainty through navigating knowledge. Active ageing changed how participants viewed and dealt with MCI with attempts to clarify knowledge of dementia risk. • Being an active ager; actively able to be active and participate in active ageing. Individuals demonstrated engagement through sharing achievements, ability and inabilities. --- Conclusion: Active ageing is a collective habitus, with absence of clear knowledge and direction creating a mismatch between rhetoric and lived experiences of people with MCI. Ultimately results inform the development of concepts in social gerontological theory and active ageing --- P43: Hormone therapy and the decreased risk of dementia in women with depression: a population-based cohort study Author: Dahae Kim --- Background: The literature has shown depression to be associated with an increased risk of dementia. In addition, hormone therapy can be a responsive treatment option for a certain type of depression. In this study, we examined the association between hormone therapy, including lifetime oral contraceptive (OC) use, and hormone replacement therapy (HRT) after menopause with the occurrence of dementia among female patients with depression. --- Methods: The South Korean national claims data from January 1, 2005, to December 31, 2018, was used. Female subjects aged 40 years or older with depression were included in the analyses. Information on hormone therapy was identifed from health examination data and followed up for the occurrence of dementia during the average follow-up period of 7.72 years. Results: Among 209,588 subjects, 23,555 were diagnosed with Alzheimer's disease (AD) and 3023 with vascular dementia (VD). Lifetime OC usage was associated with a decreased risk of AD (OC use for < 1 year: --- Conclusions: In this nationwide cohort study, lifetime OC use was associated with a decreased risk of AD, and HRT after menopause was associated with a decreased risk of AD and VD among female patients with depression. However, further studies are needed to establish causality. --- P51: Correlation between skin conductance and anxiety in virtual reality Authors: Dongjun Kim 1,5 , Hyewon Kim 2 , Kiwon Kim 3 , Minji Kim 4 , Hong Jin Jeon 1,5,6,7 1 Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 2 Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea.

Results: 11.1% had subthreshold depression, 60.8% had ≥1 high-risk factors, MDD incidence=4.7% (5.0% among completers), and mean PHQ-9 change=0.02 points. Among those with subthreshold depression, the MDD risk ratio (95% confidence intervals)=0.36 (0.06 to 1.28) for vitamin D3 and 0.85 (0.25 to 2.92) for omega-3s, compared to placebos; results were also null among those with ≥1 high-risk factors [vitamin D3 vs. placebo: 0.63 (0.25 to 1.53); omega-3s vs. placebo: 1.08 (0.46 to 2.71)]. There were no significant differences in PHQ-9 change comparing either supplement with placebo.Neither vitamin D3 nor omega-3s showed benefits for indicated and selective prevention of late-life depression; statistical power was limited.

INTRODUCTION Surakarta city or more known as the city of Solo is a city that has various activities good the field of political, economic, social, and cultural. Besides that, Surakarta City is known as city trade, p This is marked by many activities trading both scale small, medium, and big. Amount residents working in Surakarta City in 2015 reached 243,152 or 47.67% of the whole residents of Surakarta City. Resident working women reach several 43.41% of those working. In 2016 it reached 271,199 or 47.67% of the whole residents of Surakarta City. Resident working women reach a figure of 122,187 people. Amount residents who worked in 2017 of 259,304 and 45.65% of them were manifold sex girls. Enhancement occurred in 2018 with 259,465 people working or 50.1% of the total population in Surakarta. Surakarta City residents who voted to become trader experience fluctuation every year. Amount residents to be traders in 2015 as many as 1456 people consisting from trader large 32 inhabitants, traders middle 207 and traders small 1217. In 2016 the number of residents to be traders was as many as 1400. In 2017 it was 1170 and in 2018 it was 655. Big Market Hardjonagoro is the biggest market and feature characteristic of Surakarta City. This market's own building is interesting Because combines draft architecture Java-Europe artificial 1930. Traditional markets become a center gathering society in the past. Traditional markets own function as room economy, space social, and space culture. This _ is because the public can do activities sell buy, interact and earn learning from a market. Its existence as a traditional market and tourist market opens opportunities particularly in the informal sector to traders. Traders are people with relatively varied capital who are trying in the field of production and sales of goods or services To fulfil the need group certain in society. Amount traders at the Pasar Gede as many as 368 traders who have Placement Rights Letters (SHP) for Los/ Kiosks in the Market. Besides That, there are also traders who do not own the right placement or they only sell in the yard. The role of women in the public sector, especially in the field of trading the more increased. One of them is the involvement of women in the trade sector that is as traders selling in traditional markets. On the whole 60% of traders in the big market are dominated by traders Woman ie 222 traders. This is interesting for research that is for now trader motivation _ Women do activity economy as well as big contribution Pasar Gede Woman Trader to Economy His family. --- RESEARCH METHODS Study This held at Pasar Gede Hardjonagoro Surakarta City. Study this use method qualitative with analysis descriptive, purposeful For know in a manner descriptive from Motivation of Women Traders in increasing the family economy. Data used in the study This was obtained direct from the field with method of interview nor observation. Based on the table can is known that amount respondents aged 20-29 years and over _ from 80 years by 1 person (2%). Merchant Woman who owns aged 30-39 years as many as 7 people ( 14%), aged 40-49 years as many as 13 people (26%), who have aged 50-59 years as many as 15 people (30%), who have aged 60-69 years as many as 11 people (22%), who have aged 70-79 years as many as 2 people (4%). --- Working Hours In the informal sector such as trading generally working society _ No own bond time in work, so time spent by traders _ One with other No same. Following table amount Female Traders trading in Pasar Gede. Pasar Gede Woman Trader start activity selling at 03.00 WIB until 16.00 WIB. Naturally, every trader is different from the others. Traders who use time 0-4 hours per day as many as 5 traders (10%), for 5-9 hours per day as many as 39 (78%), and who use 10-14 hours for selling as many as 6 people (12%). --- Duration Trade Par3a Women Traders in Pasar Gede have a different time in starting their efforts duration trading in the Market can become an Experience for Traders. Experience is activities carried out in a manner Keep going continuously on one field profession so that someone said an expert in the field. Based on the table on can is known amount trader woman who has experience trading for 0-9 years as many as 5 people (10%), traders woman who has experience for 10-19 years with as many as 8 people (16%), traders woman who has experience for 20-29 years as many as 12 people (24%), traders who own experience for 30-39 years as many as 14 people (28%), traders woman who has experience for 40-49 years as many as 6 people (12%) and traders woman who has experience over 50 years as many as 5 people (10%). The amount Woman trading merchants for more than 30 years because they start efforts from business family down decreased. --- Analysis Motivation of Women Traders Trade Women in essence geared towards improving position, role, ability, independence as well as mental and spiritual resilience in order to become partners parallel a man who is in harmony, compatible and balanced, as part not inseparable from effort enhancement quality source Power human. Woman Trader in Pasar Gede own some possible reasons seen in the table below this: The Pasar Gede woman who started it business was down from Parents _ as many as 33 people (66%) while the women traders who started it Alone business traded as many as 17 people (34%). this _ shows that the majority of women traders only had forward businesses run by their family before, meanwhile, for Women Traders who are starting out Alone own Lots of reasons like circumstances that prompted them to work and only trade that can he do. Besides that, condition, flexible and non-flexible trading is bound to be one of the merchant reasons and women start their efforts. As a woman who has Lots not quite enough answer home, settings time to do job House before or after activity trading on the market is done. --- Analysis to Improvement of Family Economy Analysis This is the results obtained by the Women Traders during business trade during a day nor a month, which later results in income the used help or add need House ladder Trader Woman alone. Average income net earned by Pasar Gede Women Traders IDR 100,000.00 up to with IDR 300,000.00 per day or IDR 3,000,000.00 up to with IDR 9,000,00.00 per month. --- Not married yet 1 2% Besides that, no denied member of another working family finally gives portion alone in enhancement economy family. Pasar Gede women traders who own husbands Work as many as 37 people (74%). this _ shows that income is only an adder or help enhancement economy family. Whereas Trader women who don't own working husbands as many as 10 people (20%), p the show role as a Bone back family as well as income earned _ Woman Trader become income main in the economy family. Merchants women in Pasar Gede also work the open business together with their husband as many as 2 people (4%), showed that their role as a trader only help the husband so that income earned is result of business together husband. Merchant women who still Not yet family by 1 person (2%). --- CONCLUSION Of the 50 women market traders in the big market own ages 22 to with 80 years. Type traded commodity _ many kinds of start from Fruits, Vegetables, Grabah,, Wade, Grabada , Various type Meat , Fish as well food dried which is a typical souvenir of Solo. The average female traders work as trader for 27 years. They formerly help parents Then continue business man old or open alone. For starting trader, alone have reason. For fulfill need, want to forward and because of coercive circumstances. Family always support them as merchant, with arrangement adjusting time. For balance between work and affairs House ladder they get up more morning for finish affairs house ladder or do it after selling on the market.

This paper aims to describe the motivation of women traders in improving family welfare in Surakarta. It employs a descriptive method to estimate data and information. Some factors including age, working hours, and duration of trade are investigated through the analysis. The result shows the average female traders work as a trader for 27 years. They formerly help parents then continue business man old or open alone. For starting traders, alone have reason. To fulfill needs, want to forward and because of coercive circumstances. Family always supports them as merchants, with arrangement adjusting time. For balance between work and the affairs House ladder, they get up more morning to finish the affairs house ladder or do it after selling on the market.

The theoretical framework is Jaeger and Burnett's (2010) multi-level information worlds theory. In this framework, information worlds have structural and behavioral implications, in that social constructs (such as the value ascribed to disability and accessibility) and societal structures/infrastructures (such as law) directly and reciprocally inform one another. Information worlds "provides a framework by which to simultaneously examine information behavior at both the immediate and the broader social levels'' (Jaeger and Burnett, 2010, p. 1). The study will analyze five interconnected concepts of information worlds theory: social norms; social types; information value; information behavior; and boundaries. The study employs a mixed method design using both qualitative methods (interviews with DSO staff, academic librarians, and BVIPD students) and a quantitative method (surveyquestionnaire with instructors). Prior to the design and execution of the questionnaires, the research team will do extensive literature review and preliminary analysis of the relevant trends using the University of South Carolina's Social Media Insight Lab. Any news insights gleaned from both sources may lead to changes to the instructor questionnaire. The presenters will share the research design and preliminary results from the literature review and Social Media Insight Lab data. Conference participants will work in groups to reflect upon the questions above. Understanding the lived experiences of faculty working with BVIPD populations will help begin to bridge the gap experienced by these marginalized students by identifying strengths and failures of current policies and procedures between DSOs, academic libraries and librarians, and faculty. Discussions among library and information science (LIS) faculty will contribute significantly to developing a partnership model that serves the needs of all stakeholders in ensuring equity of access and accessibility for BVIPD students. They will also steer future efforts to reduce the inequalities experienced by BVIPD students. Faculty interact with students of all abilities on a more regular basis. Accordingly, faculty can offer their insights from working with BVIPD students, DSO staff, and academic librarians. The primary goal of the panel is to raise awareness for accessibility issues faced by BVIPD students and facilitate a dialogue amongst educators. Ultimately, bridging gaps in understanding the needs of BVIPD students and the roles faculty, DSOs, and academic librarians can and should play in fulfilling these needs can impact equitable access to education. Equitable access to education impacts BVIPD students' likelihood of academic success, subsequent employment, income earning potential, and ability to enjoy a full life experience. --- AUTHOR KEYWORDS accessibility; disability; visual impairment; print disability; LIS education and practice. --- PANELISTS --- Dick Kawooya Dr. Dick Kawooya's current research interests focus on the role of information (intellectual property) in fostering innovation. He is specifically looking at the role and impact of intellectual property rights (IPRs) in the exchange of innovation between formal institutions (universities, research centers, libraries, etc.) and informal businesses or sectors in Africa. Kawooya's research interests fit the broad theme of access and flow of information. He has particular interest in the ethical and legal barriers to information access and flows often with the library institution as the backdrop. --- Eric P. Robinson --- Brandy Fox Brandy Fox is a MLIS candidate with the University of South Carolina's School of Information Science. She has completed a certificate in Diversity, Equity, and Inclusion. She is in the process of starting a non-profit devoted to reducing wait times and other accessibility barriers faced by students who require course materials in audio formats.

The panel presents a research project funded by an internal grant at the University of South Carolina (USC) investigating equity of access to information by Blind, Visually Impaired, and Print-Disabled (BVIPD) students. BVIPD students often experience inequitable access to information, including but not limited to a time gap in receiving course content that is otherwise more readily available to non-BVIPD students (Scott and Aquino, 2020). This is a social justice and human rights issue. The researchers will explore ways in which university Disability Service Offices (DSOs) can work with university libraries to maximize access to accessible content to BVIPD students. The BVIPD population is historically underserved by libraries (Bonnici et al.

INTRODUCTION The intense globalization processes taking place in the world make it increasingly important to develop a more reliable system of protection of children's rights and freedoms, to protect them from various ideological attacks and aggressions, and to prevent crime among them. In recent years, reliable protection of children's rights in our country, bringing them to adulthood as perfect human beings has risen to the level of state policy under the leadership of our President. --- The main results and findings The proof of our opinion is that children's rights, their constitutional-legal status are guaranteed in the new Constitution of the Republic of Uzbekistan, laws and other regulatory legal documents. New Uzbekistan is a country that takes care of young people in all aspects, strictly monitors their social and legal protection, and is determined not only to formulate, but also to implement youth policy in the country for the growing generation. According to the words of the President of the Republic of Uzbekistan Sh. Mirziyoev: "To pay more attention to the life problems of our youth, to increase the number of modern jobs suitable for them, to support their noble aspirations and initiatives, innovative ideas, and to improve the social and household conditions of our young generation at all levels." remains the most basic, crucial task of state agencies. " In our country, any right that is considered to be related to minors is defined by considering the life and aspirations of the child as a value. A threat to his life, in practice, means an attack on the set of rights and freedoms of the child. An example of this is the fact that such threats are considered a "serious crime". The rights of every child such as freedom, inviolability of place of residence, non-disclosure of letters and correspondence, protection in court when their rights are violated are duly recognized. Like all human beings, a child is born free and equal. However, in society, these rights are not only violated, but also criminally violated, therefore, the law guarantees the right of the child to freely express his opinion, to express his opinion during any court or administrative proceedings regarding issues related to his interests. A child's right to freedom of thought, speech, conscience and religion is also among the rights guaranteed by law. --- American Journal Of Social --- CONCLUSION In this regard, if every family, neighborhood, educational institutions and regional prevention inspectors work together continuously, and if every member of the society strives to accumulate high spirituality and enlightenment in the minds of young people, then surely the creators of our future will be able to solve great and complex socio-economic and cultural tasks. allows to do.

This article emphasizes the crucial role of safeguarding the rights of minors in the construction of a fair and equitable society in Uzbekistan. As the nation undergoes significant transformations, it is imperative to prioritize the well-being and development of its young citizens. By examining the legal framework and social initiatives aimed at protecting minors, this study seeks to shed light on the importance of their rights and the impact they have on the overall fabric of society. The article underscores the multifaceted nature of minors' rights, encompassing education, health, protection against exploitation, and access to justice. It explores the progress made in Uzbekistan's child protection efforts, including legislative reforms, institutional advancements, and community-based interventions. Furthermore, it highlights the challenges and gaps that persist, such as addressing child labor, enhancing access to quality education, and tackling gender disparities. The article argues that by prioritizing the rights of minors, Uzbekistan can foster a just society that nurtures the potential of its future generations, ensuring their well-rounded development and active participation in the nation's progress. The findings underscore the need for continued commitment from policymakers, civil society organizations, and the wider community to create an environment where every child's rights are protected, enabling them to thrive and contribute meaningfully to Uzbekistan's inclusive and prosperous future.

Introduction In every social situation, we are constantly aware of how we are presenting ourselves to those around us [1]. As mobile phones become integrated with daily life, they also become a part of our appearance and a part of our presentation of self. Multimodal interfaces, that often utilize multiple streams of input and output via different modalities such as gesture or speech, provide an opportunity for new interactions on mobile phones. However, they also require users to adopt new behaviors that might be highly visible or noticeable in common mobile contexts and may cause them to feel embarrassed or shy about using them. In order to create multimodal interfaces that can be used in the real world, input methods must be designed to account for social acceptability. While an understanding of social acceptability could greatly improve the design of multimodal mobile interfaces, this has received little attention in multimodal research literature thus far. These interfaces should not be designed based solely on the abilities of technology, but also take into account user willingness to accept them. In this paper, I discuss two studies that begin to examine the social acceptability of gesture-based input in mobile settings and an outline of future plans for this research. --- Why Social Acceptability? Although social factors have been identified as an important factor in technology acceptance [2], this has been limited to minimal range of social factors. With respect to mobile interfaces, the social factors that influence acceptance are as complex as the variety of situations where mobile devices might be used. Designing for social acceptability is especially important for multimodal interfaces because the modalities used often require users to adopt new behaviors that might be strange or embarrassing in public places. However, social acceptability is not simply a matter of embarrassment or discreetness, but a culmination of a variety of factors including setting, audience, appearance, and culture. Individuals make decisions about socially acceptable actions by gathering information about their current surroundings and combining that with their existing knowledge. Actions are then carried out and feedback is gathered from the reactions of any observers [1]. These actions should therefore be described as a performance [1], where individuals intentionally make some action with the awareness of how others might perceive it. Therefore, the process of making decisions about social acceptability is circular, with performances being made and feedback gathered fluidly. With respect to multimodal interfaces, there has been limited research on the social acceptability of these performative interactions. One of the few studies on this topic, by Ronkainen et al [5], asked respondents to assess whether a gesture was useful, fun, silly looking, or not useful, in order to eliminate unacceptable gestures for a future study based on user opinions. This study used video scenarios that required users to evaluate locations and tasks in addition to gestures. --- Previous Work: Gestures in Mobile Settings As a first step towards understanding the social acceptability of multimodal mobile interactions, I examined gesture-based interfaces. This input method requires users to adopt new behaviors that can be highly visible, which may become embarrassing or disruptive in different usage contexts. Additionally, gesture interface research has often been significantly influenced by the limitations of technology [6]. These issues make gestures an interesting starting point when investigating the social factors of multimodal interface acceptance. I completed two studies; a survey using video prototypes and an on-the-street user study that examined the social acceptability of gesture usage based on the locations where gestures might be used and the audiences they might be used in front of. For this initial study, I chose to examine location and audience based on the work of Goffman [1], although there are other factors, such as culture or personality which, could also be investigated. This work describes location and audience as key social factors that help individuals determine appropriate behavior in public places. I used these social factors when developing a social acceptability survey that utilized video prototypes of 18 gestures. These prototypes, with an example shown in Figure 2, allowed me to quickly investigate these gestures without the need to develop gesture recognition code. After watching each gesture video, participants were asked to select from a list the locations where they would use the given gesture and the audiences they would use it in front of. The results, including the responses of 55 survey respondents from 15 countries, showed that both location, shown in Figure 1, and audience played a significant role in determining which gestures were acceptable, with significant differences in acceptance rates between gestures. The results showed the importance of social acceptability, demonstrating that some gestures were significantly more accepted than others. In order to verify the survey and further analyze those results, I completed an on the street user study in which participants were asked to perform gestures in both a private indoor setting and a public outdoor setting, as shown in Figure 3, over multiple trials. After performing a set of 8 gestures in each setting, participants were interviewed about their experiences, comparing the settings, sessions, and gestures. This study involved 11 participants completing 3 sessions, each 1 hour long and spaced about a week apart. The results of this survey verified that location plays a significant role in determining comfort levels and gesture acceptability, with 8 out of 11 participants describing the outdoor setting as less comfortable than the indoor one. I also found that user acceptance rates changed over time, with 8 of 11 participants describing subsequent sessions as more comfortable, citing specific positive memories from previous session. These changes occurred mainly during the second session, indicating that even just one positive experience was enough to increase comfort and social acceptability. I also developed some preliminary design guidelines based on the results of this study. Gestures that imitated everyday movements were more acceptable than those that did not. This included gestures such as shaking the phone, which was similar to shaking a bottle of juice, and foot tapping, which was similar to unconscious fidgeting. --- The Next Step for Social Acceptability Although my previous work has been limited to gesture-based interfaces, there are other multimodal interaction techniques that might also benefit from social acceptability evaluations. For example, speech-based input is a technology that shows potential but has not seen widespread use. Like gesture-based interfaces, speech input requires users to adopt behaviors that might be embarrassing in mobile contexts. Social acceptability evaluations of different types of audio input and output, using both speech and non-speech sounds, would not only provide some guidelines for acceptable audio input but also demonstrate successful evaluation methods. Additionally, I would like to evaluate more factors of social acceptability, such as culture, personality, and position on the innovation adoption curve [4]. In my future evaluations of multimodal input techniques, I will experiment with developing a variety of prototypes and research methods, comparing different evaluation methods. For example, video, paper, and Wizard of Oz prototypes will be compared as possible tools for designing and evaluating socially acceptable inputs. These will be compared using different methods such as focus groups or user studies. Results of such studies would provide new guidelines for the design of input with respect to social acceptability. The results of these studies would also include a comparison of different prototypes with respect to the level of detail provided by users, time and effort required to complete, and cost to the experimenter. As a verification to these studies, I would also complete longitudinal studies using ethnographic methods to compare the results gained using prototypes to those gained from real world continued experiences. Other important issues that we have not yet investigated include task pairing and user personality differences [3]. With respect to task pairing, I would like to examine the effect that motivations have on gesture acceptability. For example, if you could quickly silence your phone with a gesture or voice command, would you be more willing to do a more obtrusive movement if it ensured the phone would silence immediately? A better understanding of how personality differences affect social acceptability could also influence the design of multimodal interfaces with respect to the range of modalities utilized and the personalization needs of users. --- Long Term Vision This thesis work seeks to contribute validated evaluation methods for determining the social acceptability of multimodal interaction techniques and define a set of socially acceptable interactions that can be used in a variety of applications. Additionally, this research will develop a set of heuristics which can be used to describe the social acceptability of multimodal techniques and improve design overall. This will provide designers with a methodology for multimodal interface design based on the social factors as identified by users, guiding future research in sensing, recognition, and multimodal interface design.

Multimodal mobile interfaces require users to adopt new and possibly strange behaviors in public places. It is important to design these interfaces to account for the social restrictions of public settings. However, past research in multimodal interaction has primarily focused on issues of sensing and recognition rather than the investigation of user opinions and social factors that influence the acceptance of multimodal interfaces. This research examines the factors affecting social acceptability of multimodal interactions, beginning with gesture-based interfaces. This work includes a survey and an on-the-street user study that examine how users determined which gestures were acceptable. Future work seeks to examine other modalities, in order to create guidelines for socially acceptable designs and a methodology for investigating social acceptability.

Introduction Volunteering is formally defined as freely giving time and labor for community service. Through analyzing which demographics tend to volunteer more, we can determine which factors influence the volunteering rate positively or negatively. Using those factors, we can target specific potential volunteers and understand why people volunteer. Factors such as age, employment status, race, and sex are all major contributors to the volunteer force and its limitations. This study answers questions such as: Do more educated people tend to volunteer more? Does Race play a large role in civic engagement? Etc. These are questions that are important to consider in raising the numbers of the volunteer force all over the world. Many of these generic factors have larger correlations to other specific factors such as: religion, marital status, inequity in education, etc. --- Description of the Analysis --- Introduction and Goals In my experiment, I looked at many different demographic factors (race, sex, age, employment, education) and compared them to their volunteering rate as a demographic. This allows for understanding of which factors are correlated, and what exactly this means for our community in its entirety. The goal of this experiment was to determine which demographics have an impact on volunteering in America. --- Methods --- Hypotheses Before conducting my analysis, I made predictions about the data using my previous knowledge. I predicted that women would volunteer more than men, since simply from personal experience I have seen more women in my volunteer work than men. I also predicted that those who were unemployed would volunteer the most because they may have greater amounts of time to volunteer rather than those that are employed full-time. Finally, I predicted that teenagers would volunteer the most because of their required service hours in high school. I did not draw predictions on race because I believed that race did not play a role. --- Tools In this experiment, I used the python packages: seaborn, matplotlib, numpy, and pandas and performed data analysis on a data set from the U.S. Bureau of Labor Statistics. I was able to use bar graphs, tables, and pie graphs to get the density of volunteering within the demographics listed above. --- Background on Data Set The Bureau of Labor Statistics (BLS) with the U.S. Department of Labor used data on volunteering that was collected in the supplement to the 2015 September Current Population Survey. The BLS defines volunteers as "persons who did unpaid work (except for expenses) through or for an organization". The CPS collected monthly data through a survey of about 60,000 households. This survey obtained data on the U.S. civilian population of ages 16 and over on their volunteering activities for an organization (even if they were only performed occasionally). There were special efforts made to have each household member answer the questions on the survey themselves because usually, one member of the household answered the questions on behalf of the entire household. The BLS deemed the responses of each individual as important because research indicated that respondents, when answering the survey themselves, could answer more easily. In the end, about 2⁄3 of the responses were individual responses. --- Reliability of Data Set The statistics in this data set are samples of the United States population. There is a chance that there may be a sampling error and these estimates differ from the true population values. According to the news release by the BLS in 2015, "There is about a 90-percent chance, or level of confidence that an estimate based on a sample will differ by no more than 1.6 standard errors from the true population value because of sampling error". The Current Population Survey data is affected by non-sampling error. This can result from failing to survey a certain percentage of the population, not being able to obtain data from all respondents, not having 100% accurate information, or errors made in processing the data. --- Results --- Quantitative Results --- Sex Figure 1. Throughout the years 2011-2015, the percentage breakup of Women:Men volunteering remained largely the same. Women volunteered more than men by almost 30%. The above graph shows percentages of the total volunteers who were either employed full time, employed part time, unemployed, or not in the labor force. As shown, those who were employed part time volunteered the most, and those that were not in the labor force volunteered the least. Those that are not considered a part of the labor force are: unemployed and not seeking work, students, retired persons, those taking care of family or children (ex: stay at home moms), those under 16 years, those on active duty in the Armed Forces, and those confined to nursing homes or prisons. The graph above showcases the number of volunteers in comparison to their educational attainment. Those with a Bachelor's degree or higher tended to volunteer more and those with less than a high school diploma tended to volunteer the least. This bar plot creates a somewhat exponential curve. It shows that those with higher educational attainment tend to volunteer the most. This chart shows the race breakup of volunteers in the most recent year in the dataset (2015). As shown by this, the most volunteers were white. White people make up 80% of the Volunteer force, thus proving a probable correlation to another demographic factor. This factor could be religion. According to the Washington Post, very few Jews are non-White, and most Christians are either Black or White. Judaism and Christianity are religions that have volunteering as one of their core values. This is possibly why White people make up such an overpowering majority of the volunteer force. --- Employment Status --- Educational Attainment --- Race --- Age Figure 5. The age distribution makes somewhat of a parabola shape. Most volunteers are middle aged and consistently between the ages of 35-54. The least number of volunteers are between the ages of 16 and 24. This makes sense because most of those years are during undergraduate and Junior/Senior year of high school. --- Correlations Figure 6. As shown from the above as well as Figure 4, it is likely that most volunteers are White with a Bachelor's Degree. The other four races had fewer volunteers in comparison to the White population. White population is much larger than the other races, so it can be assumed that most volunteers with Bachelor's degrees were White. --- Figure 7. Figure 7 shows the correlation between one race (Black), and employment. As seen, Black people make up a small percentage of the employed volunteers. Also, employed volunteers are more likely to volunteer, as shown by Figure 2. As shown in Figure 8, the most employed people are White. Along with the statistic that those who are employed are more inclined to volunteering, it can be shown that White people are also more able to be employed, indicating that education access is not equitable. --- Qualitative Results The main volunteer activity was collecting, preparing, distributing, and serving food, but other activities were reported such as tutoring, fundraising, engaging in general labor, reffing games, etc. Women were more likely to volunteer in collecting, preparing, distributing, and serving food, fundraising, and tutoring, while men were more likely to volunteer in general labor and coaching sports teams. People with a bachelor's degree or higher were more likely to tutor or teach than volunteers with less education and less likely to serve/prepare food than those with less than a bachelor's degree. In addition, parents were more likely to ref, supervise, tutor, and mentor and engage in activities to do with children. --- Limitations While this data set is almost 8 years old, the statistical demographical breakup of volunteers observed experienced little change throughout September 2011-September 2015, so we can assume that this trend will not drastically change post 2015. --- Conclusion Voluntary work is, contrary to popular belief, correlated heavily with ones background. Voluntary work is not widespread, and through the factors of Education, Age, Sex, Race, and Employment Level, the different demographics of volunteering can be analyzed. Women volunteered more than men, by almost 30%. Employed community members volunteered much more than those who were not. Individuals with the highest level of education volunteered the most. White people volunteered the most. Middle-aged people volunteered the most. Per this analysis, volunteering is an act that only those in privilege are accustomed to. The race statistic itself supports this in that White people tend to volunteer significantly more, and through many other figures in section 3, it can be proven that those who were White also tended to have a higher level of education and employment that other races often lacked. Those that were employed tended to volunteer more, and most employed citizens are between the ages of 35-44, therefore also marking a connection between age and race. Privilege of any form, whether it be education, race, or employment directly correlates to a higher level of civic engagement. Women volunteering more than men could be related to a variety of factors such as: the effects of childbirth, raising a family, characteristic qualities, inclination to perform tasks without pay, etc. While non-profits may use this information to target campaigns to get more volunteers, the factors analyzed in this study (age, employment, race, sex) also point to a social disparity within civic engagement. --- Code The Jupyter notebook created to analyze the data can be found here: https://github.com/anika1324/VolunteerDemographics

Voluntary work can have many benefits to individuals such as decreased depression and mortality and increase in overall health. Volunteering also leads to many community benefits like sustainability and community unity. In this study, I set out to analyze who exactly volunteers by taking data from the US Bureau of Labor Statistics on volunteering over 5 years and reviewing many common trends. Volunteering is, surprisingly, an act that a very small number of Americans take part in. Through this study, I was able to conclude which demographics those volunteers are from. I used the factors: Education, Age, Sex, Race, and Employment level. These factors all play a role in which sector of Americans, demographically, contribute to their community through volunteering. Through the five years that the US Bureau was able to collect data, the numbers had a low standard deviation, leading to the conclusion that even though the last date that the data was collected was in 2015, the numbers in terms of demographic percentages, would not have changed. This information could be used by non-profit organizations to target specific demographics when sharing volunteer opportunities, so they can maximize the possibility of finding volunteers.

of life among N = 157 older women (45 years and older) under correctional custody in Oklahoma. Based on the Model of Developmental Adaptation, path analysis was conducted positing valuation of life, the developmental outcome, regressed on the proximal influence of socio-emotional support and forgiveness and the distal lifetime report of miscarriage. Endogenous measures were controlled for age, race, marital status, education, and crime type. Using Mplus 8.8 and an estimator (MLR) that provides parameter estimates and a chi-square test statistic robust to non-normality, the model fit well with a non-significant chi square test statistics and significant parameter estimates. For these women, 40.5% of the variation in positive valuation of life was explained, primarily by socio-emotional support. Miscarriage had a significant positive association with socio-emotional provisions (β = .15, p < .05) but not forgiveness. Meanwhile, forgiveness had a significant direct association with positive valuation of life (β = .46, p < .001). A significant indirect effect emerged for miscarriage on positive valuation of life through socio-emotional support (.047, p =.035, one-tail test). Results suggest that older incarcerated women with a reported history of miscarriage achieve a positive life outlook to the extent they feel emotionally supported. Greater engagement in forgiveness also appears to contribute to a positive life perspective. This has implications relative to how correctional counselors, social workers, and case managers offer services to support older incarcerated women with a reported history of miscarriage. Abstract citation ID: igad104.2167 --- FACTORS ASSOCIATED WITH THE PSYCHOLOGICAL WELL-BEING OF OLDER MEN WHO HAVE SEX WITH MEN IN THE CHINESE POPULATION Alex Siu Wing Chan 1 , and Elsie Yan 2 , 1. The Hong Kong Polytechnic University, Hong Kong, Hong Kong, 2. THe Hong Kong Polytechnic University, Hong Kong, Hong Kong Older men who have sex with men (OMSM) experience discrimination based on their age and sexual orientation, which presents major challenges to their health. Existing studies have examined discrimination experienced by younger MSM. This study aims to examine the discrimination experienced by OMSM in the People's Republic of China (PRC), Hong Kong, and Taiwan. The eligible participants for this research comprised OMSM aged over 60 years. The demographic information of the participants was collected. Particularly, the General Health Questionnaire-12 (GHQ-12), Personal Social Capital Scale (PSCS), Perceived Acceptance Scale (PAS), and Global Index on Legal Recognition of Homosexual Orientation (GIRLHO) scales were used to assess psychological well-being, discrimination, social capital, perceived acceptance, and legal inclusion. Discrimination differs across PRC, Hong Kong, and Taiwan (F(2, 450) = 112.07, p < .001), and it also has a negative impact on psychological well-being (B = -1.16, p <.001). Social capital was found to have a negative impact on psychological well-being (B = -3.38, p < 0.001), and a positive impact on legal inclusion (B = 1.55, p< 0.001). Lastly, social acceptance has a positive impact on psychological well-being (B = 0.52, p = .035). This study provides new insights into the negative impact of discrimination on the psychological health of OMSM and mitigating factors representing the positive

Sexuality is fundamental to the human experience and midlife is a transition period in adulthood where sexual changes often occur. Sexual satisfaction (SS) in midlife and older adulthood is still under studied. However, researchers have found a more pronounced decline in SS among women compared to men beginning in late midlife or early old age. The purpose of the present study was to examine how sexual satisfaction changes across adulthood (20-92 years) and at what ages women and men differ on their ratings of sexual satisfaction. Participants were from waves 1, 2, and 3 of MIDUS (n=2,348; Mage=54.34 years). SS was operationalized using "How would you rate the sexual aspect of your life these days," with a scale from 0 to 10 where 0 means "the worst possible situation" and 10 means "the best possible situation". Time-varying effect modeling (TVEM) revealed that there was an overall linear decline until the early 60s, then the decline steepened. Men and women did not differ from ages 20 to 44. However, around age 45, men (β=5.95; CI:5.83,6.07) began reporting significantly greater SS than women (β=5.62; CI:5.45,5.74), which lasted almost four decades. At age 84, women (β=3.36; CI:2.94,3.78) reported significantly greater satisfaction then men (β=3.32; CI:2.89,3.74). On average, SS declined with age. Women reported lower SS than men for almost four decades (ages 40-80); however, women reported higher satisfaction than men starting in their early eighties. No studies have examined SS across adulthood or gender differences in SS using TVEM.