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Introduction Health policies that cater for the needs of gay people have often been disregarded. The population is thought to be the most susceptible during the HIV/AIDS era, therefore the longstanding unsatisfying health policies reach a high. The spread of discrimination against gay people in the HIV/AIDS era has shown the needs of gay people are somehow uncommon and governments are not doing enough to cater for the needs of the population. The lessons learnt from the HIV/AIDS era indicates the importance of valuing fewer common needs of different population, the importance of defamilization of social policy, mental health issues of sexual minorities group brought by discrimination as well as the intersectionality of inequalities that make gay people further disadvantaged. Moreover, gay people's negative and marginally discriminatory experience points to the value of recognising the needs of marginalised groups in order to attain social welfare equality. The essay illustrates the issue with health policies for gay men in the HIV/AIDS period and proposes recommendations for future policymakers by analysing peer-reviewed papers on the subject. --- 2. --- Lessons Learnt from the HIV/AIDS Era --- Policies should Cater the Needs of the LGBTQ+ Group The less common needs of gay people should be catered and the relevant measures of protection, infrastructure and resource availability should be built. In the HIV era, the needs of gay people are often neglected, specific needs are not met and supports are not enough. For instance, according to the Centres for Disease Control and Prevention (CDC) of the United States, anal sex is deemed as the highest-risk sexual behaviour and one of the main ways of transmission of HIV [1]. However, the vaccination rate against HIV found that among the HIV-infected population in the United States, only 42% are vaccinated as a result of limited awareness and lacked infrastructure [2]. The vaccination rate demonstrates how there is much space for improvement and how the present infrastructure does not adequately serve gay people. Hence, when making health policies, the specific needs brought by the sexual activities of gay people should not be neglected while enhancing the infrastructure for resource allocation. Besides HIV, gay people are more vulnerable to other diseases related to receptive anal intercourse, which can be less common in the general population. The stratified analysis suggests that receptive anal intercourse has the primary role in anal HPV transmission, and the use of a condom does not have protective effects against high-risk HPV [3]. Thus, gay people are often exposed more to HPV and anal cancer. Some improvements have been achieved as a result of the lessons learned during the HIV/AIDS era. For instance, HPV 9-valent vaccines are believed to be effective prevention of anal cancer and are part of the NHS vaccination programme offered routinely in England for a student in year 8 [4,5]. Through making the vaccine offered routinely in the NHS programme, the availability of resources and awareness have been improved compared to the HIV era regarding considering the needs of gay people respectively but also improving the health of all populations through vaccination. The approaches toward prevention against diseases associated with high-risk sexual activities have been enhanced as a lesson from the HIV era. However, it should be encouraged that global advancements continue. --- The Importance of Defamilizing the Health Policy The defamilization of health policy is needed to meet the needs of gay people. In the HIV/AIDS era, families rather than individuals are the focus of most areas' health policies. Nowadays, though it is still illegal for heterosexual couples to get married in many countries and regions, in countries where same-sex marriage is legalised, there is a continuous inclining trend for same-sex couples to get married. For instance, after the legalised same-sex marriage nationwide in the United States in 2015, 49 per cent of cohabiting gay couples were married in 2016 and the population of LGBT is predicted to double by 2060 [6]. But during the major AIDS/HIV outbreak in the 1980s, same-sex marriage is not legalised in the United States nationally [7]. For instance, welfare states with policies to suit the traditional family forms and rely heavily on the family as a provider of welfare and social services back then does not meet the needs of gay people, in particular, older gay people as the traditional dependency relationship is highly unlikely to apply to them [8]. It also shed light on the issue of cohabiting couples, regardless of gender, who get less welfare as a result of not getting married. By focusing primarily on the requirements of the majority of families, the diversity of relationships should not be ignored. The transformation of family forms should not be neglected; hence welfare and health policy should be defamilized. The defamilization of policies and welfare reduces care and responsibilities between family members which increases the relief from dependency relationships brought by gender and intergenerational policies [9]. The family structure is continually evolving as a result of societal development, yet enhancing personal welfare will always be comparatively efficient since different families are always constituted by individuals. Through defamilization policy, the emphasis of healthcare and welfare on gender, marriage and children are shifted to a less significant role, putting gay people in a less disadvantaged position as many of them are not raising children and not performing the gender-stereotyped role. Members of the family are given fewer moral obligations when the role of the family in healthcare is removed and it allows individuals to have healthcare in their own right, instead of the moral duty of their family members. Health policies should relieve the responsibilities of interdependence between family members and provide equal access and responsibilities for all individuals without gender, intergenerational or sexual orientation constraints. --- Mental Health Issues Arise from Discrimination Due to discrimination and exclusion toward gay people, mental health policies are needed to meet their needs. Discrimination and negative impacts on the mental health of gay people have longstanding and persist today. The HIV/AIDS epidemic worsens the mental health situations of gay people, in particular older gay people who have experienced the HIV/AIDS epidemic. Nearly all older gay men alive today have been impacted in some way by HIV/AIDS with threats posed by the stigmatisation of HIV and homophobia [10]. This illustrates the extent of the devastation done to gay people's mental health at that time. Research evidence shows LGBT people experienced more minority stress and live under stigma, prejudice and discrimination in a stressful social environment which causes mental health problems [11]. Even when the HIV/AIDS epidemic ends, the mental health of gay people remained a severe issue. This raises the issue of weak mental health among the sexual minorities population and health policies targeting the needs of sexual minorities should be valued. According to the CDC of the United States, discrimination and rejection by friends and family all have negative consequences on gay people's mental health because of the limitation of access to high-quality health care while adding to poor mental health and poor coping skills and increasing suicidal attempts [12]. Hence, more health policies catering for the mental health of sexual minorities should be made and implications against discrimination and homophobia should be strengthened to prevent minority stress. --- Intersectionality of Inequalities Gay people with HIV are strongly correlated with high unemployment and financial difficulties due to discrimination. They were more exposed to the inequalities due to the lower SES. Sexual minorities often experience more discrimination during each stage of their life. Discrimination against gays and lesbians in hiring persists within the OECD countries, with gay people facing more discrimination than lesbian people [13]. The discrimination against sexual minorities has made this population more financially disadvantaged. Moreover, research founds gay men, bisexuals and men who have sex with men that live with HIV were 12 per cent less likely to be employed and 9 per cent more likely to experience financial difficulties than those without HIV [14]. Thus, HIV does not only the health conditions but also the financial condition of gay people as these individuals suffered from inequality as a result of job discrimination. As a result, even if medical treatment is available, it may not be inexpensive or insured for this particular group of individuals. Future health policy should make healthcare affordable and available to people, in particular to sexual minorities. To prevent future unfair conditions for the population of sexual minorities, policies against discrimination in the workplace should also be enhanced. --- Conclusions To conclude, besides catering for the general population, future health policies should target to address the needs of gay people which might not be common in the general population. It is important to take into account the demands of each group and the makeup of the overall population. Each group can suffer from particular challenges that are not common in other groups, whether healthcare policies can cover and be efficient in these categories can be extremely vital to providing good quality healthcare to all people with equal access. The makeup and composition of families today may alter significantly from those of the past due to the ongoing physical and social development of society. The defamilization of policies is vital to meet the changing social structure as more families nowadays are not 'traditional' anymore. In order to better ensure the rights and access to healthcare for all citizens, policymakers should replace family duty with individual access. By doing so, it does not only guarantee access to healthcare for each individual, but it also allows for state supervision and planning from a macro level. Nowadays, there is a lot of talk about mental health because people are beginning to recognise how serious mental health issues may affect someone's well-being. As gay people are more vulnerable to discrimination, the mental health of the population should be valued and paid greater attention to. Discrimination can be found frequently in daily lives, and how the government approaches social issues can be important as it affects the well-being of its citizens both physically and mentally. The government must take this issue seriously since changing societal norms, people's views and beliefs and dealing with prejudice may be difficult and time-consuming. Existed inequalities and discrimination against gay people in all disciplines may lead to worse SES for gay people. It is important to consider how disparities overlap. Hence, the lessons can be learnt that the structure of policies catering to sexual minorities and in particular those with disadvantaged backgrounds should be improved and policies should target to prevent people to be more disadvantaged as a result of discrimination.

The HIV/AIDS era has witnessed considerable discrimination against gay men and exposed the underlying issue of familization of health policies. As the millieu constantly change over times, health policies catering the needs of family does not necessarily meet the needs of individuals. For instance, when viewing family as a unit, it held family members liable for certain duties, while easing the role of the state. It is important to recognize the needs of different population, mental health issues of sexual minorities as well as the intersectionality of inequalities that put certain group in an even more vulnerable stance. The essay illustartes the issue with health policies for gay men in the HIV/AIDS period and proposes recommendations for future policymakers by analysing peer reviewed papers on lessons learnt from the HIV/AIDS era.

This book is not only about social palliation but also highlights systemic injustices and barriers to receiving care, care that is culturally meaningful and fulfilling. It provides insights into the limits of palliative care in relation to the needs of "continually displaced" interlocutors. While Dossa effectively makes the case for social palliation throughout the book, the study has some limitations. Social palliation is not clearly defined in the book. Instead, attributes of social palliation are uncovered through case examples over various chapters. In sum, social palliation recognizes that death and dying cannot be cut off from life and living, acknowledges the care recipient as part of a complex web of social relationships, and affirms that one's life and border-crossing experiences matter. Dossa argues that palliative care is based upon neo-liberal values, such as individualism, which diminishes the importance of the social in health, healing, and palliation. As such, palliative care is "patient-centred focus" and "premised on fulfilling the wishes of the patient as an individual, not as a person embedded in a world of social relationships, and also as someone with a history and life experiences that should matter" (4). Palliative care becomes "contingent upon a diagnosis of terminal illness," (4) and often ignores other circumstances where ongoing care might be necessary, such as for those with temporary limitations, unique healthcare needs, or permanent disabilities. Dossa discusses how her Canadian-Ismaili and Canadian-Iranian participants come from cultures and societies where death and dying are not cut off from life and living, which lead her interlocutors to feel displaced, lonely, and isolated when dying in Canada. The author contends that the foundational problem lies within Canada's neo-liberal capitalist system, which "fosters individualism and self-care, while absolving society from its responsibilities towards its citizens" (138). Dossa finds that her participants, due to their unique migration histories and being racialized minorities, are continually displaced, resulting in what she calls "social wounds." Dossa defines social wounding as "a mode of research that lends itself to a multilayered understanding of the lives of marginalized persons" (180). She argues that displacement "is a politicized phenomenon that profoundly affects people's lives because they are compelled to leave their place of birth, after living there for generations" (5). Upon resettlement, she contends that "displaced persons are subject to continuing trauma," which "is largely a function of colonization and neo-imperialism" (5). One form of trauma identified is the "nonrecognition of their credentials and erasure of their life experiences," which she deems "a function of structural exclusion" (6). Another form of trauma is that of being removed from social networks and the "home" to die alone. Through research and interviews with palliative care practitioners, Dossa contends that the current healthcare situation, "privileges those who are already privileged, and disenfranchises those who are dispossessed" (37). She argues that the terminally ill, "are marginalized by the existing health and palliative care systems because of their exclusive focus on end-of-life," which, "cannot be divorced from life," and should take into account the lives of participants who crossed "geopolitical and social boundaries [to remake] a home in a new land in the wake of displacement" (37). According to Dossa, the notion of palliative care is constructed in relation to bio-medicine, and while it may be built with intentions of inclusivity and compassionate care, it ignores border-crossing experiences and the social needs of care recipients, lending them to feel ignored, isolated, and lonely. An engaging feature of the book is Dossa's ability to draw readers into the lives of her interlocutors through the medium of storytelling. As part of her research methodology, she invites study participants to share their stories, allowing us to observe how they piece moments of their lives together and make meaning with those moments, often highlighting social wounding in their accounts. Dossa argues, "an important aspect of the genre of storytelling is its close association with the wound (continual displacement). Emanating from the inner recesses of life, wounds tell stories that challenge us to reflect on aspects of lived realities that might otherwise recede into the background" (9). Through her storytelling, readers are able to better understand how displaced participants try to re-make their everyday worlds in their new homeland, give meaning to their experiences, and restore integrity in both life and death in small but significant ways. Another appealing feature of the book is the conclusion, where Dossa presents fragments of each community's sacred traditions, inviting us into the collective consciousness of these communities, which offers a glimpse into their worldviews around living and dying. Dossa does not engage with the selected excerpts: instead, she invites the reader to reimagine how we each think about life, death, and dying, and how these sacred narratives might provide meaning in the lives of study participants and their families. The book is insightful and a pleasure to read. Its major drawback is its exclusive focus on first-generation migrants. Dossa explains that she chose these communities because of her long-standing relationships with them (179). Had the study even included 1.5 generation participants from the same communities of interest, it would have helped paint a bigger picture of the impacts of displacement and social wounding in living and dying, as the 1.5 generation would have spent most of their lives in Canada. This sample would help us to understand why socialization in a particular cultural context matters. Building on the present study, it would be worth repeating the study on second-generation Canadian-Ismaili and Canadian-Iranians, as this would help us to examine whether the effects of displacement, and subsequently social wounding, must be experienced first-hand, or whether the "wounds" can be transmitted intergenerationally, and if so, to what extent. However, these research questions are clearly beyond the scope of this study. It would also be of benefit to the readers if they knew about a recent development in the Ismaili Muslim community in Canada. In 2019, the Ismaili community opened its first multi-generational housing complex in Calgary, Alberta, called Generations, with plans to open more across Canada. Generations aims to respond to the needs of the aging and disenfranchised members of society. According to their website, the complex in Calgary "encourages high-quality social interactions across generations from early childhood through to older years" (Generations -Multi Generational Housing and Community Centre, n.d.). Unfortunately, the book does not mention these efforts or whether this highprofile initiative responds to the social palliative needs described by the authoreven though the complex's development stages and awareness campaigns were present during the study. This high-profile initiative is worth mentioning as it reveals how the burden of culturally relevant care is being taken up by the community, not the state. While Canada prides itself on the values of diversity, inclusivity, and pluralism, it further supports Dossa's argument that neoliberalism, as a system of governance, "fosters individualism and self-care, while absolving society from its responsibilities towards its citizens" (158). Still, Social Palliation fulfills its objective of adding nuance to the way we think about palliative care and would be an important read for healthcare professionals, policymakers, and other stakeholders. Dossa helps us to acknowledge that study participants live and die in a "complex web of relations, which encompass the politics of suffering and pain" and how, "without meaningful social relationships and mutual connectivity," they are "deprived of life at the fundamental level of experiencing its relationship to death" (20). This book comes at a perfect time. As I read the book, I could not help but reflect on the current situation, including the impact of the COVID-19 pandemic on long-term care homes and healthcare more generally. As we continue to recover and learn from the impacts of the pandemic, where the elderly, disabled, and terminally ill have arguably been hit the hardest, this book offers readers a new way of thinking about palliative care.

S ocial Palliation, by Parin Dossa, draws insights from the experiences of first- generation Canadian-Ismaili Muslims of South Asian origins and Canadian-Iranians to answer the questions: "What bearing does displacement have on living and dying in a new land? And what kind of work do displaced persons engage with to restore the integrity of life and death, even if this is in small but not insignificant ways?" (4). The book is an ethnographic study, conducted in Vancouver from May 2015 to May 2018. From the outset, the reader is introduced to the book's activist mission, to politicize issues of life and death and expand the boundaries of palliative care to include social palliation. Through the medium of storytelling, Dossa invites us into the lived experiences of select research participants, making a case for a more culturally inclusive and holistic form of palliative care, which she calls social palliation.

INTRODUCTION Why are individuals altruistic to their friends? Evolutionary psychology suggests that such altruism is primarily the product of adaptations for reciprocal altruism [1,2], which evolved to solve the problems of social exchange that were recurrent in the social lives of our hunter -gatherer ancestors. Adaptations for reciprocal altruism follow a strategy of conditional cooperation, opening interactions with a 'nice' move, and then either reciprocating cooperation orif cheating is detected-withdrawing cooperation and imposing sanctions [3]. Previous research has focused on the individual and relationship factors influencing levels of reciprocal altruism. With regard to individual factors, it has been found, for example, that: cooperation in experimental games is moderately heritable [4], and influenced by personality factors [5] and temporal discounting [6]. With regard to relationship factors, it has been found, for example, that: altruism is influenced by the expectation of reciprocity and the expectation of future interaction, and is contingent upon others' continued cooperation [7][8][9]; that individuals are more likely to cooperate with others when they are being watched (or made to feel as if they are being watched) [10,11]; and that individuals cooperate at higher levels when there is the option to punish cheaters [12,13]. However, theory also suggests that levels of altruism will depend not only on properties of individuals and dyads but also on properties of the larger social network in which they are embedded [14,15]. For example, to the extent that reciprocal altruism is facilitated by the opportunity to form reputations [16], and to the extent that connections between network members facilitate reputation-formation, then increased network connections should encourage reciprocal altruism. Within such networks, individuals with more connections to other members are in effect being 'watched' by a larger audience; this should increase their incentive to reciprocate altruism (in terms of positive reputation), and decrease their incentive to cheat (in terms of negative reputation, and sanctions or punishment). As such, they should be more cooperative, and we should expect individuals to be more willing to engage in reciprocal altruism with them. This effect should be enhanced by the fact that altruism towards such well-connected individuals will broadcast the donor's cooperativeness to a wider audience also. However, there has been relatively little empirical work on the effects of network structure on cooperation, and even less on network connections, and what research there is has yielded mixed results. One study found that altruism in networks declines as a function of the 'degrees of separation' between donor and recipient [17]; another found that recipients of altruism 'pay it forward', creating 'cascades of cooperation' in networks [18]. One small-scale ethnographic study found that in networks of family and friends (n ¼ 16), the overall 'density' of network connections (density ¼ actual/total possible connections) was associated with more supportive networks, and with the degree to which reciprocity was delayed and indirect as opposed to immediate and direct [19]. Another found no effect of network density on reciprocity (n ¼ 29) [20]. The present study uses a novel correlational design to test the prediction that individuals will be more altruistic to well-connected members of their immediate networks of friends. --- MATERIAL AND METHODS A sample of working-age adults-supplied by a commercial participant-panel supplier (Maximiles; www.maximilesgroup.com)-was recruited to complete an online questionnaire about themselves, their friends and the relationships between their friends. Each participant was paid 200 iPoints (approx. £2) for completing the questionnaire. First, in order to investigate individual-level factors influencing altruism, participants completed a short-form assessment of the Big Five personality traits [21], including two-agreeableness and conscientiousness-thought to be most relevant to cooperation [22]. Second, in order to investigate relationship-level factors, participants identified their eight (same sex) best friends (excluding sexual or romantic partners), and answered a range of questions regarding their relationships with each of them, including two-'For how many years have you known your friend?', and 'How often are you in contact with your friend?'-likely to be especially relevant to the maintenance of reciprocal altruism. Participants also completed short-form agreeableness and conscientiousness items for each friend. Third, in order to assess altruism, participants were asked to state how likely they would be on a scale of 1-7 (where 1 ¼ 'very unlikely and 7 ¼ very likely') to (i) lend £5000, and (ii) donate a kidney, to each friend. Finally, in order to assess how well-connected each of their friends was to their other friends, participants were asked to state how frequently each friend was in contact with each other friend (1-8; never/lost contact, every few years, yearly, every few months, monthly, weekly, daily and several times a day). 1282 ¼ 8.17, p ¼ 0.004); and accordingly participant sex will be accounted for in the remainder of the analysis. --- RESULTS --- Two Responses to the questions about contact frequency between friends were heavily skewed (with 55% of friend-to-friend relationships described as 'never/lost contact'), and so the original variable responses were recoded into binary variables (1 ¼ not connected, 2-8 ¼ connected); and these were summed to give number of network connections for each friend (0-7). An example of a network with median number of connections is given in figure 1. The two altruism measures (lend, kidney donation) significantly correlated, (r ¼ 0.53, p , 0.000), and so they were standardized and combined to form a composite measure of altruism. A hierarchical linear model (HLM) was used to investigate the relationships between altruism and the individual, relationship and network factors, and especially to test the hypothesis that individuals would be more altruistic to well-connected friends. Accordingly, years known, frequency of contact, agreeableness of friend, conscientiousness of friend and network connections of friend were entered into the HLM as level 1 fixed factors. Agreeableness (participant), conscientiousness (participant) and sex (of participant) were entered as level 2 fixed factors. Participant identity (a means of identifying 'subjects') was entered as a level 2 random factor. Parameter estimates showed that each of the individual, relationship and network variables, including network connections, made a significant unique contribution to altruism, but there was no unique contribution of sex (table 1). At level 2, the variance component associated with subjects was 0.46, while the residual variance component was 0.19 (p , 0.001 in both cases) yielding an intraclass correlation coefficient of 0.71. The high variance associated with 'participant' justifies the use of an HLM to control for it. --- DISCUSSION The present study investigated the effects of individual, relationship and network factors on altruism to friends. All predictors exerted significant contributions, with frequency of contact (between a participant and their friend) making the largest contribution. Specifically, as predicted, individuals were more likely to be altruistic to better-connected members of their social networks. This novel finding highlights the importance of social structure in explaining patterns of altruism and cooperation. Note that the direction of argument here is that the relationship between altruism and network connections arises because well-connected members will be more cooperative, and hence will be more attractive as cooperative partners. One alternative possibility is that the causal arrow runs the other way: more cooperative individuals generate and maintain more connections. However, the findings regarding recipients' personality traits go against this interpretation. If network connections were merely a reflection of the general cooperativeness of the recipient, then we might expect the effect to disappear once we controlled for the personality of the recipient. As the results show, even when controlling for the agreeableness and conscientiousness of the recipient, the effect of network connections remains highly significant. Note also that the conscientiousness (sample item: '. . . does a thorough job') of the participant is negatively associated with altruism; while the conscientiousness of the friend is positively associated with altruism. One interpretation of this result derives from the logic of reciprocal altruism, which suggests that individuals should be willing to share resources acquired through luck, but not those acquired through effort; and similarly, that individuals should view the victims of misfortune as more deserving of help than the victims of their own indolence [23,24]. Consistent with this, individuals in the present study who considered themselves to be hard-working were less likely to be altruistic to friends, and were less likely to be altruistic to friends they perceived to be lazy. This intriguing possibility merits further study. Finally, although the focus here was on network connections creating conditions for reciprocal altruism (through reputation and indirect reciprocity), it is of course possible that such connections may promote altruism in other ways too. For example, better-connected individuals may be higher status and have access to more valued resources, making them more valuable cooperative partners. Alternatively, to the extent that altruism is a costly signal of social status [25], altruism to well-connected individuals may broadcast this signal to a larger audience. Teasing these apart will require more thorough investigation in future studies.

Why are individuals altruistic to their friends? Theory suggests that individual, relationship and network factors will all influence the levels of altruism; but to date, the effects of social network structure have received relatively little attention. The present study uses a novel correlational design to test the prediction that an individual will be more altruistic to friends who are well-connected to the individual's other friends. The result shows that, as predicted, even when controlling for a range of individual and relationship factors, the network factor (number of connections) makes a significant contribution to altruism, thus showing that individuals are more likely to be altruistic to better-connected members of their social networks. The implications of incorporating network structure into studies of altruism are discussed.

Introduction and Background Technology-wise, we are living in exciting times: novel interactive technologies and applications enrich our lives and allow us to tackle challenges previously considered unsolvable. Examples include head-mounted-displays and smart personal devices for ubiquitous assistance, deep neural networks enabling the first true applications of artificial intelligence, or autonomous vehicles for increased comfort and safety. New interface technologies are the core of HCI and how they will be used in social situations is crucial to the field. Simultaneously, the very same technologies introduce new threats, raise new societal concerns, and can increase social tension between users and non-users. For example, unconventional interface technologies can face resistance from bystanders and can potentially cause embarrassment when used in public places. Increasing autonomy of agents can raise broader ethical and societal discussion on the roles and purposes of technology (c.f., [3,19]). In light of this, we believe that HCI needs to account for how the social and cultural aspects of technology use are critical factors in successful innovation. The influence of ICTs upon not only the primary user but also their social networks and any surrounding public has opened up many new pitfalls to social acceptance -or non-acceptance, as it may be. As a consequence, research on social aspects of technology usage, particularly social acceptability (which had been named as part of system acceptability already in 1994 [13]) has drawn increasing interest from various areas of HCI and beyond. Nevertheless, research systematically studying "social acceptance" or "social acceptability" is rare. More often social acceptance considerations emerge as a by-product of studies or are discovered by accident, far too late in development processes, i.e., just before or even after a product is shipped. Only a few authors (e.g., Montero et al. [12]) have attempted to conceptualize social acceptability in HCI so far. In addition, there are no agreed upon best practices, or heuristics for designing socially acceptable interfaces, which has also been noted as a key research area during our CHI 2018 workshop on social acceptability [8,7]. Social acceptance is, however, a timely issue as everyday interfaces are becoming increasingly ubiquitous. For example, the acceptability of "performing" human-machine interactions in front of others has drawn HCI researchers' attention. Most prominent areas of interest include human-robot-interaction [18], mobile, gestural and on-body interfaces [1,12,16,17]. The advent of commercially available voice user interfaces (e.g., Amazon's Alexa or Google Home) also brought speech interfaces, their social acceptance [5,6], and their use in social context [14] to attention. The question of how to design for social acceptability has been taken up in the areas of wearable computing [10], drones [2,22], recording technologies [4,9], gaming [11], as well as accessibility [15,20]. This workshop will continue the efforts started at CHI 2018 and intends to foster critical re-thinking of social aspects in the adoption and creation of novel, interactive technologies. It will contribute to the conceptualization of social acceptability in HCI research; particularly how it is understood, encountered, evaluated and measured in the HCI community and beyond. In contrast to 2018, we aim for more tangible outcomes, namely a more mature conceptualization, and a collection of best practices. In light of this, we view INTERACT 2019 to be the ideal venue for this workshop. --- Topics of Interests and Workshop Objectives We aim for a highly interdisciplinary workshop, bringing together designers, researchers, and practitioners from different domains of HCI to generate a shared understanding of "social acceptance" and "social acceptability", and to discuss the implications of this for the HCI community. The first workshop of this series, at CHI 2018, attracted 11 submissions by 24 authors from different technology domains (AI, data science, wearables, extended reality) as well as from different epistemological standpoints (empirical reports, hypothesizing and argumentation papers, and preliminary theorizations). By bringing the workshop to INTERACT and Europe, we aim to broaden participation by reaching out to researchers and practitioners with different backgrounds, including various design disciplines, and social sciences. To help ensure strong participation from industry, we will also explicitly target practitioners through industry bodies and discussion groups and personalized invitations through our own networks. During the workshop we will discuss which problems and challenges regarding social acceptance are being faced during research and design activities, along with solution strategies for mitigating risks of social non-acceptance of new HCI technologies and artifacts. In the interest of establishing a research community, we aim to maintain and extend the discourse about which methods and metrics are suitable to comprehensively measure the social acceptability of an interactive system. We believe INTERACT 2019 to be the ideal venue for this workshop as INTERACT invites an interdisciplinary dialogue and has a long tradition in critically discussing social and societal aspects of technology usage. The workshop will provide a platform for presenting and discussing open issues and challenges as well as novel ideas on how to design for social acceptability. Its topics of interest include, but are not limited to (1) Design/system contributions, i.e., interactive systems that provide socially (more) acceptable qualities, provocative designs or breaching experiments. (2) User Studies about social aspects of technology acceptance, usage of human-machine interfaces in social context, or similar. (3) Experiences, case studies, and lessons learned from designing (not) socially acceptable interactive systems, and (4) Formal and theoretical approaches to social acceptability, e.g., conceptualizations, evaluation measures, design considerations, or heuristics. The practical objectives of the proposed 2019 workshop are to distill what is already known in terms of best-practices and heuristics, and start a collection of design patterns for socially acceptable interfaces and interactions (to be included in a "case book", c.f. [21]). We furthermore aim to initiate a discourse about which methods and metrics are suitable to comprehensively measure the social acceptability of an interactive system. As reflected in the mixed background of workshop organizers, a priority is to bridge theoretical and practitioner perspectives. Thus we seek to produce a working definition and models that are both academically robust but also relevant and actionable for commercial development teams. Finally, we aim to put those theories in context through hands-on experiences (field trip in the second half of the workshop) and through design examples and the collection of best practices ("case book"). --- Target Audience and Expected Interest Social acceptance is an element that often becomes apparent in user studies, whether it was purposefully studied or not. For this reason the workshop aims to include both those that are studying, tackling and working on social acceptability, and those that stumble across social acceptability issues when testing prototypes or deploying their products in the wild. We believe that the social acceptability of emerging technologies is of direct interest to all designers, researchers and practitioners who design, study or use (novel) interactive systems. The workshop has ties to various areas in HCI, including mobile, wearable and ubiquitous computing; interaction in public spaces; on-body interfaces; intelligent personal assistants and HRI; interactive and provocative design; and social software. The workshop is also intended to attract attendees having more socio-scientific interests, such as computer ethics, social computing, or any psycho-social dynamics of HCI. --- Organizers Marion Koelle is a research associate at the University of Oldenburg. She is currently pursuing her doctoral dissertation on designing body-worn cameras that intelligently adapt to social contexts. Her research on the social acceptability of emerging technologies and novel interaction paradigms was published at NordiCHI, MobileHCI, CHI, and TEI. Ceenu George is a PhD student and research associate at LMU Munich. Her work focuses on interactions between HMD users and people not wearing HMD devices (bystanders). In the context of mixed presence collaboration, she is interested in the social acceptability of HMD devices for bystanders, usable security considerations between these two collaborators and in enabling a communication channel whilst maintaining presence in both realities. Valentin Schwind is post-doctoral researcher at the University of Regensburg. His research is dedicated to improving extended reality systems that enabling immersive experiences. In his work, he also explores multimodal and social interaction with avatars in virtual reality, as well as social implications of using extended reality devices. He has experience as a committee member for international conferences and in organizing workshops. Daniel Perry is research scientist at North Inc. where he conducts research on applications for wearable computing. He is interested in the social acceptability of wearable interfaces, games for work and learning, and visual analytics. He was previously a Data Science postdoctoral scholar at UC Berkeley. He has organized several workshops on STEM games at the University of Washington. Yumiko Sakamoto is a psychologist and a research associate at the University of Manitoba, Canada. With her psychology background, she focuses on various types of HCI research involving human perception and behaviors. Khalad Hasan is an assistant professor at the University of British Columbia (Okanagan), Canada. His research focus is on developing and studying novel interactions with mobile and wearable devices. More specifically, he is interested in exploring users' needs and making an impact in their lives when it concerns efficient and socially acceptable mobile interactivity. He was previously a postdoctoral fellow at the University of Waterloo, Canada. He also has experience serving in committees at international conferences. Robb Mitchell is associate professor at University of Southern Denmark, and academic mentor for UX at Beijing Normal University. He is a graduate of Environmental Art at Glasgow School of Art and has a PhD in facilitation. He has led hands-on workshops at TEI, DRS, Participatory Innovation, and Service Design conferences. In addition, he organized many creative interdisciplinary gatherings for New Media Scotland, The Electron Club, and The Chateau, Glasgow. Thomas Olsson is associate professor at Tampere University, focusing on the experiential and social implications of information technology and research through design. His research interests include designing socially aware and acceptable information technology, enhancing social interaction with the help of emerging ICT, Big Social Data analytics, and extended reality technologies. He has organized several interdisciplinary workshops in the field of HCI. --- Expected Outcomes In addition to the workshop contributions, which will be part of the adjunct proceedings, we will propose a discussion piece (e.g. Interactions magazine), where we intend to discuss the workshop outcomes along with recent research and future perspectives. On the practical side, we will start a collection of examples, case studies, and best practices for evaluating social acceptability, which will be brought together as a continuously updated "case book" of social acceptability in HCI (c.f. [21]), which we will publish online.

The spread of information and communication technologies (ICTs) in all aspects of our lives increases the range and scale of potential issues with social acceptance. In the HCI community there is a growing interest and recognition of social acceptability issues with emerging technologies and novel interaction paradigms. This workshop builds on the success of the CHI 2018 workshop on social acceptability by bringing together academics and practitioners to discuss what social acceptance and acceptability mean in the context of various emerging technologies and modern human-computer interaction. We aim to bring the concept of social acceptability in line with the current technology landscape, as well as to identify relevant research steps for making it more useful, actionable and researchable with well-operationalized metrics. The intended outcome of the workshop is two-fold: first, we will continue the efforts to provide an actionable conceptualization of social acceptability in HCI. Second, we will start a collection of best practices and practical examples to be brought together as a continuously updated "case book" of social acceptability in HCI.

548 city of Sulaymaniyah. This study is one of the analytical studies. It is used descriptive approach and the content analysis. Lastly, the study identifies several results: -Globalization is a continuous social, political and economic reality in all societies, including the Kurdish society. -The study showed that there is a difference between specialists in determining the stages and the date of the emergence of the phenomenon of globalization. The phenomenon of globalization has a set of features and characteristics of its own. furthermore, a clear impact on all levels and areas of life for individuals and societies, directly or indirectly negatively likewise, the loss of the original Kurdish social values such as honesty, honesty, love for the homeland, religion, the right of neighbourliness, and various social responsibilities. Positively, it is an attempt to link the new world with social values. Authenticity, expanding the mind of the Kurdish individuals against various topics in the individual and society. --- ‫العولمة‬ ‫دور‬ ‫الكوردية‬ ‫المجتمع‬ ‫االجتماعية‬ ‫التنمية‬ ‫في‬

This study aims to identify the positive and negative remnants of globalization on social development, as well as to the role of globalization in changing customs, traditions and culture. However, to show its role in improving the life of the individual and society in a scientific and practical way in the Kurdish society, especially in the

I. INTRODUCTION Dementia is one of the major causes of disability and dependency among older people and the seventh greatest cause of death. 1 Especially in low-and middle-income countries, in addition to the lack of public knowledge and understanding of dementia, stigma also exists and hinders timely diagnosis by healthcare professionals in primary care settings as well as effective care coordination between healthcare facilities and social support networks. 2 Vietnam is a typical developing country with a lowresource healthcare system where the stress of family caregiving may be amplified by a lack of community resources, cultural stigma discouraging the seeking of outside help, and the costs of care. 3,4 According to estimates, Vietnam had 660,000 dementia sufferers in 2015, and dementia-related expenses totaled US $ 960 million. 5 6 Aside from big cities like Hanoi, Ho Chi Minh City, and Da Nang, dementia-specific healthcare facilities are scarce in the majority of the country. There is inadequate education available for healthcare professionals in dementia diagnosis and treatment. 7 In terms of dementia care, person-centered care (PCC), also known as patient-centered care, is a sociopsychological treatment approach that recognizes the individuality of the patient in relation to the attitudes and care practices that surround them. 8 Family, caregivers and the person with dementia (when possible) should always be involved in drafting a care plan based on person-centered care. 9 In clinical practice, PCC includes incorporating personal knowledge of the person with dementia, engaging in meaningful activities, prioritizing well-being, and enhancing the healthcare provider -patient relationship. 10,11 In the PCC support teams, nurses play an essential part because their responsibilities include dementia recognition, management and reducing the burden on caregivers. 12 Acute care setting nurses are known for their role in preventing adverse events and improving patient experiences and outcomes. 13 And nursing home staff took over almost half of nursing home residents' ADL and IADL in the daily activities. 14 Regarding long-term care models, most elderly care services are provided primarily by family members who are largely uneducated or supported by outsiders. Family-based care is increasingly decreasing and insufficient. 15 Up to now, the non-family long-term care models in Vietnam as well as Hanoi have been quite diverse, including types of social and medical care. 15,16 In particular, key non-family longterm care sources are nursing homes, nursing centers, rehabilitation hospitals, geriatric hospitals and general hospitals with geriatric departments, all of which employ nurses as the primary care workforce. 17 --- II. MATERIALS AND METHODS --- Study Setting and study population The survey among nurses employed in selected nursing homes and geriatric units in --- Measures and Instruments A self-administered questionnaire, which included five major sections on respondent sociodemographic characteristics, dementiarelated experience, knowledge about dementia, attitude toward dementia care, and confidence in dementia care was used for all data collection activities in the present study. Current confidence in dementia knowledge as self-rated by the nurses. The rating score ranges from 0 to 10 points. The higher the rate, the more self-confident they are in their knowledge. Current desired level of dementia training as self-reported by the nurses. The score ranges from 0 to 10 points. The higher the score, the more they want to be trained in dementia. (3)(4)(5) Knowledge, Attitude, and --- Confidence in dementia care The Dementia Knowledge Assessment Scale (DKAS 2.0) is a reliable and valid measure of dementia knowledge across four domains: causes and characteristics (7 items), communication and behavior (6 items), care consideration (6 items), and risk and health promotion (6 items). 18 Response options are rescored to fully correct (2), partly correct (1), or incorrect (0) and added to calculate a total score ranging from 0 to a maximum score of 50. 19 The higher the final score, the greater the individual knowledge about dementia. The Dementia Attitude Scale (DAS) was used to assess nurses' attitudes toward dementia care. It has a two-factor structure with the first factor covering "dementia knowledge" (cognitive items) and the second factor covering "social comfort" (affective and behavioral items forming a single factor). 20 The instrument consists of 20 items on a seven-point Likert --- Ethical considerations The study was approved by the Hanoi Medical University Institutional Ethical Review Board on March 14, 2023 (786/IRB HMU). --- III. RESULTS Out of a total of 313 nurses invited, 273 participated in the study and 269 of them completed all assessments and were included in the analysis (response rate 86%). --- Demographic characteristics among two nurse groups --- Demographic and dementia-related experience among two nurse groups The difference in professional qualifications and seniority is obvious between the two groups of nurses. Corresponding to the higher age and seniority working in the healthcare field, hospital nurses also have more seniority devoted to caring for dementia patients. This result is also similar to the difference in seniority between employees of the public and private longterm care service systems in Hangzhou city, China. 22 These differences in age and seniority come from certain regulations in recruiting medical employees at each facility. According to regulations of the Ministry of Health, public hospitals recruiting nursing officers require level 4 -diploma nursing candidates to have completed 6 months of internship before being allowed to practice. 23 Meanwhile, there are no mandatory recruitment or internship standards for nursing homes, where recruitment depends not only on job requirements but also on the employer's ability to pay employees. With a higher frequency of contact with patients with dementia among nursing home nurses (mostly from over 20-100%), the results showed that nursing homes have a high prevalence of dementia and higher rate of patients with dementia than in hospitals. This is also consistent with research by Nguyen Ngoc Bich 2019 with the prevalence of dementia in the community being 46.4% and Tran To Tran Nguyen 2019 with the prevalence among inpatient of geriatric units being 24.3%. 24,25 The reason that may explain the difference comes from the length of inpatient care, because dementia care requires long-term and continuous care, with a lot of focus on maintaining stability and supporting daily living activities for the patient instead of admitting to treat emergency --- Knowledge, attitudes, and confidence in dementia care among two nurse groups Regarding dementia knowledge, there was no difference in the total score between the two groups. However, about domains of the knowledge scale, hospital nurses had higher knowledge scores in pathology and dementia prevention while nursing home nurses had the better result in "communication and behavior". This shows that each facility has certain strengths and weaknesses, specifically in nursing homes, nurses have limited knowledge about dementia recognition and prevention, while dealing with and managing behavioral disorder symptoms in patients is their strength. Anthony Scerri 2017 in Malta also found similar results that qualifications were not associated with confidence while higher level nurse positions were associated with higher levels of confidence as measured by the CODE scale. 33 With the percentage of chief nurses nearly three times higher than that of hospitals, this may also be the reason why the average confidence score of nurses at nursing homes was higher. --- V. CONCLUSION Hospital nurses have greater age, education level, and seniority in the healthcare as well as dementia care than nursing home nurses. Nursing home nurses receive and come into contact with a higher percentage of patients with dementia than hospital nurses. Hospital nurses were more knowledgeable about dementia pathology and health promotion, whereas nursing home nurses had a better understanding of communication and dealing with behavioral difficulties in patients, as well as having more confidence. --- Abbreviations

Nurses play an important role in dementia care delivery in hospitals and communities. Exploring nurses' capacity aspects in dementia care such as knowledge, attitudes, and confidence is essential for developing appropriate health professional education to achieve optimal care in different aged care facilities. This crosssectional study aimed to describe and examine the differences in population characteristics and dementia care capacity between the nursing home and hospital nurses in Hanoi, Vietnam from January to March 2023. Data were collected using three self-administered questionnaires: The Dementia Knowledge Assessment Scale (DKAS), the Dementia Attitude Scale (DAS), and the Confidence in Dementia Scale (CODE). The number of nursing home and hospital nurses completing the survey was 111 and 158 respectively. There were no statistically significant difference in the mean of the total knowledge score and attitude score between the two nurse groups. Hospital nurses were more knowledgeable about the dementia pathology and health promotion, whereas nursing home nurses had a better understanding of communication and dealing with behavioral difficulties in patients, as well as having more confidence (p<0.05). Different professional training for different types of facilities should be developed and implemented to achieve qualified dementia care.

In 1979, Berkman and Syme stated that "[i]ndividuals undergoing rapid social and cultural changes…as well as those living in situations characterized by social disorganiza-tion…, and poverty…appear to be at increased risk of acquiring many diseases" (1, p. 186). The extent to which this statement rings true today cannot be overstated. The US population is undergoing rapid changes in the social, technological, political, and economic landscapes that fundamentally alter the social networks and interactions that form the bedrock of societies and ultimately impact health. Some of the barriers to maintaining networks today include increases in aging populations, growing economic inequalities, and a large rise in the numbers of refugees and displaced populations around the world. In their landmark paper "Social Networks, Host Resistance, and Mortality: A Nine-Year Follow-Up Study of Alameda County Residents" (1), Berkman and Syme explored and rigorously tested the theory that diminishing social networks among adults altered their mortality risk from 1965 to 1974. Berkman and Syme's study was highly innovative in that it was the first in which social contacts in a large population-based health survey were directly measured and enumerated (1). Data originated from individuals 30-69 years of age who participated in the Human Population Laboratory Sample emanating from the California State Department of Health. The study population was a stratified systematic sample of Alameda County residents that comprised more than 4,000 men and women. Berkman and Syme measured and categorized a range of social ties in an egocentric network to test whether different types of social networks measures, including marriage, contacts with close friends and relatives, church membership, and informal and formal group affiliations, affected mortality (1). They developed a social network index to measure a construct referred to as "social isolation" that took into account both the number of social ties and the relative importance of these ties by weighting certain contacts. For example, intimate contacts were given greater weight in the index than were church affiliations or memberships in group activities. After collecting social network information at baseline, individuals were followed for 9 years, and information from the state death registry was used to confirm age at and cause of death. The data were presented as mortality rates adjusted for age, socioeconomic status (income and educational level), and "health practice" (e.g., smoking, alcohol intake, preventive health care). The results of the study by Berkman and Syme showed robust network gradients, whereby those with fewer network connections and weaker social ties had significantly higher mortality rates across age and sex categories (1). There were also some differences by sex. For example, unmarried men had a higher mortality rate than did unmarried women. In contrast, having fewer friends and relatives that one sees regularly was associated with higher mortality rates among women than among men. In addition, the authors observed a dose-response relationship between "social isolation" and mortality that became more pronounced as individuals aged (see Figure 1 from Berkman and Syme (1)). Moreover, the risks associated with greater overall social isolation were larger than those of any single network measure, including marital status or contacts with friends or relatives. Berkman and Syme then identified potential confounding variables and tested whether these factors accounted for the observed associations. The association between social networks and mortality persisted in these sensitivity tests. On the basis of these findings, Berkman and Syme called for future studies in which the physiological pathways that might increase susceptibility to disease and the development of more sophisticated network measures for analysis were explored (1). Since the work by Berkman and Syme was published in 1979, results from numerous studies and randomized interventions targeting social networks have supported the importance of networks for health and well-being (2,3). Investigators have demonstrated that humans have a negative physiological response to social isolation that results from persistent overreaction of the stress response system, which may alter hormonal, immunological, and even epigenetic pathways that may ultimately influence health outcomes (4)(5)(6)(7)(8). Results from some randomized intervention studies have supported the notion that enhancing social networks and interactions can be beneficial to human health, especially in older-aged populations (9,10). Together, this body of research has uncovered some of the potential physiological mechanisms that Berkman and Syme had suspected altered host susceptibility in their early work on this topic. Berkman and Syme's early call for a better conceptualization of networks continues to be very pertinent today. The recognition that networks matter for health and the composition of one's social network is important continues to be explored in research addressing social isolation, social exclusion, and segregation (11)(12)(13)(14)(15)(16)(17). Moreover, the work by Berkman and Syme has not only influenced the inclination for epidemiologists to collect information on social networks and related phenomena but also likely contributed to highlighting the importance of these measures for causal inference. Indeed, networks and interactions have been found to be key factors in influencing causal inference in the form of "interference" or "dependent happenings" (18,19). In addition to conceptual and methodological advances related to networks, the availability of mobile technologies and the Internet have resulted in profound changes in social networks. There are now several global social networking platforms, such as Facebook (Menlo Park, California), Instagram (Menlo Park, California), and Twitter (San Francisco, California). Facebook is by far the most popular networking technology, hosting 1.86 billion users (20). The advent and widespread use of the Internet, smartphones, and social network online services have fundamentally changed the way that we interact with each other. With the availability of online network data coupled with novel smartphone applications that can track individuals and their contacts in space and time, we can now more accurately measure both online and person-to-person interactions, as well as the changing dynamics of these interactions on a daily basis (21)(22)(23). These advances have led and will continue to lead to the development of new tools for network analysis, such as the creation of computer algorithms to process data from large networks online and in the real world (24)(25)(26). It remains unclear whether the network concerns that Berkman and Syme uncovered many years ago will continue to influence disease risk in the same manner today. To catch up with innovation, epidemiology in the 21st century should quickly develop new frameworks and methods for studying the network mortality trends that Berkman and Syme observed in 1979. This should be a public health imperative, given the new, consuming, and almost inseparable ways in which we interact through technology, along with the associated sedentary and isolating behaviors that these innovations promulgate (27). Although results from some studies support a positive impact (28,29) or no effect (30,31) of social network site use on mental health and well-being, others have described some concerning negative impacts (32)(33)(34). The most recent and perhaps most rigorous test of the influence of Facebook network interactions on health is from a recent paper by Shakya and Christakis (34). Using longitudinal data accessed from thousands of Facebook users, as well as surveys of their social networks, Shakya and Christakis showed that an increased quantity of Facebook use was associated with worse self-rated health, worse mental health, and greater body mass index (34). They also showed that although real world face-to-face interactions were protective for overall health, the negative associations between Facebook use and health were comparable in magnitude to the positive impacts of real-world interactions (34). In addition, having a greater number of Facebook friends over time was not significantly protective for any of the health outcomes examined. Although the associations of real-world networks with health and well-being were quite similar to the protective findings for mortality that were reported by Berkman and Syme almost 40 years ago and the physiological pathways by which real-world social isolation may impact health have since been explored, the specific mechanisms by which Facebook social networking might harm or improve health has not been thoroughly examined. Shakya and Christakis argued that viewing profiles that put forth a blemish-free picture of one's daily life may influence mental health by leading to negative self-comparisons among Facebook users, which has some support from earlier research (35)(36)(37). In addition, they suggested that sedentary behaviors associated with online network engagement may influence health and well-being (34). Technologies such as smart phones have been associated with a decline in both quantity and quality of person-to-person interactions (38,39), thereby lessening the protective effects associated with strongly connected networks of intimate contacts. One might argue that Berkman and Syme's call for understanding the physiological pathways linking networks and health might similarly apply to Facebook users through stress-mediated biological pathways, but this idea has yet to be tested. One issue that researchers will need to contend with when working with social media is the fact that social networking sites tend to provide data on only select segments of society, limiting representativeness. Overall, the important influence of networks that Berkman and Syme noted many years ago may magnify in the future as more populations gain access to and as a whole become more inclined to socialize through internet platforms, forgoing face-to-face interactions. Although the internet has been an incredibly beneficial source of information and connection in the 21st century, the potential downsides for realworld social interaction need to be studied more carefully. Additionally, as Berkman and Syme urged many years ago, research should continue on the mechanistic pathways by which networks, now in a virtual realm, influence health. This issue is especially pressing as technology continues to become a cornerstone of modern life. Berkman and Syme's research continues to be a profound example of the importance of social networks as a determinant of health. Epidemiologists would do well to look back on the context of their findings to better understand the crucial next steps that will need to be taken when examining the impact of both our online and offline social networks on population health in today's technology-driven society. --- Conflict of interest: none declared.

Almost 40 years ago, Berkman and Syme demonstrated that social networks were related to the risk of early mortality (Am J Epidemiol. 1979;109(2):186-204). Their study was highly innovative because they directly measured and quantified social networks in a large prospective population-based survey with mortality follow-up. The results of the study showed robust network gradients, whereby those with fewer networks and weaker social ties had significantly higher mortality rates. The important influence of social networks that Berkman and Syme noted many years ago is likely to heighten in the future, as demographic characteristics shift and individuals become more inclined to socialize through online platforms instead of real-world interactions. Berkman and Syme's research in 1979 continues to play a key role in shaping recent efforts to uncover the influence of social networks on health. Looking back on their findings may help epidemiologists better understand the importance of both online and offline networks for population health today.

Who is Phoenix? Roberto D'Angelo "Some patients find it difficult to be in the present because they are stuck in the past; others, by contrast, struggle to remain connected with the past and are suspended in a so-called present that is effectively atemporal, that is out of time". 1 (p.360) For psychoanalysts, the most profound and ultimately ethical way that we can help individuals, is by helping them know themselves. This involves discovering how they were shaped by their past and how their ongoing self-experience cannot be understood in isolation from its constitutive contexts. Psychoanalysts help patients explore foundational questions such as: 'Who am I?' 'How did I get here?' 'How am I implicated in my own suffering?' 'How can I grow and flourish and truly engage with my life?'. The answers to these questions emerge from a detailed exploration of the persons lived relational history, their current social and relational context and the political systems within which they are embedded. It is via this expansion of self-awareness that individuals can access agency and true freedom of choice. The clinical approach presented by Notini et al 2 is grounded in a completely different, radically decontextualised understanding of human experience. Their conceptualisation of Phoenix's gender identity is ahistorical and atemporal: it is indeed 'out of time'. For these authors, gender identity is assumed to be an immutable core essence, much like Ehrensaft's 3 (p.341) 'true gender self…. there from birth'. It simply 'is'. This is a politically charged assumption, as we still have no established model for how gender identity/variance develops. The model that Notini et al privilege is in essence a biological one (see Fausto Stirling 4 ), which remains unsubstantiated. This model locates the problem within the individual body/mind and therefore the solution involves correcting the identity-body mismatch. Phoenix's social and relational context only has relevance insofar as it is supportive or rejecting of his gender identification. Phoenix's gender identity is the starting point, the immutable and irreducible bedrock, from which this treatment journey begins. The key question is: how can we make Phoenix's body align with who they feel they are? This immediately raises serious questions about the ethics of using a risky somatic intervention 5 6 based on an unsubstantiated theory. I argue instead that how Phoenix experiences their gender is a point in time along the complex, non-linear and evolving journey that is their life. Phoenix's non-binary identity has a history and a formative context. It is an emergent phenomenon that arises at the intersection of a multitude of interacting systems and factors, including developmental, relational, biological, interpersonal, family context, social, economic and political systems. The aim of treatment, as I see it, is to understand how Phoenix came to feel that they are in the wrong body, or that their developing body will become the wrong body. Although this approach may sound radical, it is not: it incorporates the systemic, psychodynamic and biopsychosocial approaches that psychiatry has successfully drawn on for decades to understand and ameliorate emotional suffering. The authors are proposing patient care that breaks with this tradition. With its narrow focus on gender identity as concrete, the clinicians and ethicists effectively ignore or even erase the complexity of Phoenix's lived history and the context within their gender distress is constituted. The paper is striking for the absence of any sense of Phoenix, the person, even for a hypothetical case. Phoenix has effectively been reduced to a diagnosis or a gender identity to be treated. The reification of Phoenix's non-binary identity effectively erases all personal meaning, the impact of the relational context and the sociopolitical surround. It constitutes a decontextualisation and dehumanisation, which is arguably profoundly unethical. 7 Who is Phoenix? We know nothing about how and when Phoenix came to identify as non-binary or what being non-binary, male or female means to them, beyond how they would like to appear. How did Phoenix come to feel distressed by the potential of having an adult, sexed body and what does sexuality mean to them? What influences formed Phoenix's notions of gender: the family, peers, the culture, social media? Does Phoenix feel constrained by narrow definitions of what it means to be male or female, or by how gender is regulated sociopolitically? What possibilities does being a non-binary person make available that would not be available to them as a sexed adult, and why? How do Phoenix's erotic life, fantasies and sexual orientation relate to the desire to have no secondary sex characteristics? We are also told nothing about Phoenix's relational and developmental history. How does the family function? What identifications with parents and significant others did Phoenix form? Is there a history of trauma or abuse? What unconscious processes are going on in the family? Does one of the parents not want Phoenix to grow up? Is there a family problem which Phoenix's identification helps to manage? Does Phoenix have interpersonal difficulties and what is the interpersonal function of asserting a non-binary identity? Is it a way of asserting separateness and independence, or is it a way of hiding and feeling less vulnerable? Does Phoenix see a non-binary identity as a solution to emotional pain, the causes of which Phoenix may not yet have considered. This kind of psychotherapeutic exploration can extend in all directions, illuminating whether the causes of Phoenix's suffering are more complex than they first appear. The aim is not to identify psychopathology or to convert, but to explore the origins and meaning of Phoenix's distress, and to facilitate a process of personal growth in which Phoenix will come to know themself and find new and creative ways to thrive. In contrast, medicalisation of Phoenix's distress constitutes an erasure of the inevitably complex sources of Phoenix's pain, effectively dissociated, forgotten, via the medical reconfiguration of the body. Is this an attempt to 'forget' or to erase a painful developmental history? Is Phoenix indeed 'out of time', disconnected from the past? From a perspective that considers the whole person in context, ongoing puberty blockade (OPD) constitutes a therapeutic abandonment. While gender-affirming medical intervention aspires to help the individual Commentary actualise their true self, it potentially forecloses authentic self-discovery if not preceded by a thoroughgoing psychological exploration. Hopefully, Phoenix will discover answers to the question 'Who is Phoenix?' that are more complex than 'non-binary'. Armed with deeper selfawareness, Phoenix will then be in the best position to decide whether OPD will indeed be liberating, or whether it will deprive Phoenix of true growth and freedom.

This paper has been updated since first published to update author name 'Roberto D'Angelo'.

Introduction Facebook (FB) is the world's largest social networking site (SNS), with more than 500 million users worldwide (Facebook Stats, 2011). The rapid adoption of SNSs, such as FB raises important questions about the impact SNSs have on the formation of social capital. Researchers have been debating whether SNSs are improving or harming our social relationships (Barkhuus and Tashior 2010;Ellison et al. 2007;Steinfield et al. 2008;Subrahmanyam et al. 2008). While some recent studies have found that FB use supports bridging social capital (Ellison et al. 2007;Steinfield et al. 2008), the impact of FB use on F2F interaction with friends and family in particular has not yet been investigated. Another limitation of recent research is that little is known about how diverse age groups interact socially on SNSs. So far the empirical research on SNSs has focused primarily on teenagers (e.g.; Barkhuus and Tashior 2010;Ellison et al. 2007;Steinfield et al. 2008), or those in their twenties (e.g.; Subrahmanyam et al. 2008). Older adults have been found to have different kinds of usage patterns and expertise than younger adults on FB (Brandtzaeg et al. 2010), and may also have different social needs. Also, with rare exceptions, most of the previous studies on the Internet and friendships, as well as on SNSs, are based on cross-sectional survey data, and thus are limited to one point in time. Thus the question arises: Does FB use, in different age groups, support offline contact over time, such as F2F interaction with family members and friends? Or, in others words, Does FB makes us more social? Whether SNSs are increasing or decreasing, offline social interactions in our close relationships could have a substantial impact on society. The present paper provides insight into how people interact in FB and in F2F settings, and explores the relationship between these two social contexts. This helps to shed light on how SNS users handle the offline and online practices, and if online interaction displaces offline contact. We investigate this by tracking 311 FB users ranging from 15 to 75 years old over three annual waves (2008-2009-2010). --- Social Capital: The Internet and SNSs Social capital is difficult to define, because it is not just a single entity, and there is no single generally accepted definition or operationalization of social capital (Ellison et al. 2007). However, we are in this paper, defining social capital in line with what Barbieri (2000) labels 'network based social capital', which is understood as the number of connections individuals have, and how often the individuals are nurturing these connections. This concept includes family connections or what we will label as "family-based capital" (e.g., Coleman 1990). Our operationalization of social capital is the frequency of social interaction, and the size of the individual social networks, offline and online (e.g., Brandtzaeg et al. 2010;Putnam, 2000). A specific contribution of this paper is that we also focus on F2F interaction among friends and family members. In addition, we distinguish between different types of social capital -bonding and bridging capital. According to Ellison et al. (2007), bridging capital is associated with weak ties (acquaintances), and bonding capital with strong ties (family and close friends). However, it should be noted, that we only map the social network and the association between offline and online contact -not the consequences of social capital as a social resource or value. --- Research Hypotheses The majority of previous research has uncovered a positive correlation between electronic communication such as SNSs, and F2F interaction, as well as different types of social capital formation (e.g. Ellison et al., 2007). Based on this prior work we propose the following hypotheses: Family-based capital, offline and online: New reports show that family members and older adults increasingly visit SNSs such as FB (Ellison et al. 2009;Facebook statistics 2011), which might make it easier for family members to stay connected online and offline: • H1a: The use of FB will be positively associated with users' F2F interaction with family. • H1b: The use of FB will be positively associated with users' online FB interaction with family members. Prior research (e.g., Barkhuus and Tashiro 2010;Ellison et al. 2007) suggests that the Internet can enhance F2F interaction, and that FB is mainly a tool to keep up with existing offline relationships, rather than to initiate new online. Our next hypotheses are therefore: • H2a: The use of FB will be positively associated with an increase in users' F2F interaction with close friends. • H2b: The use of FB will be positively associated with an increase in the number of users' close friends' offline. • H2c: The use of FB will be positively associated with an increase in the number of users' close friends' online. Bridging capital, offline and online: Previous research shows that the use of SNSs and FB is positively associated with bridging social capital (Ellison et al. 2007;Steinfield 2008), therefore: • H3a: The use of FB will be positively associated with users' number of offline friends and acquaintances (bridging capital). • H3b: The use of FB will be positively associated with the number of acquaintances (bridging capital), and the frequency of contact with acquaintances and "people you only have met online". --- Method This research uses longitudinal data. The data was collected using an online questionnaire filled out by a sample of FB users from Norway aged 15 to 75 years, in 2008, 2009 and 2010 --- Measures In addition to demographics (Table 1), the questionnaire included the following measures: Offline interaction: We used two questions to measure the frequency of F2F interaction with 1) Family, and 2) Close friends using a 6-point response scale: 1-Never; 2-Rarely; 3-Several times a year; 4-Several times a month; 5-Several times a week; 6-Daily. Offline social networks: Two questions: (i) How many close friends do you have? Using a 7-point scale: 1 (None), 2 (1-2), 3 (3-5), 4 (6-8), 5 (9-11), 6 (12-15), 7 (More than 15). (ii) In total, how many friends and acquaintance do you have? Using a 10-point scale; 1 (Fewer than five), 2 (6-10), 3 (11-20), 4 (21-30), 5 (31-50), 6 (51-100), 7 (101-200), 8 (201-500), 9 (501 -1000), 10 (More than 1000). Online-interaction on FB: We asked the following four questions: "With usage of FB, how often do you have contact with the following persons?" 1) Close friends, 2) Acquaintances, 3) Family members you do not live with, and 4) People you only have met online. We used the same 6-point scale as for offline interaction. Online-social networks on FB: We asked questions about (1) the number of acquaintance's on FB (similar 10-point scale as offline), (2) the number of close friends on FB (similar 7-point scale as offline), and (3) the number of family members on FB (5-point scale). --- Overall use of FB: "How often do you visit Facebook?" With answers ranging between: 1-Never or almost never, 2-Several times a month, 3-Several times a week, and 4daily. --- Analysis and results We assess how FB usage influences social capital offline and online. We used Partial correlations (r) controlling for age, gender, and education. We did this in the three time periods, to study the developmental trends from 2008 to 2010. We also tested the statistical significance of the differences between the correlation coefficients over time, using the Fisher r-to-Z transformation. Descriptive statistics for all our social capital measures are available in Table 2 3. Partial correlations (r) between the overall use of FB with offline and online variables (2008-2009-2010), (N=311). Notes: Correlation is significant at the 0.05 level ** (2-tailed). --- Family-Based Capital: H1a and H1b H1a: Partly supported. No significant correlation between family interaction, and overall FB usage (see Table 3). H1b: Supported. FB use is significantly and positively correlated with family interaction online in FB. Bonding Capital: H2a, H2b and H2c H2a: Partly supported. FB-use is positively associated with individuals' F2F interaction with friends over time, but not significantly (see Table 3). However, in Table 4, when we investigate the use of FB as a communication channel with friends, we see a significant positive correlation, however, the trend shows that this declined from 2008 to 2010, p = 0.403. H2b: Not supported. We find no significant correlation between the use of FB and the number of close offline friends. The trend is somewhat negative from 2008 (r)-2010 (r), but not significant. H2c: Supported. Online bonding capital in FB, among close friends, is positive and significantly (see Bridging Capital: H3a and H3b H3a: Not supported. There is a significant correlation between the use of FB and a wider circle of friends and acquaintances offline in 2008, but not in 2009 and 2010. H3b: Supported. There is a significant correlation between the use of FB, and a having a wider circle of friends and acquaintances on FB, as well as a frequency of contact with them. However, this trend declined over the years (with a significant difference between the correlation coefficients in 2008 and 2010, p = 0.003). "Interaction with people I don't know" is not significant (except in 2009). --- Discussion and conclusions The results reveal a rapid growth of FB-usage from 2008 to 2010 among all age groups, which implies a substantial change to our traditional ways of interacting with others. FB has become commonplace and a well integrated communication tool to keep up with friends and family. Further, this study makes a number of contributions: First, we found that F2F interaction with close friends is positively related to FB communication with close friends in all three waves. In addition, we also found that FB communication with family members is associated with F2F communication with family members (see Table 4). This might imply that different communication behavior on FB supports certain kinds of F2F interaction. FB use can, therefore, have a reciprocal effect on F2F interaction with strong ties. A second contribution is the identification of the increasing presence of family members on FB; both in terms of number of family members who are FB friends, and the frequency of interaction (see Table 3). A growing age diversity of the user population on SNSs (Ellison et al., 2009) explains the increasingly important role of FB in facilitating family interactions. A third contribution of this study is that our findings, in general, contradict the assumption of the social displacement effect (e.g., Kraut et al. 1998), that time spent on social media will displace other and more apparent offline social activities such as F2F interaction. Fourth, the findings support the bridging capital hypothesis online but not necessarily offline. Finally, this study has limitations. The study was conducted in a specific SNS, namely FB, and in one country, Norway. While there is a strong rationale for these choices (FB is the largest SNS, and Norwegians are early adopters of technologies in general; SNSs in particular) studies of other SNS, possibly in other countries, could enhance the generalizability of our findings.

How does the use of social networking sites (SNSs) affect social capital offline and online? The increasing popularity of SNSs such as Facebook (FB) implies a significant change in the way we interact with others. In an extensive longitudinal study (N = 311), carried out in Norway between 2008 -2010, we examined the relationship between FB use and social capital, with a focus on interpersonal interaction, including face-to-face (F2F) interaction. Our findings suggest that overall FB use does not significantly affect offline capital, despite a significant increase in the use of FB from 2008 to 2010, after controlling for age, gender and education. However, different types of communication strategies on FB correlate with various kinds of F2F interaction. Importantly, FB users who focus on FB communication with their close friends, also interact more frequently with their close friends F2F, compared to those using FB to communicate with "online strangers". The results also indicate that FB has become an important tool for keeping in touch with family members and existing friends rather than forming new connections.

The transition from Dental School to postgraduate Dental Foundation Training: strengthening the interaction between stakeholders Introduction Most UK dental and medical undergraduates progress into NHS posts involving further postgraduate training. Two key organisations, a higher education institution (University) and Health Education England (Postgraduate Dental Deanery), interface at this transition. It has been suggested that collaboration between these two organisations at this key transition is imperative to facilitate tailored training supporting personal, professional and clinical development. 1 This collaboration is now well established in Dentistry at Newcastle University and Health Education England, working across north east and north Cumbria (HEE NE) under the umbrella of a Dental Foundation Programme Undergraduate Liaison Group (FPUG). This opinion piece provides the historical context of the relationship between these two key stakeholders in dental education and the establishment of the current positive and productive collaboration. We wish to pass on what we have learned and encourage others in similar roles to initiate and establish this type of group to support learners at a fundamental transition in their clinical and professional development. --- Historical context of group Prior to the establishment of FPUG, the School of Dental Sciences and what was then the Postgraduate Dental Deanery strove to establish a forum for communication across this interface. This took the format of a large-scale lecture theatre based meeting. All Vocational Training Trainers in the region were invited along with those members of clinical staff from the School and Hospital that were appointed as Educational Supervisors to trainees undertaking the two year longitudinal training programme (General Professional Training). It is unclear whether formal terms of reference were ever established for this group, as no minutes were recorded. Anecdotally, the meeting became an opportunity for both parties to vocalise criticisms of one another, with discussions often straying beyond the intended context and spirit of the meeting. These interactions were seldom helpful to either party and on occasion generated animosity. As a consequence, and despite the meetings being held within working hours, many of the Ttrainers and Educational Ssupervisors distanced themselves from attending,. pPerhaps demonstrating a lack of interest and further deterioration of the intended relationship. The meetings were perceived to be damaging unhelpful to allboth parties and abandoned. In September 2009 the initiative was taken to re-establish a forum using a smaller group of leaders of dental education from the Dental Deanery and University. The agenda of the initial meeting was to discuss the concept of, and define clear terms of reference for, membership of this re-established group. Subsequent to this, the purpose, terms of reference and membership has been iteratively redefined to take into consideration changes to the organisational structures of postgraduate clinical education. --- Current Position Specifically the responsibilities of the group as described in its Terms of Reference, are to:; The School has presented helpful information regarding the changing nature of dental student skills (both clinical and non-clinical) and experience upon graduation. This has enhanced the understanding of HEE NE and ESs in practice regarding the skill set of the 'safe beginner' when they commence DFT. 6 Both parties have gained an increased awareness of dental educational research which is relevant to the transition to DFT, enhanced through FPUG discussions covering research related to ES expectations of dental graduates discussed the implications of research relating to ES expectations of graduates. 1 Soon after FPUG was formed, arrangements were made for HEE NE to communicate directly with students through Blackboard, the School's online learning environment. However, this was found not to be effective, and alternative communication pathways were enabled via FPUG members and events organised for the students.  --- Stakeholder engagement A number of the activities of FPUG have resulted in the two organisations developing a better understanding of each other by engagement in each other's activities. For example; Attempts to encourage engagement have met with varying success. Ppractice ESs were invited to visit and observe student clinics, to promote opportunities to and consider becomeing Associate Clinical Lecturers at the School and teach on student clinics. This approach waswere not successful, largely due to the issues surrounding obtaining observer status, howeveralthough a similar strategythis could be considered again. --- Initiative development and impact FPUG discussions have resulted in a variety of new initiatives which we feel have benefitted all stakeholders, principally in relation to DFT National Recruitment, information sharing with the wider groups represented at FPUG, and changes to clinical training. A number of examples of the impact of these initiatives are highlighted here. With the advent of DFT National Recruitment, the School was anxious to assist students in their preparation, without excessively coaching. 7 An annual Pprofessional Ddevelopment Dday was developed with input from HEE NE, who delivered a lecture to final year students about the National Recruitment process, whilst ES's who were not scheduled to participate in National Recruitment but who had a clear understanding of the process assisted in delivering 'mock assessment ' opportunities for final year students. HEE NE arranged a highly popular final year student trip visit to their dedicated Postgraduate training facility; this was promoted and advertised by the School staff and facilitated the students gaining a greater understanding and appreciation of the local DFT Schemes. Both organisations wished to support students who failed to transition at the expected time, (either bythrough failure to obtain a DFT place throughin National Recruitment, or deferral or /resitting their fFinal BDS examinations). HEE NE provided timely support and reassurance and facilitated a programme of hands on clinical sessions at their training facility. These sessions aimed at preventingto prevent deskilling prior to applying again to National Recruitment. FPUG also considered how the organisations could work together to support remediation of Foundation Dentists with performance concernsin difficulty. 8 considered included direct input from the School, but it was agreed that HEE NE was best placed to support such dentists, through a process which has since informed national Satisfactory Completion protocols. 3 The School took part in 'ES training' and provided average summary data on the clinical experience data from their undergraduate portfolio -iDentity. 9 This helped to manage ES expectations with respect to the typical volume and range ofdispel some myths about potentially inadequate undergraduate clinical experience, addressing a recognised source of tension between those involved with undergraduate and postgraduate dental education which has caused some to question the competence and preparedness of new graduates. 1,10 Graduating students are also encouraged to share their personal clinical experience records from iDentity with their ES. 1 Immediately prior to completion of the undergraduate programme the Sschool now supports final year students to extend their on-going Personal Development Plan into their DFT year, to share relevant information with their ES and incorporate it into their DFT e-Portfolio. More recently at the behest of Foundation Dentist and student representatives on FPUG, HEE NE has produced a checklist of requirements post-graduation and before starting DFT, including items such as when to apply for Performer List entry. Also at the request of the Foundation Dentists, the Sschool has generated a list of specialist contacts from the School and Hospital, with whom Foundation Dentists could make contact to discuss their individual career plans. HEE NE has made this list available to all Foundation Dentists in their schemes. CSome changes to clinical training have arisen through FPUG discussions, in particular the introduction of clinical refresher sessions for new graduates over summer to address the risk of deskilling before commencing DFT in September. These have been delivered by both HEE NE Training Programme Directors and School staff, including the authors. FPUG identified that further minor oral surgery training was a common learning need for new graduates, a widely acknowledged finding. 1,10,11 11 There are have been a few areas where FPUG has not achieved the planned outcome, such as the failurenot being able to communicate directly between HEE NE and the undergraduate students using Blackboard. However, on reflection this route was perhaps not necessary and we have found alternative ways to communicate more effectively at all levels of both organisations. The unsuccessful plan to encourage more ESs to become Associate Clinical Lecturers in the School was not successful at the first attempt, but we feel this would be worthy of further consideration to strengthen direct links between undergraduate teaching and DFT. Changes in DFT continue apace, 2,3 providing plenty of material for discussion in future FPUG meetings, and in turn generating innovative ways in which the organisations can mutually develop. We recognise the need to review the results of recent collaborative research undertaken locally and nationally on the transition to DFT. 37,10,11 This analysis will hopefully generate proposals from FPUG for further local developments in relation to the undergraduate programme or DFT to better facilitate the transition. --- Conclusion By establishing and maintaining this FPUG group, and with a small investment in time, all stakeholders involved with undergraduate and postgraduate dental training have benefited from the positive collaboration. The group has been highly effective at helping to facilitate dental students' transition into DFT in the North East of England and North Cumbria. Formation of a similar group merits consideration in other areas of the UK. --- Formatted: Heading 1

This opinion piece demonstrates the benefits of collaboration between dental educators in undergraduate and postgraduate settings, to facilitate the transition of dental students into Dental Foundation Training (DFT). The School of Dental Sciences at Newcastle University and Health Education England, working across north east and north Cumbria, have strengthened links by forming a Dental Foundation Programme Undergraduate Liaison Group (FPUG) involving all stakeholders. The group has shared information between the organisations, enhanced stakeholder engagement, and developed several initiatives including workshops to help prepare final year students for the transition to DFT. A small investment in time has been highly effective, and the formation of a similar group merits consideration in other areas of the UK.

Introduction Pokémon Go, the "inescapable force of nature" 1 that began sweeping the world a year ago, made it near impossible to venture outside without seeing crowds of users happily catching monsters with their smartphones. The augmented reality game was released on 6 July 2016; during its first 20 days on the market, it was estimated to have been downloaded 75 million times 2 and rapidly gained more daily users than the 10-year-old social media platform Twitter. 3 This popculture phenomenon has generated tremendous interest from all sectors of the media, and has been simultaneously portrayed as both the worst and the best thing for the future of humanity -a heavy burden for a relatively simple smartphone application. --- What is Pokémon Go? Pokémon Go builds on the video game franchise created by Japanese game developer Satoshi Tajiri. In short, it is an augmented reality game, freely available Why the public health sector couldn't create Pokémon Go Becky Freeman a,b,c , Josephine Chau --- Unintended health benefits Amid the exaggerated news media and social media reports, Pokémon Go appears to have unintended health benefits. Hunting for Pokémon may be contributing to public health by stealth. Anecdotally, trying to "catch 'em all" and hatching eggs appears to have led to players walking more and increasing their daily step counts 4 , families spending hours together outdoors 5 , and fostering of greater social interaction and sense of community. 6 Users have also reported improvements in mental health conditions, such as depression and anxiety, as a result of playing the game. 7 The public health sector has so far had limited success in using mobile-based apps and games to successfully change health behaviours. 8 Equally, the commercial fitness sector, although able to design hugely popular apps and wearable tracking devices, is yet to show that users make permanent changes to their physical activity levels. 9 Pokémon Go shows that there may be another path to positively affecting health, through the creation of games that appear to have no health focus whatsoever. A recent study shows that there are short-term increases in step counts among Pokémon Go players across sex, age and body mass index categories. 10 It is hard to imagine public health researchers setting out to develop a game that is fun, taps into pop culture, reaches a wide target audience, makes use of physical and virtual environments, and creates a sense of both competition and community, and then waiting to see whether there are any spin-off health benefits. This is the opposite of the approach currently employed, where the 'behaviour' of focus is often the only driver considered in development of health-related games. The difference may help to explain why so many of these mobile-based health behaviour change interventions fail. 11 If, instead, games were developed based on a model other than health behaviour change, there may be a much higher chance of achieving health gains. Public health should turn its focus to developing mobile-based interventions within a framework that embraces pleasure, rewards, participation and community. --- Opportunity for partnership Although public health researchers may not have a high level of knowledge about designing games for health promotion, they do have expertise in evaluating and studying the impacts of games and associated media interest through a health-focused lens. Similar to the situation with wearable technologies, where scientists have been granted access to users' raw data, scientists should take a proactive approach, and engage with game makers and other stakeholders to form partnerships for better health understanding. For example, physical activity researchers could examine how many steps Pokémon Go players accumulate each day over several weeks or months and track long-term impacts of the game on physical activity. Health communications researchers could study Instagram posts about Pokémon Go, see who players are out and about with, and examine associations with social connectedness. Mental health researchers could investigate the effects of Pokémon Go on symptoms of depression. Additionally, collaborating with game designers would help researchers navigate the relatively poor funding landscape in public health. Pokémon Go was developed by Niantic, a software development company that was originally a start-up within Google, together with Nintendo and the Pokémon Company. Since the costs associated with developing and testing new games are immense, it is important to recognise the possible co-benefits for game makers and researchers in working together and making the most of their respective capacities. --- Public health is too slow An overarching issue that stymies public health research in this sector is the relatively slow speed at which researchers operate to rigorously design studies, collect and interpret data, and prepare a peer-reviewed paper. By the time a randomised controlled trial with objective measures is set up to investigate the health effects of Pokémon Go, the game's popularity may well have passed, and the game may have been superseded by the next craze. The rapid rise and fall of a game's popularity is salient to game makers; does anyone remember Angry Birds? Public health stakeholders also need to reconsider how health-related gaming is marketed and promoted. This Twitter comment nicely sums up how public health would have ruined the Pokéman Go game with poor branding: "Man, @Nintendo made the right call with #PokémonGo instead of the original title: Get Some Fresh Air and Exercise". 12 Corporations that harm health exploit popular trends Even if Pokémon Go, with all the associated media hype, is a quick-lived fad, it may signal the beginning of a new genre of apps and games that lead to unanticipated health outcomes. If public health stakeholders want to capitalise on this genre, it is essential that more meaningful partnerships across health, information technology, marketing and communications are formed. Some companies that endanger public health quickly used the Pokémon Go trend as an opportunity to promote consumption of fast food. 13 Public health agencies need to be just as nimble and responsive, or forever be creating games that nobody plays. --- Author contributions All three authors conceived of the paper and contributed to the writing.

Pokémon Go has been subject to much attention -from both the players that download the augmented reality game and the news media. Amid the exaggerated media reports, Pokémon Go may have unintended health benefits. Players have reported walking more, spending more time with family, experiencing improvements in their mental health and feeling more connected to their communities. It is hard to imagine public health researchers developing a similar game that is fun, taps into pop culture, reaches a wide target audience, makes use of physical and virtual environments, creates a sense of both competition and community, and has spin-off health benefits. Companies that endanger public health immediately recognised the value of the Pokémon Go app, and exploited it to advertise and promote consumption of unhealthy foods. Public health stakeholders need to develop mobile-based interventions within a framework that embraces pleasure, rewards, participation and community. Public health agencies need to be just as nimble and responsive as companies that are harmful to health, or forever be creating games that nobody plays.

B R I E F R E P O R T Neonatal healthcare workers' perceptions of the impact of the COVID-19 pandemic Societal restrictions and infection control measures introduced during the COVID-19 pandemic significantly impacted neonatal care. 1 Restrictions challenged parental presence and participation in models of family integrated care (FICare), an evidence-based approach which supports parents as the primary caregivers for their infant, in partnership with the clinical team. 2 In addition, neonatal healthcare workers (HCWs) were required to adopt new infection control practices, adapt to service re-organisation and were at risk of exposure to the disease. This study aimed to evaluate neonatal HCWs' perceptions of the impact of the COVID-19 pandemic. We performed a prospective, anonymous electronic survey of HCWs in two tertiary neonatal intensive care units with established FICare ethos, in July 2020. Thematic analysis of qualitative responses was performed independently by two assessors and coded using nVivo. The participating neonatal units at the Royal Hospital for Children, Glasgow and Leeds Centre for Newborn Care, each provide regional specialist medical and surgical neonatal services. Restrictions during COVID-19 in both centres required parents to wear face masks and to avoid public transport, permitted only one parent at a time and excluded all visitors. 147 surveys were completed, 82 (56%) in Glasgow and 65 (44%) in Leeds. Of the respondents, 104 (71%) were nurses, 6 (4%) advanced nurse practitioners/specialist nurses, 30 (20%) medical and 7 (5%) administrative, management and housekeeping HCWs. Key themes identified by HCWs were as follows: --- | NEGATIVE IMPAC T ON C ARE DELIVERY PPE and social distancing restricted practical delivery of care and communication. Workload increased to cover colleague absence. Loss of normal opportunities to socialise preventing informal debriefing contributed to increased work-related stress. Rapid changes in policies and processes led to anxiety and confusion. --- | NEG ATIVE IMPAC T ON FAMILY INTEG R ATED C ARE As outlined in Table 1, parents were felt to be less involved in the care of their baby, less able to bond with them or to develop collaborative partnerships with the clinical team, due to restrictions on parental presence and new barriers to communication created by PPE. Parental involvement was also affected by loss of face-toface training and closure of communal areas preventing peer-to-peer support. --- | IN CRE A S ED PARENTAL S TRE SS Resulting from increased separation, financial work and childcare concerns, and the loss of normal supports from partners, friends and family. --- | NEG ATIVE IMPAC TS ON H C Ws OUTS IDE WORK Healthcare workers (HCWs) lost access to usual hobbies and social activities and reported increased stress and anxiety related to health concerns, childcare and schooling, money and employment, as well as inability to grieve properly following bereavements (Table 1). --- | P OS ITIVE A S PEC TS OF THE PANDEMIC RE S P ONS E Healthcare workers reported improved team working and resilience, organisational efficiency, and rapid adoption of new technologies supporting remote care and working. Reductions in visitors resulted in quieter, calmer units, improved infection control and was felt to give parents uninterrupted time with their babies. These findings demonstrate the profound impacts of COVID-19 on HCWs and families in the neonatal unit, whilst also identifying positive mitigating developments. The most striking and concerning effect of COVID-19 was the impact on parental involvement in care and FICare delivery, due to combined effects of reduced parental presence, loss of usual support from HCWs, family and peers. Consistent with our findings, a recent survey of parents in neonatal units during COVID-19 found that 60% reported restrictions on their presence in the neonatal ©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd unit, negatively impacting parents' involvement in care, breastfeeding and bonding. 1 HCWs in both centres were resourceful in addressing these challenges. In Leeds, a dedicated Family Support Team was created. In Glasgow, teaching videos were created to replace face-to-face parental teaching, and social media were used to create positive relationships between families and with staff. HCWs lobbied for improved parental access, safe re-opening of parent areas and engaged third sector partners to support parental well-being. The impact of COVID-19 on communication, between HCWs, and with patient families was also a key theme. Sub-optimal communication is a root cause in patient-safety incidents and complaints. COVID-19 increased the risks of these, by exacerbating causative factors including stress, workload, fatigue and inconsistent instruction. 3 Mitigating these challenges were accelerated adoption of live and recorded video services for remote team working, teaching and family communication. COVID-19 affected HCWs and families mental health, due to the loss of usual social supports, combined with anxieties around health, family and finances. Similar impacts have been described in other disease outbreaks and require organisational recognition and response. 4 HCWs perceived aspects of their organisations' early pandemic responses as 'top-down' and inconsistent, but recognised that changes in practice and policy were delivered with new and welcome efficiency. Actively identifying these enablers of change may be key to sustaining improvements in healthcare management beyond COVID-19. 5 Based on our findings, we make three recommendations for the future delivery of neonatal services, during and beyond the COVID-19 pandemic. 1) Family integrated care should be the future standard of care in all neonatal units. Parents should always be supported as primary caregivers and partners in the clinical team. 2) The COVID-19 recovery is an unprecedented opportunity for service re-design and digital innovation, removing previous barriers --- Impact on work --- Communication 'Wearing face masks at all times makes communication with families and with the team difficult' 'Inconsistent information with daily or weekly changes' Workload 'I worked so many additional shifts to assist the ward but also to ease the pain of loneliness'

to change and delivering more convenient, sustainable, healthier neonatal care. 3) The impact on HCW well-being must be understood and addressed, to support and maintain a healthy, effective workforce. Our study was limited by absence of accurate response rate data. We did not survey parents as this has been addressed by other authors. Our findings represent a cross-sectional evaluation of HCWs' during a dynamic pandemic.

INTRODUCTION Multiple sclerosis (MS) is a chronic, inflammatory, immune-mediated demyelinating disease of the central nervous system (CNS). Though the cause of MS is still unknown, there is a growing body of evidence demonstrating its multifactorial origin as a result of the interaction between environmental aspects in genetically susceptible individuals, triggering the immunological changes underlying the disease process [1,2]. MS usually starts between 20 and 40 years of age, is more common among women (female:male ratio &2:1), and may progress via different evolutionary patterns. In most cases, it develops in a relapsing-remitting (RR) form, with clearly defined relapses separated by complete or partial recovery; some RR patients later present with a secondary progressive (SP) MS type accompanied by disease progression with or without further relapses [1]. A few patients have progressive evolution of their disease from the beginning without experiencing relapses; these patients have primary progressive (PP) MS or rarely, if they have occasional superimposed relapses, progressive relapsing MS [1,2]. Depending on the actual diagnostic criteria, monosymptomatic forms of MS have also been recognized and termed clinically isolated syndromes [1]. Considering the clinical hallmarks of MS, such as its chronic and unpredictable course that usually begins in young adulthood, i.e., during the most productive phase of life on an individual, professional and societal level, the social aspects of MS appear to be very important. However, these aspects have been scarcely studied so far. In fact, similar to other chronic diseases, MS raises social issues beyond clinical changes, causing physical, psychological and social problems. Overall, the inter-relationship between the disease and all these problems will influence how the patient perceives their health and quality of life (QoL). Health-related quality of life (HRQoL), defined as a multi-dimensional construct that includes physical, mental and social health [3], has been increasingly studied in MS, since the wellbeing of patients involves living and coping with a chronic neurological condition and incorporates social aspects, combining physical, mental and social health [4,5]. In addition, HRQoL is also a measure of the effectiveness of interventions in health care at the clinical practice level and in planning public policies, supporting the view that health is the most important domain of QoL. As far as we are aware, the first study of HRQoL in MS was published in 1992, and since 2002 more than three-dozen articles have appeared in the literature [4]. Overall, research has focused on the relationship between the clinical effects of the disease, such as disability, pain, fatigue, psychological and cognitive symptoms [5]. The methodology includes case-control and cross-sectional studies, which compare MS with other chronic diseases [6] or with the general population [7][8][9] to analyze the HRQoL of MS patients according to treatment and different forms of the disease [10][11][12][13][14]. These studies have demonstrated that MS patients have worse QoL than the general population [8,9], their disabilities are a predictor of HRQoL [7,15], they have a high incidence of pain [10,[16][17][18][19][20][21], and they suffer with more frequent depressive symptoms [7,12,16,[22][23][24][25][26][27][28], cognitive deterioration [11,20,21,[25][26][27][28][29] and fatigue [13,19,24,28,30]. However, few studies have focused on the relationship between patient social characteristics and HRQoL [7,9,22,23,[30][31][32]. Studies that have analyzed the relationships between the social characteristics of MS patients and HRQoL [7,9,22,30] have frequently presented limited results, since they only compare two or three social characteristics [9,11,30,33], and have often not reached significance levels. This study aims to evaluate the association between the social and clinical characteristics of MS patients and their HRQoL, addressing an issue scarcely discussed in the literature and raising the need for different health care professionals to pay more attention to these aspects to improve QoL in MS. --- MATERIALS AND METHODS A Costa with the clinical assistance of Maria J. Sa ´. --- Instruments The EDSS [34] is the most widely used scale for assessing disability in MS patients. It consists of an ordinal scale with a range of values from 0 (corresponding to a normal neurological examination) to 10 (death by MS). The EDSS has 0.5 increments between units, except for the range between 0 and 1. Scores from 0 to 3.5 are considered to represent mild disability, scores of between 4.0 and 6.0 represent moderate disability, while scores of C6.5 represent severe disability [29]. HRQoL was assessed using the Health Status Questionnaire (SF-36v2) [35,36] We found that among our sample, 66% of MS patients were married and only one other study had analyzed marital status in relation to HRQoL [9]. As in our study, the authors of this other study also observed that there was no statistically significant relationship between being single and HRQoL measures. However, our study found a statistically significant relationship between marital status and PF and GH. We believe it necessary to reapply this analysis in light of sociological literature stating that married persons have better HRQoL than single persons [31]. We found that education level was associated with all SF-36 subscales. Patients who had higher levels achieved better scores than those with lower education levels. These data are similar to those of other studies, such as the one by Gottberg and collaborators [9]. Turpin et al. [22] showed that 28.5% of MS patients lacked an occupation; however, none of the analyzed studies took into account occupation in relation to HRQoL. In our study, better educationally qualified patients presented with better scores on all SF-36 subscales than those with a lower education level. These differences were statistically significant in the PF, PR, BP and SF subscales. The employment status of MS patients presents a statistically significant relationship with all HRQoL dimensions. Employed patients had better scores than those who were unemployed, retired and student/housewife/ inactive, and these differences were statistically significant. These results are similar to those obtained by Gottberg et al. [9], Shawryn et al. [11], Aronson [30] and Pluta-Fuerst et al. [33]. These other studies clearly Household size was not statistically related to HRQoL measures. Patients who lived in larger households had better results than those living in smaller households, as expected, but this difference was not statistically significant. As a matter of fact, the sociological literature [31] indicates that the probability of getting help is greater in larger households. However, this relationship was not shown to be true according to the HRQoL results of our MS patients. MS parameters in our study referred to the duration and type of MS, and MS-associated disability. Our results were similar to those in the literature [3,9,21,23] in which the relationship between these parameters and HRQoL was analyzed. The duration of MS was significantly associated with PR and all SF-36 mental health dimensions, such as VT, SF and ER. Patients with a shorter MS duration had higher scores on all HRQoL dimensions than those with a longer MS duration. These results are consistent with those of other studies [9,16], highlighting the negative correlation between all HRQoL domains and MS duration when it lasts for more than 10 years [5,11,33]. The clinical course of MS was statistically related to PF, PR, GH, SF and ER. The score obtained by MS patients with the RR form of the disease was higher than the score obtained by MS patients with other forms of the disease (PP and SP). These results are similar to those obtained in other studies [5,9,11,22]. Patients with mild disability had higher HRQoL scores than those with severe levels of disability. These differences were statistically significant for these subscales. These results are similar to those of the majority of studies reviewed, as it indicates that disability is a predictor of HRQoL [9,15,33]. Although there are scales that are more specific to the MS setting, such as the MSQoL-54 [38], the generic SF-36 is the scale used mostly in studies of HRQoL in MS patients [7]. In addition, the only scale adapted and validated for a Portuguese population is the SF-36 [35,36]. Finally, the authors could not identify publications entirely devoted to the comparison between the socio-demographic characteristics of MS patients and HRQoL --- CONCLUSIONS Our study illustrates the social characteristics of MS patients that impart a significant impact on their perception of HRQoL. The HRQoL concept is known to be multifactorial. Younger MS patients, those who have higher education levels, those who are employed and have a lower degree of MS progression and lower disability reported greater QoL than others. These results may contribute to more detailed knowledge concerning the importance of social characteristics in MS patients in relation to HRQoL to provide improved health care planning. --- ACKNOWLEDGMENTS No funding or sponsorship was received for this study or publication of this article. Dr. David Costa is the guarantor for this article, and takes responsibility for the integrity of the work as a whole.

Introduction: Few studies have analyzed the importance of socio-demographic variables on the perception of health-related quality of life (HRQoL) in patients with multiple sclerosis (MS). Methods: The sample was composed of 150 patients with MS. Statistical analysis was performed using Mann-Whitney U and Kruskal-Wallis H non-parametric tests comparing sociodemographic items with HRQoL. Results: We found statistically significant differences between age, education levels, employment status, disability and all dimensions of HRQoL. Discussion: This study contributes to a more systematic knowledge about the relationship between social characteristics and HRQoL, which is important to improve the planning of health care in MS patients.We found that younger patients, those with higher education level, those who were employed, and with lower disease progression and lower disability, had better HRQoL.

INTRODUCTION The prevalence of Trichomonas vaginalis infection among US women between ages 14 and 49 years is 3.1%, and even higher in certain subgroups. 1 Individuals infected are often asymptomatic 1 and, without treatment, T. vaginalis may increase risks for conditions such as pelvic inflammatory disease 2 and HIV infection. 3 Research conducted among US women suggests that T. vaginalis is associated with Latina and African-American ethnicity/race, increasing age and poverty. 1 Among low-income African-American adolescent women, studies reveal 13% prevalence and significant associations between T. vaginalis and sex with non-steady partners. 4 While the epidemiology of some sexually transmitted diseases can be better understood in the context of social determinants of health, such as race and poverty, behavioural and contextual data have traditionally been limited. 5 In particular, few studies regarding T. vaginalis have been conducted exclusively among low-income adult women, an endeavour that could reveal unique patterns of infection. The goal of this study was to provide a better understanding of T. vaginalis transmission patterns and inform screening services intended to reduce health complications associated with untreated infection in very low-income women. --- METHODS This cross-sectional study was conducted within 'Shelter, Health and Drug Outcomes among Women', an existing cohort study aimed at understanding women's health, health services use and experiences of violence, with a focus on influences from HIV infection. Recruitment has been described previously. 6 In brief, a mobile outreach team approached women at free meal programmes, homeless shelters and low-cost single room occupancy hotels. Inclusion criteria were female sex (biological), age >18 years and a lifetime history of housing instability (homeless or stayed with a series of other people because there was nowhere else to sleep ('couch-surfed')). HIV testing occurred during study screening and infected women were oversampled to ensure statistical power for HIV-specific analyses. Participants were reimbursed $35 for study participation. Data presented here represent one study visit per participant between April and October 2010. Participants provided self-collected vaginal swab specimen and were interviewed about potential correlates of infection. Specimens were tested for T. vaginalis infection using a commercially available point of care assay (OSOM Trichomonas Rapid Test; Genzyme Diagnostics). In accordance with treatment guidelines at the time of the study, individuals who tested T. vaginalis positive were offered single-dose Metronidazole therapy and provided take-home doses for treatment of sexual partners. Independent variables exploring social determinants of health during the prior 6 months have been described and cited in our previously reported research. 6 They included socioeconomic factors, sex exchange, violence and HIV status (table 1). Unprotected sex (ie, sex without a condom), number of sexual partners and sex exchange were considered to be in the causal pathway of T. vaginalis infection and were therefore not included in adjusted analyses; however, they are reported here for descriptive purposes. ORs and CIs determined the magnitude of effect and variability in each estimate. Inferences were based on simultaneous adjustment for independent variables using multiple logistical regression with Firth's bias correction to account for quasi-complete separation due to small cell sizes. Covariates with a CI that did not include one in unadjusted analysis were included in adjusted analysis. Multicollinearity between covariates was examined using the variance inflation factor and none was found (all VIFs <2.3). --- RESULTS Among 300 homeless and unstably housed women participating in the cohort study, interview and T. vaginalis testing data were available for 245 individuals (126 HIV+ and 118 HIV-). No significant differences were detected between participants who did and did not have available data for the current analysis with regard to socioeconomic and sexual behaviour variables (p>0.05). Most study participants were of non-Caucasian race/ethnicity (72%), the median age was 47 years and half were HIV-infected (51%; table 1). During the 6 months prior to baseline, 41% of participants had insufficient access to food, clothing, a bathroom, a place to wash or shelter, 18% slept on the street or in a public place and 11% were incarcerated. The overall prevalence of T. vaginalis infection was 12%. One-third of women in both the T. vaginalis-positive and T. vaginalis-negative groups reported no gynaecological symptoms (ie, severe pelvic pain, burning during urination, blood in the urine, abnormal discharge or odour, new sores, lumps or warts on the genitals) 7 during the 6 months prior to being interviewed (33.3% vs 32.7%; p=0.95). Regarding unadjusted risk factors established in prior research, 9% of respondents reported exchanging sex for money (no significant association with T. vaginalis infection), while 7% reported exchanging sex for drugs, food or a place to sleep (OR=3.51, 95% CI 1.10 to 10.02). The median number of male sexual partners was one; having more than one male sexual partner increased the odds of T. vaginalis infection by 5% (OR=1.05, 95% CI 1.01 to 1.22). Just over 38% of respondents reported unprotected vaginal or anal sex in the past 6 months, which increased the odds of T. vaginalis infection by more than threefold (OR=3.79, 95% CI 1.74 to 8.68). Regarding social determinants of health, adjusted analysis indicated that the odds of T. vaginalis infection were significantly lower among women in each of the two oldest age quartiles compared to the youngest quartile (OR age=48-53 = 0.12, 95% CI 0.02 to 0.40; OR age>53 = 0.15, 95% CI 0.03 to 0.52; table 1), and correspondingly, older than the population median (OR age>47 = 0.14, 95% CI 0.04 to 0.38). In addition, short-term homeless shelter stays increased the odds of infection fivefold (5.36, 95% CI 1.57 to 18.26), and longterm homeless shelter stays did not reach a level of significance. The estimated sensitivity to detect infections by screening persons who reported recent unprotected sex (20/30=0.67) was significantly higher than sensitivity to detect infections by other targeting criteria including screening those who were younger than the population median (4/30=0.13; p<0.01), reported recent short-term homelessness (6/30=0.20; p<0.01) or reported gynaecological symptoms (10/30 = 0.33; p = 0.01). --- DISCUSSION The prevalence of T. vaginalis infection in this cohort of homeless and unstably housed adult women was high (12%) compared to the general population (3%), 1 and one-third of the infected women were asymptomatic. In opposition to findings from the general population, race/ethnicity and income were not significantly associated with T. vaginalis infection. Consistent with findings from other vulnerable populations, the 12% prevalence of T. vaginalis observed here was similar to the 13% prevalence reported by Crosby et al 4 among low-income African-American adolescent women. Taken together, the existing evidence confirms higher T. vaginalis prevalence and different correlates of infection in samples comprised exclusively of low-income individuals compared to the general population. Unique to the current study, and specific to unstably housed individuals, was the finding that the odds of T. vaginalis infection were over fivefold higher among women experiencing short-term homeless shelter stays, while the effect among those experiencing long-term homeless shelter stays was nonsignificant, with an OR close to 1. Reasons for this difference by time homeless are currently unclear. Future studies that distinguish length of time homeless may elucidate this finding. While the sample is small, results also uniquely indicate that testing all unstably housed women who reported recent unprotected sex would have identified more infected individuals than the current common practice of testing women who report gynaecological symptoms (p = 0.01). The prevalence of trichomoniasis among HIV-infected women reported in previous studies has been high (6.1%-52.6%) and interactions between T. vaginalis and HIV infection have been noted. 8 However, we did not find a strong association between HIV and T. vaginalis. This is likely due to the cross-sectional nature of the current study and the fact that T. vaginalis can be cleared with treatment, whereas HIV cannot. It is also possible that risks linking HIV and T. vaginalis are strongly mediated by socioeconomic factors, 9 some of which may have been undetectable in the current study due to a population composed entirely of extremely impoverished women. Results should be considered in light of several potential limitations. The 12% T. vaginalis prevalence found in this study using OSOM technology may not be significantly different from previous studies showing lower T. vaginalis levels because many previous studies have used less sensitive microscopic examination ('wet mount') of vaginal fluid. However, the 3% prevalence among US women reported by Sutton et al 1 was established using PCR, which is even more sensitive than OSOM. Thus, the difference between the general population and unstably housed women is likely to be at least as large as that reported here. In addition, the sample population included in the current study was small. However, recruiting a probability sample of unstably housed women from community venues likely reduced the possibility of a biased sample from San Francisco's larger population of homeless and unstably housed women. The high prevalence of asymptomatic T. vaginalis infection reported here suggests that homeless and unstably housed women are at disproportionately high risk for negative health outcomes associated with untreated infection. Because T. vaginalis is treatable, this concerning public health finding may also be seen as an opportunity. Our data support enhanced T. vaginalis screening and treatment among impoverished women, 10 emphasising the potential of non-clinical settings like homeless shelters. Targeting all unstably housed women reporting recent unprotected sex, especially young impoverished women and all women experiencing short-term homelessness, may be an effective strategy to identify and treat T. vaginalis infection and reduce associated complications from untreated T. vaginalis. --- Author Manuscript

Objective-The social context of poverty is consistently linked to Trichomonas vaginalis infection, yet few studies regarding T. vaginalis have been conducted exclusively among lowincome individuals. We identified social determinants of health associated with prevalent T. vaginalis infection among homeless and unstably housed adult women.April and October of 2010, we conducted cross-sectional T. vaginalis screening and behavioural interviews in an existing cohort of San Francisco homeless and unstably housed women. Data were analysed using multivariable logistical regression. Results-Among 245 study participants, the median age was 47 years and 72% were of non-Caucasian race/ethnicity. T. vaginalis prevalence was 12%, compared to 3% in the general population, and 33% of infected individuals reported no gynaecological symptoms. In adjusted analysis, the odds of T. vaginalis infection were lower among persons older than 47 years, the population median (OR=0.14, 95% CI 0.04 to 0.38), and higher among those reporting recent short-term homeless shelter stays (OR=5.36, 95% CI 1.57 to 18.26). Race and income did not reach levels of significance. Sensitivity analyses indicated that testing all women who report recent unprotected sex would identify more infections than testing those who report gynaecological symptoms (20/30 vs 10/30; p=0.01).

the postfeminist terrain and its implications for theory and research in girlhood and education. Ringrose charts the contemporary discourse of postfeminism, exploring how it is central to media representations of girls and women. She positions herself alongside Angela McRobbie (2004) and Gill and Scharfe (2011) in her conceptualization of postfeminism as "a set of politics and discourses grounded in assumptions that gender equity has now been achieved for girls and women in education, the workplace and the home" (Ringrose, 2013, p. 2). Postfeminist narratives also frame feminist goals as having gone too far in that women have now surpassed men in their achievements, and that these successes have been gained at the expense of men. Ringrose closely links neo---liberal and postfeminist perspectives in her analysis of girlhood: postfeminism works to commodify the female as the empowered consumer, reinforcing neo--liberal emphasis on individual consumption as primary social, economic, and political participation. In the first half of the book, she repeatedly critiques the oppositional construction of girls as "either empowered consumers/winners or vulnerable victims of sexualized society" (Ringrose, 2013, p. 4) within postfeminist and neo---liberal discourses throughout her analysis of media narratives of girlhood and education. Ringrose begins by outlining the relationship between media representations of girls and educational policies and discourses shaping girlhood experiences of schooling. This link is explored through three feminine figures resulting from media---fueled postfeminist panics over the state of Western girlhood: the successful girl, the overly aggressive girl, Book Review: Postfeminist education? Girls and the sexual politics of schooling STARKMAN 77 and the overly 'sexy' girls. Utilizing Arjun Appadurai's (1996) notion of the mediascape, or a media landscape, Ringrose maps the patterns of feminine representations and societal interpretations within the media that are related to these three girlhood figures. She guides the reader through her interpretive process of the mediascape by comprehensively outlining out the media surrounding these girlhood figures, and then injecting critical questions into the media available, demonstrating how she has framed the material from a postfeminist perspective. The first postfeminist mediascape addresses the figure of the overly successful girl; it constructs "the fantasmic figure of feminine success positioned as a direct consequence of feminism" (Ringrose, 2013, p. 20), and situates men and boys as the new disadvantaged group. The concerns that Western schooling has become feminized and that education has swung too far in support of girls evoke a frightened public cry that boys are being left behind. The resulting postfeminist discourse vilifies girls who are seen as too successful, and fuels policy initiatives designed to redress male disadvantage. For example, Ringrose cites a pedagogical intervention in Canada calling for more male teachers and active learning strategies to suit boys' learning style in the classroom. --- Ringrose (2013) explains the implications of this policy direction as: A shift from a feminist stance that understands complex socio---cultural patriarchal power relations as underpinning social institutions like schooling (Spender, 1982) to what I am calling a postfeminist educational policy terrain that understands 'gender gaps' and 'sexist society', to refer almost solely to the need to help boys catch up to girls in school. (p. 24) Through the mediascape of the overly successful girl, Ringrose persuasively illustrates how postfeminist anxieties about changes to the dominant gender order manifest in gendered educational policy and practice. Ringrose then examines the mediascape constructing girls' aggression as rampant and increasing (emphasizing bullying behaviours), and the psychological development discourses arguing that girls are more aggressive than boys. Within these postfeminist discourses, feminism is figured as responsible for unleashing too much "girl power" (Ringrose, 2013, p. 28), resulting in female aggression and "revers[ing] earlier claims of girls' vulnerability into claims of mean---ness and powerfulness" (Ringrose, 2013, p. 28). In this analysis, Ringrose To make sense of the three feminine figures resulting from postfeminist media panics, Ringrose (2013) develops a "new discursive, psychosocial and affective theoretical---methodological approach" (p. 70). She employs Judith Butler's poststructural theories of subjectification, discursive agency, and re---signification, "for thinking about how discursive contradiction and interplay can subvert the gender order" (Ringrose, 2013, p. 72). She then situates her methodology within Book Review: Postfeminist education? Girls and the sexual politics of schooling STARKMAN 81 psychosocial research tradition in the UK, utilizing psychoanalytic tools "to understand contradictory discourses of idealized femininity… explore how and why girls 'invest' in both repressive and problematic discourses of femininity and how and through which processes, oppressive discourses can also be resisted" (Ringrose, 2013, p. 75). Finally, Ringrose (2013) harnesses the recent "affective turn" (p. 70) in sociological and educational research exemplified by "post--psychoanalytic poststructuralism derived from Deleuze and Guattari" (Ringrose, 2013, p. 70.) and their use of schizoanalysis to theorize aspects of feminine subjectivity that she finds otherwise impenetrable. Schizoanalysis aims to first, "overthrow" the "binary logics, normative strata and totalizing theory" reproduced in psychoanalysis; second, to discover research participants' "desiring machines"; and third, to "find lines of flight" around the production of desire that "ruptures a given stratum" (p. 79). In weaving together this theoretical---methodological approach, Ringrose emphasizes these tools' utility to think outside of discourse, and to move beyond the potentially problematic surface claims of narrative and voice, and the subsequent assumptions about agency. Furthermore, this work contributes to the burgeoning conversation around the creative applications of Deleuzo---Guattarian theory to method. Ringrose then brings in empirical data from two UK---based studies she previously conducted to challenge the validity of the postfeminist claims set out in the mediascapes of the successful, the aggressive, and the sexy girl. The data best demonstrates current shortcomings in educational policy designed to address gender and girls' experiences within the school. Ringrose's 2004/5 study, Girls and the subject of aggression and bullying, addresses media, policy and research contexts around femininity and sexualized aggression, drawing out how heterosexual competition regulates and disciplines girls' behavior and performance. Ringrose (2013) shows how anti---bullying interventions in the school "can miss the complex power relations of gender, sexualized and classed culture, and parenting and school choice, which shapes the unfolding of the interpersonal dynamics between the girls" (p. 99), supporting her claim that the concept of bullying in the current educational discourse is "ineffectual" (p. 100). The second set of data from a 2008 study at the London Knowledge Lab explores young people's negotiations of social networking sites, providing insight into how girls perform sexual identities in the context of new digital technologies. Ringrose aims to balance tensions between viewing girls as producers of new media; understanding the limited discursive conditions of possibility through which to form their online identities; viewing online as an enmeshed space with school and the subsequent impact on identity; and exploring embodied processes of self--commodification from the girls' perspectives. From this research, Ringrose contends that educators and policy---makers need to come to terms with how girls continue to be defined by their sexualized bodies online, and how these definitions structure social relations at school. For researchers, Ringrose's use of a psychosocial and affective theoretical---methodological approach expands the methodological toolbox used in qualitative research with youth. She successfully applies the theoretical to the empirical, demonstrating how to utilize this complex theory in a generative way in data interpretation. Furthermore, Ringrose (2013) advocates for a new way of analyzing agency: "Rather than always searching for easily discernable resistance acts (or revolts) through our research narratives, we need to track the regulative rhythm of the normative to find some spaces where gender 'undoings' emerge" (p. 147). This form of analysis is key in the book's contributions to the field in demonstrating how to rethink resistance and agency. Finally, Postfeminist Education? draws attention to gender and sexuality---related shortcomings in current curricula. For example, postfeminist panics about overly sexual girls result in sex education curricula that focus only on imparting "age appropriate" (Ringrose, 2013, p. 43) biological information. This singular focus in sex education results in girls (and all youth) failing to learn valuable skills in communication and critical analyses of relationships that will help them to navigate the sexual waters they actually live in. Ringrose argues against anti---bullying interventions, persuasively demonstrating how they are largely ineffective and how they fail to capture the nuanced dynamics of girls' conflicts. She also challenges both the 'boys at risk' narrative underscoring pedagogy, and the attempts to separate social media technology and schools for their ability to obscure ongoing issues of sexual difference and sexism that girls continue to experience in the classroom. This book would be very appropriate for scholars working with girlhood and postfeminism; education policy analysts looking for provocative interpretations of the discourses shaping gender within the schools; and curriculum scholars who wish to explore the enmeshed dynamics between media, policy, and schooling.

In, Postfeminist Education?, Jessica Ringrose (2013) powerfully illustrates how postfeminist media discourses have infiltrated Western educational policy and curricula. Ringrose's book contributes significantly to the field of curriculum studies for the ways that she knits postfeminist media exemplars, poststructural and (post) psychosocial theory, and educational policy together to demonstrate the shortcomings in current policies and practices that shape girls' experiences in school. Postfeminist Education? is divided into three sections: the first unpicks three "postfeminist panics" (Ringrose, 2013, p. 4) around the current state of girlhood; the second develops a conceptual and methodological approach to unpacking these panics rooted in psychosocial and Deleuzo---Guatarian theories; and the third draws on empirical data from two UK--based studies to challenge the validity of the postfeminist claims set out therein. These three components persuasively build an understanding of

Introduction LGBTQ2+* individuals often have poorer physical and mental health than heterosexual and cisgender people. 1,2 The physical health disparities that lesbian, gay and bisexual populations experience range from poorer general health status to increased rates of cancer, cardiovascular disease, asthma, diabetes, arthritis and other chronic conditions. 1 Transgender youth also experience mental health disparities, including higher risk of reporting psychological distress, self-harm, major depressive episodes and suicide, 2 which have been positively associated with experiences of discrimination, harassment and violence. 3,4 Canadian LGBTQ2+ youth often experience exclusion, isolation and fear. 5 Many of the health inequities observed in sexual and gender minority (SGM) populations are hypothesized to stem from societal stigma, 6 which may include the co-occurrence of stereotyping, labelling, status loss, separation and/or discrimination, 7,8,9 and from negative social experiences that create heightened stress. 1,2 Processes of stigma and discrimination play a central role in driving health inequities for SGM populations, contributing to experiences of stress and trauma throughout a lifetime. They also lead to inequitable access to the social and material resources needed to promote good health (e.g. employment, income, housing, quality and quantity of education, and health care). 10 For example, 40% of the 2873 trans and non-binary respondents to a 2019 Canadian survey were living in a low-income household and 45% reported having one or more unmet health https://doi.org/10.24095/hpcdp.41.12.04 * LGBTQ2+ is an umbrella acronym used in this document to describe individuals with a diverse sexual orientation and/or gender identity, which includes, but is not limited to, individuals who identify as lesbian, gay, bisexual, transgender (trans), queer and/or are Indigenous Two-Spirit. identity intersects with other marginalized social identities, such as their ethnicity or class. 13 To date, most research in this domain has focussed on health inequities and there has been substantially less research on intervention development and evaluation. 6 There is no comprehensive portrait of the interventions addressing these determinants among LGBTQ2+ people in Canada. We conducted an environmental scan between February and March 2019 to meet this need. Following the release of the Parliamentary Standing Committee on Health's report, The Health of LGBTQIA2 Communities in Canada, 14 in June 2019, we updated the scan with more entries. We shared the results with select community organizations for member checking in early 2020. --- Methods A systematic search identified programs focussing on determinants of health at the macro (structural or social, economic and political factors), meso (institutional) or micro (individual and interpersonal) levels. Programs targeting specific health behaviours or health outcomes were also included. The search was conducted by province and territory to identify programs across the country that address one or more of the social determinants of health and target SGM populations. The search excluded programs that included people who do not have lived experience as a sexual and/or gender minority person. Preliminary scanning revealed an abundance of programs that focussed on "downstream" and individual-level considerations (i.e. reducing stigmatizing or discriminatory individual knowledge, attitudes and behaviours; increasing social connectedness). Given important linkages between the health inequities and structural conditions that SGM populations face, we focussed the scan on mid-and upstream interventions. We therefore excluded downstream recreational programs, such as LGBTQ2+ sports teams, choirs, coffee groups, school-based gaystraight alliances (GSAs), social programs and clubs offered by postsecondary institutions, affirming churches/religious institutions, Pride festivals and one-off events. (The initiatives excluded by these criteria alone could populate an entire scan.) Thus, this scan captures interventions at higher orders of the social ecosystem, such as systemic interventions, and interventions that target social determinants of health (other than social connectedness), such as lack of access to employment, stigma and discrimination, poverty and food insecurity. First, we used the Google search engine for broad Internet searches of English and French websites. Second, we conducted targeted searches of the Canadian Agency for Drugs and Technologies in Health (CADTH) database, provincial 211 directories (which provide information on and referrals to community and social services) and Tri-Council funding † results. Third, in order to identify community organizations, programs or services, we inspected LGBTQ2+ Pride festival guides from 2018 as well as the three most recent programs from the Canadian Professional Association for Transgender Health, the Community-Based Research Centre Summit and Rainbow Health Ontario conferences. Finally, a scan of academic databases was conducted using Summon 2.0 (University of Victoria, Victoria, BC). All searches were considered complete when two subsequent website pages yielded no new or relevant information. Program information was analyzed using NVivo 11 (QSR International Pty Ltd., Melbourne, AU). Coded data were analyzed for semantic themes in order to move beyond pure description of the data and into interpretation. 15 The analysis produced a description of the location and types of programs being implemented and the social determinants of health being addressed. Member checking was conducted by sharing the results of the scan with at least one organization listed in the scan in each province. Members were asked to identify any gaps they noticed either nationally or within their region. --- Results The final scan included 220 programs (see Table 1). Counts vary by information availability and some programs targeted multiple populations. A third of the programs (34.5%) were nonspecific, being available to all LGBTQ2+ people. In locations with smaller populations, this was almost exclusively the case. Most of the programs (65.5%) targeted specific LGBTQ2+ groups, with almost half of the targeted programming focussing on youth. The definition of "youth" varied across organizations, but was most commonly defined as those aged 29 years and younger. The scan yielded few programs for adults 55 years and older (data available from the authors on request). The second most prominently targeted group was people with trans lived experience. Approximately 15% of targeted programs were oriented towards trans and gender diverse people, with some delivered by organizations that solely serve this population. These almost always focussed on providing support groups, primary health care or support navigating health care systems, particularly for gender-affirming care (e.g. referrals, accessing hormones, surgeries). Approximately 20% of programs were designed specifically for gay, bisexual and other men who have sex with other men (Table 1); these were largely HIV/AIDS service organizations. Programs targeting men most often focussed on sexual health, with some focussing on social health, physical health, mental health and overall well-being. --- Discussion Our scan revealed inequities in program availability. 16 The emphasis on age-targeted programming may limit the range of programming available. 16 This could have implications for health systems planning and health promotion efforts among members of the "missing middle." 16 Fewer than 10 programs focussed on Indigenous and Two-Spirit people or racialized/ethnic minority LGBTQ2+ people. [17][18][19] Often, these were support groups that catered to individuals with a shared ethnicity or cultural background. There were also few (<10) programs designed specifically for recent immigrants and/or refugees; those that did exist were exclusively located in large cities. 20 Further, while this search was only conducted in English and French, only seven programs were identified that were offered in a nonofficial language, which may be a significant barrier for speakers of other languages. † Together, the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC) and the Social Sciences and Humanities Research Council (SSHRC) make up the Tri-Council funding agencies, the primary mechanism through which the Government of Canada supports research and training. --- Conclusion Work is needed to better address the upstream determinants of health affecting diverse LGBTQ2+ people across Canada. Efforts to develop new programming should consider LGBTQ2+ communities who are underserved by existing services (e.g. women, Indigenous people, racialized/ethnic minority populations, people with recent immigration and refugee experiences). The large number of programs promoting social support and reducing social exclusion suggests these programs are still important to end users. This may also reflect a systemic funding preference for downstream interventions, as opposed to more complex and long-term upstream systems intervention and evaluation. Given the scarcity of systemic interventions, future efforts should focus on identifying promising practices for designing, delivering and evaluating structural-level interventions that promote health equity and adapting these to address the specific contexts of SGM populations. --- Conflicts of interest The authors have no conflicts of interest to declare. --- Authors' contributions and statement BEJ and NJL conceptualized this work and designed the study with RH. BH conducted the scan, conducted initial data analysis and drafted the initial paper. RH revised the analysis and completed the final paper draft. All authors helped to interpret the data, revised the paper drafts and approved the final version. The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada. Note: Not all information was available for every program, and counts between categories are not equivalent. --- Category n % Health promotion and other individual-level interventions by population (n = 302) a Refers to programs that promote inclusivity of LGBTQ2+ people in non-LGBTQ2+ specific spaces, structures and organizations. b Refers to programs addressing specific health outcomes explicitly, such as HIV/STI screening, harm reduction supply distribution, counselling and addictions services. c Only those programs that specifically mentioned participant ages were counted in these categories, i.e. programs for youth (<30 years) and older adults (≥55 years).

Highlights • A number of gaps exist in programs promoting health equity and interventions by addressing social determinants of health for sexual and gender minorities in Canada. • Efforts to develop new programming should consider LGBTQ2+ communities who are underserved by existing services (e.g. Indigenous people, ethnoracial minor ities, women, recent immigrants or refugees). • Very few programs addressed employ ment, disability, education or housing, which are important upstream determinants of health. • Most programming focussed on the individual and interpersonal levels of intervention. • Systemic interventions were scarce; efforts should focus on examining existing structural-level interventions to consider scalability. care needs within the previous year. 11 Bisexual women and men in Canada report, respectively, 2.8 and 2.5 times higher rates of household food insecurity than their heterosexual counterparts and poorer health outcomes when compared to their gay and lesbian peers. 12 These inequities may be amplified for individuals whose sexual orientation or gender

The Times letters page on 17 March had several contributions from older people arguing against the advice. 1 Their arguments boiled down to some older people being far fitter and more active than other older people (or indeed than much younger people); having enough common sense to make self-protection decisions; and feeling insulted, patronised, and categorised by the generic advice. There are some very legitimate concerns about the policy. Older people are already prone to social isolation, loneliness, and their effects on mental health. They may worry that they'll lose further fitness by staying indoors; that their contributions as good neighbours, volunteers, and workers will be lost; and that they'll still require food, drink, and maybe personal care. But there are ways to mitigate many of these. This may not have been communicated clearly enough through mainstream media, but the policy has a clear rationale, as justified by modelling from Imperial College. 2 Part of that rationale is not to belittle older people or fail to recognise their diverse levels of youthfulness. I've devoted my professional life to care of older people and have campaigned repeatedly against ageist attitudes, language, and blatant discrimination with no rationale behind it. But even the Equality Act allows for some "differentiation" based on age, as "a proportionate means of achieving a legitimate aim." 3 Not having avoidably large numbers of people over 70 being admitted acutely to hospitals that are already struggling to cope, and with a far higher risk of what could be an unpleasant death from respiratory distress syndrome, seems legitimate to me. Of course, many people in their 70s and 80s remain fit, active, independent, and socially connected, making major contributions to society. By no means do they all live with severe frailty, 4 dementia, or life limiting conditions. We see major differences between different groups in healthy life expectancy at 65. 5 However, even fit older people show poorer immune responses than their younger selves in the face of infection. 6 The speed of the covid-19 pandemic doesn't allow us to assess each person over 70 for individual risk-and the government has made a pragmatic decision. What is undoubtedly ageist is a collective fear of ageing and death in our societal and media values, meaning that appearing old is seen as being diminished, invisible, and unvalued by society. This in turn leads to older people themselves "othering" any older people they see as being vulnerable, different from their more youthful and active selves. This can lead to "grey on grey" ageism. We need to put ego aside here and do what's in the national interest. The policy on over 70s is not an excuse for a youthfulness contest or an excuse to take umbrage. It's a serious business, which earlier generations who went through wartime privations and restrictions would recognise. --- Competing interests: See www.bmj.com/about-bmj/freelance-contributors. Provenance and peer review: Commissioned; not externally peer reviewed. --- Views and Reviews --- VIEWS AND REVIEWS

Older age and a range of underlying medical conditions mean a higher risk of serious illness, admission, and death from covid-19 than in younger or fitter groups. Over 70s have been advised to avoid unnecessary social contact, remain largely indoors, and to do any outdoor exercise at a safe distance from others. The reaction of some older citizens to this announcement shone a light on some wider attitudes towards ageing-not least from older people themselves.

How do we compare projects? Comparison is critical for REDEFINE's case studies as it helps understand intricate dimensions and contingency embedded within infrastructure projects' lifecycles and unearths new knowledge that is important for business and policymakers. As Ching Kwan Lee (2017) argues, thinking comparatively prevents us from seeing Chinese exceptionalism a priori in every Chinese overseas and domestic activity. There are multiple frameworks for case comparison. Principally, we use process tracing (PT), which qualitatively examines whether and how a potential cause or causes influence or have influenced a set of changes. Among different 'options' to conduct PT, we have selected the 'productive continuity' approach. Here, the emphasis is on explaining an outcome rather than focusing on the process. To understand the different results of COSCO's port investment, we are developing a chronological timeline. This is important because as processes are traced and explained, we better understand what has happened and when. This also helps to see how, if and when events run in parallel because processes don't always have clear-cut boundaries. --- REDEFINE analyses cases in real time because the infrastructure projects we analyse are ongoing and subject to change at any moment. As a result, we must be cautious while employing a PT framework as we are dealing with an unfinished set of results and an imperfect method. As such, we are careful to avoid spurious correlations or associations where variables connect but do not necessarily offer causal analysis, which would negate our findings. For example, we do not claim that because COSCO has been 'successful' in one country, it will always be so. Often, relationships can be unclear; we might be able to 'see' some connections prima facie but need to move towards understanding them more thoroughly. Therefore, we also include McMichael's (2016, p. 198) notion of 'incorporated comparison', which recognises the significance of case-by-case particularities and 'does not proceed with an a priori conception of the composition and context of the units compared.' --- A tale of different outcomes: COSCO's port investments Established in 1961, the state-owned Chinese shipping conglomerate COSCO has developed into one of the largest firms in the global shipping industry by revenue ($84.1 billion at 2022 levels, according to Fortune). The company is no stranger to investing in foreign ports: as of June 2023, COSCO had invested in 56 terminals worldwide, including 49 container terminals (COSCO Shipping, n.d.). Ultimately, COSCO is by far the most dominant Chinese state-owned terminal operator, accounting for 75 per cent of all twenty-foot equivalent units handled by China (Merk, 2020). In the European context, COSCO has shares in at least 15 ports with a range of ownership and leasing contracts (Ghiretti and Gunter, 2022). (Luo, 1997). This understanding is vital to better understand the lifecycles and dynamics of infrastructure projects serving as international business gateways for Chinese enterprises. --- PROJECT NAME This section reveals the diversity in investment outcomes in each example. First, the most well-known case is the Greek port of Piraeus. In 2008, COSCO leased two piers for a 35-year period. In 2016, the firm acquired a 51 per cent stake in the Piraeus Port Authority, with another 16 per cent transferred to COSCO in 2021. These waves of investment all occurred in the wake of the 2007-2009 Global Financial Crisis, which impacted Greece more heavily than any other European state. What is significant in this story is that the shipping firm continues to invest in the port with local actors and organisations, notably Greek shipowners and the national government supporting agreements despite growing tensions between China and the United States. Second, in 2022, COSCO's Hamburg investment became highly politicised, which caught much media attention in Germany and abroad. Government members and opposition parties voiced criticism over the agreement. In response, Chancellor Olof Scholz enforced a reduction in ownership from the initial 35 per cent sought by the port owner to a maximum of 24.99 per cent. This result, on the one hand, maintains capital inflow critical to the terminal's development, appeasing the port owner, while on the other, removes COSCO from any management of operations, customer relations or IT infrastructure. The whole saga caused rifts within and across German politics. The three-party coalition government had differing viewpoints on the transaction, with one Green Party politician declaring: "It was wrong, it is wrong, and it remains wrong" (Sueddeutsche, 2022). Additionally, alluding to security concerns, an opposition politician stated: "Since the intelligence services and other ministries have massively warned against the sale of shares in the port terminal to COSCO, the whole thing looks even more like a solo effort by the Chancellor on his wrong path in China policy." (Sueddeutsche, 2022). Ultimately, however, the government held firm and saved face; a weaker coalition may have split. Third, the largest inland port in the world, in Duisburg, has experienced a complete divestment from COSCO. Originally, the shipping firm constituted one-third of an approximate €100 million trilateral investment consortium that purchased one of Duisburg's container terminals, the Duisburg Gateway Terminal. In mid-2022, COSCO fully divested from the project for reasons that remain opaque. REDEFINE's lines of inquiry are ongoing, but at this stage, we can only speculate it seems likely that, as per the Hamburg example, local and/or national political pressure forced the firm out of the agreement. --- Contrasting tales of gateway projects REDEFINE's two UK projects are London's Royal Albert Dock (RAD) and Airport City Manchester (ACM), each positioned as significant gateways to the UK and European markets for Asian enterprises. Under the Greater London Authority's (GLA) oversight, the RAD development aimed to transform East London into a business hub and create 30 000 new jobs, leading to local economic revitalisation. Supported by Boris Johnson during his mayoral tenure (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), the project attracted investments from a Chinese private firm, ABP Investment Limited, and Chinese state-owned CITIC Group, representing a Sino-UK cooperative endeavour. However, the project has faltered. The GLA terminated its relationship with the ABP due to unmet commitments leading to ABP's liquidation. REDEFINE's site visits to RAD in 2022 and 2023 revealed a desolate scene, indicating stagnation despite substantial pledged financing from a consortium of major Chinese banks. In contrast, though it does not act as a gateway for substantial Chinese investment, the ACM project presents an optimistic narrative. Initiated in 2013 with backing from the Manchester Airport Group and Manchester local government, the £800 million development has made consistent progress aligning with broader development strategies and is anticipated to generate significant economic impact and employment over the next 15 years. Chinese developer BCEGI UK has been instrumental in this progress, receiving praise for its efficiency and contribution. Additionally, ACM plays a pivotal role in broader development strategies, including China's Belt and Road Initiative and the UK's Northern Revitalisation Plan, underscoring its strategic importance, even if it is not a primary gateway for investment. --- Power plays How can we understand these outcomes? What are the underlying reasons for the diversity in investment results? We posit (political) power as a chief variable. In social science, power is a slippery term. Multiple theorists throughout the ages and across disciplines have attempted to conceptualise and theorise it. Resultingly, we focus on two contemporary ways of 'power thinking' in the context of Global China. First, Lee's (2022) emphasis on the relationality of power helps us pay attention to myriad aspects that come under the large umbrella of 'China in Europe'. Her onus on the minutiae of power's content inspires our research to consider the multiple actors involved in decision-making. Second, Selina Ho's (2020) dichotomy of 'structural power' and 'discursive power' illuminates how we can better understand asymmetries within power relationships and the use of discourse to create meaning. Taken together, these approaches to understanding power augment the PT method we employ across these case comparisons. The result is a clearer mapping of the investments over time and, consequently, an augmented understanding of Chinese capital's presence in European infrastructure development. In the case of Piraeus, the investment has been successful. Here, political power at the state level has maintained COSCO's investment and withstood international pressure to oust the conglomerate. Conversely, in Hamburg, multiple secondary data sources demonstrate the German federal government entered the story to force a reduction in the investment, appeasing the port owner and COSCO. The Duisburg case is a story of an investment failure, however. Here, we can only assume that a similar event occurred, as in Hamburg, and political pressure-or REDEFINE 66 67 --- DISSEMINATION DISSEMINATION

The REDEFINE project focuses on eight Chinese-financed infrastructure projects across four European states: Germany, Greece, Hungary and the United Kingdom (UK). As work has progressed, we have identified: (i) that both successes and failures have resulted from the same firm's investments in the same sector but in different countries; and (ii) different firms' investment successes and failures in the same country. To fully understand why and how these outcomes have occurred, we employ a comparative methodological approach to investigate the different levels of investment success throughout the lifespan of the infrastructure development. We highlight three examples of COSCO's investment into European ports: the inland port of Duisburg, the seaport of Hamburg in Germany, and the seaport of Piraeus in Greece. Additionally, we study the dynamics of two UK enterprise zones backed by different Chinese companies in London and Manchester.

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INTRODUCTION Between 2013 and 2016 West Africa experienced a major Ebola outbreak, which was followed by a parallel outbreak in the Democratic Republic of the Congo (DRC) between August 2018 and June 2020. As health care providers sought to fight the epidemic they faced major challenges because significant proportions of the population believed in conspiracy theories regarding Ebola. These narratives were not confined to isolated communities in West Africa or the DRC, but rather were influenced by writings and videos on social media globally. When health care workers are attacked, and the work of health authorities are undermined, we need to reconsider how fake news and conspiracy theories are spread. Social media and software corporations -such as WhatsApp, YouTube, and Twitter-need to collaborate with authorities not only to eliminate some channels, but also to help spread constructive information. In the case of COVID-19 major social media organizations have sought to limit the spread of conspiracy theories on their platforms, including YouTube. 1 But little has been done regarding Africa's Ebola outbreaks. This needs to change, as in late 2022 Africa again faces a new Ebola outbreak in Uganda. --- OVERVIEW False narratives about disease have plagued efforts to fight all the major epidemics globally since the 1970s. These conspiracy theories have led people to attack healthcare workers in Pakistan, to inject themselves with HIV in Cuba, 2 to refuse effective treatments for HIV/AIDS in South Africa, and to oppose mosquito eradication efforts designed to prevent the spread of Zika. 3,4 Epidemics -as the 2009 influenza pandemic illustrated-can evoke denialism and conspiracy theories. 5 On YouTube and other platforms theories have proliferated that blame COVID-19 on everyone (and everything) from philanthropist Bill Gates to 5G wireless networks. 6 In Great Britain theories spread on social media that 5G networks were the cause of COVID-19, which led to groups to burn multiple cell towers. 7 Mobile UK feared for its workers. 8 In China, online commentators angrily responded to theories that COVID began with a lab leak with their own conspiracy theories that blamed the United States. 9,10 The African experience paralleled that of many other epidemics. In December 2013 a West African outbreak began in Guinea when a young boy-perhaps a one-year old-was infected. By March 2014 a significant number of people had come down with the disease. The outbreak soon expanded both in terms of the number of both patients infected and nations involved. Unlike earlier outbreaks, which were controlled relatively quickly, this outbreak lasted until March 2016, during which time over 26,000 people were infected throughout West Africa, as well as a handful of people in the developed world. Given the sheer number of cases, and the time for public health messaging around this epidemic, it might seem difficult for people in affected communities to deny the outbreak's reality. But both denial and violence against health facilities were key features of the epidemic. In August 2014, a crowd of men overran an Ebola clinic in Monrovia, the capital, after which seventeen patients disappeared. The looters even stole a bloodied mattress used by patients at the facility. The head of the health workers' association described the situation for the patients: "Of the 29 patients, 17 fled last night (after the assault). Nine died four days ago and three others were yesterday (Saturday) taken by force by their relatives." 11 According to two journalists, Zoker and Chen, during the attack people called out that there was no Ebola, a sentiment that was shared by local people in the community. During the Ebola outbreak denial in both West Africa and the DRC was widespread, which fostered such attacks on health care facilities. A "rumour mapping" project by the Red Cross "detected 33,016 separate rumours, observations and beliefs across 17 health zones in DRC." 12 What is striking about these beliefs was their diversity, as they blamed everything from witches to health care workers, and in particular doctors. Although a plethora of these conspiracy theories circulated, two particular narratives exposed health care workers to popular anger. The first dangerous conspiracy theory was that Ebola was a real disease, which had been manufactured deliberately by actors such as the U.S. military or in some other nation's military lab. 13,14 For example, in 2014 Alan Feur published a piece in the New York Times, titled "The Ebola Conspiracy Theories," in which he described the narratives circulating around the virus: "The outbreak began in September, when The Daily Observer, a Liberian newspaper, published an article alleging that the virus was not what it seemed -a medical disaster -but rather a bioweapon designed by the United States military to depopulate the planet." 15 Many similar narratives circulated in West Africa (as documented in the region's press), which described a cabal of external actors that had created Ebola. On Twitter 52,000 people tweeted that the virus had been developed as a form of population control. These theories circulated not only in West Africa, but also on YouTube and Twitter in the United States and Europe. 16 Social media played a dangerous and directive role. A second common belief was that the World Health Organization was manufacturing false cases of Ebola, if not the entirety of the outbreak. This belief was expressed, for example, in Sierra Leone in January 2016 when local people accused the World Health organization of "manufacturing" Ebola. 17 Similarly, in January 2015 a BBC film crew in Liberia interviewed people in Guinea. A group of young students and teachers said that Western doctors had invented the epidemic as a way to sell medicines: "Ebola is not true. Honestly, Ebola is not true." 18 Such beliefs that doctors or the government had invented the disease as a means to attract foreign aid were widespread even where Ebola was common. [19][20][21] These popular conspiracy theories during the West African Ebola outbreak reflected political, historical and social factors. 22 There was a widespread belief that the government was ineffective and corrupt. People did not see a significant presence of the state. The legacy of colonialism had left a deep mistrust of Western actors. Ebola was new, and some of the initial symptoms were similar to that of other diseases such as malaria. 19 This fact led to confusion when people died, also was the case in the DRC outbreak. 23 For all these reasons, people did not trust the information that they received either from governments or from NGOs. As people interpreted what was happening, they drew on material from WhatsApp groups, Twitter and YouTube: "'It's mainly spread by word of mouth,' says Thuong Ngoyen, who is French-Vietnamese and the information management coordinator for the Red Cross. 'But there is an extensive phone network in DRC, and people use Whatsapp. There are whole groups dedicated to talking about Ebola.'" 12 For this reason the narratives that spread these beliefs could only be contained with support from the major social media companies. In the DRC the disease first appeared in a remote and impoverished area, but these areas were aware of social media narratives circulating in urban areas. For this reason, fighting conspiracy theories is part and parcel of fighting the epidemic. The DRC and international organizations organized a coherent campaign to communicate with the populace using door to door trips, radio and tools. 24 While efforts by groups such as the Red Cross in the DRC are valuable, they focus on local narratives, while social media giants have a global reach. In this context, it is helpful to consider the actions taken by these social media organizations when confronted by COVID-19. Facebook worked to highlight information from the World Health Organization. Twitter highlighted the U.S. Center for Disease Control on the platform. 25 In addition, Twitter labeled misleading Tweets, and even deleted Tweets that the company believed to be dangerous. 26 This was not a decision confined to isolated companies. In March 2020 most major social media companies came together to announce that they would work together to fight disinformation on their platforms: On Monday, the major social platforms-Facebook, LinkedIn, Reddit, Twitter and YouTube-along with Google and Microsoft, issued a joint statement announcing that they had banded together to fight COVID-19-related misinformation. "We're helping millions of people stay connected while also jointly combating fraud and misinformation about the virus, elevating authoritative content on our platforms, and sharing critical updates in coordination with government healthcare agencies around the world," the statement read. 25 As observers noted, these companies made a concerted effort to promote information from accurate sources and control misinformation was new, but drew upon existing tools. That is, these companies had always had the ability to take these measures. 27 What was striking was that these same companies had not made a parallel effort with Ebola. Without this support no health information campaign is likely to succeed. 26 --- CONCLUSION As David Fidler has argued, we cannot count on international NGOs in the field to deal on their own with conspiracy theories. 24 We also have to recognize the geographic breadth and historical depth of these theories. The narratives chosen are recycled from AIDS to Ebola. The same arguments are made; the same scape-goats blamed; and the same fears manipulated. The actors that support these arguments range from Russian trolls blaming the U.S. for a supposed bioweapons program, to zealots within the antivaccination movement. People in rural Africa also adapt folklore regarding the colonial era to the modern crisis, by incorporating elements from global conspiracy theories. Narratives quickly jump from developed nations to African countries through WhatsApp, Twitter or YouTube. Public health authorities need to not only analyze these theories, but also to call on social media companies to have a sense of media responsibility. Currently, channels are shut-down or demonetized on YouTube if they include racist symbols or violence. But conspiracy theories regarding Ebola proliferate. Social media companies should handle diseases in developing countries the same as they would COVID-19, which would improve public health communication before the next pandemic.

The public health campaign against Ebola in the Democratic Republic of the Congo faced serious challenges, some due to conspiracy theories and denial. These beliefs were so powerful that they even caused repeated attacks upon health care providers and medical centers. These conspiracy theories were nothing new, as they are a common feature of all frightening epidemics, such as HIV and COVID-19. These narratives also circulated during the 2015 West African Ebola outbreak. Addressing conspiracy theories during an epidemic requires a coordinated campaign involving not only local leaders but also the cooperation of social media organizations.

Minecraft is a first-person perspective sandbox game -a threedimensional, procedurally generated, Lego-like environment made up of blocks of different compounds (Duncan, 2011;Mojang, 2016). Players mine these compounds and re-place them to create various structures or shape the landscape. Minecraft has been purchased over 100 million times and in every country in the world (incl. Antarctica;Mojang, 2016). We think Minecraft is more than a global phenomenon, and may represent a critical and historical transition; an eminently popular videogame that is highly social and collaborative (Bainbridge, 2007;Entertainment Software Association, 2016;Granic et al., 2014;Przybylski, 2014), casting doubt on the depiction of video gamers as disconnected adolescents (Zimbardo & Coulombe, 2016). While early videogame research focused predominantly on the negative impacts of gaming (Strasburger et al., 2010), researchers are now starting to focus on the positives and Minecraft is at the forefront of this change (Granic et al., 2014;Nebel et al., 2016). Unlike other games, when played in its traditional settings, Minecraft has no aim or specific goals, which allows players the freedom to immerse themselves in their own narrative, build, create, and explore. Players can build alone, or join/create servers to play cooperatively. Given the creative nature of Minecraft and the open world environment, it is unsurprising that some have used the platform to create immersive worlds, artworks, and performances (Bukvic et al., 2014;Duncan, 2011). Importantly, Minecraft lends itself to socialization. The nature of the game has led to the formation of communities and groups that share and support creative creation. Given the move towards social and online gaming, it is unsurprising that a recent review found that videogame play is associated with social outcomes (Greitemeyer & Mügge, 2014). But unlike other games, Minecraft may be used to actively promote socialization. An example of this is Autcraft, a semi-private Minecraft server and online community formed around those with Autistic Spectrum Disorder (ASD;Ringland et al., 2016). Those with ASD often struggle with face-to-face social interactions, but they still express a desire to connect socially. Playing Minecraft can help these players meet their social goals and gain the positive effects of socialization (Ringland et al., 2016). Although the effectiveness of Autcraft on wellbeing has not been tested, ethnographic research has suggested that the platform has successfully promoted collaboration, socialization, and community. Ensuring that individuals meet their social goals is critical in improving health and wellbeing (Holt-Lunstad et al., 2010;Jetten et al., 2012;Scarf et al., 2016), and the Autcraft blueprint can be used to help other groups meet their social goals (e.g., older adults who have become housebound or geographically isolated; Osmanovic & Pecchioni, 2016). The collaborative nature of Minecraft can also promote prosocial behavior outside the videogame context (Gentile et al., 2009;Greitemeyer & Mügge, 2014). For example, to harness the prosocial behavior Minecraft instills in players and to promote civic engagement, Minecraft partnered with the United Nations Human Settlement Program (UN-Habitat) to engage communities in planning urban public spaces (Block By Block, 2016). The program provided residents with Minecraft and computer access so they could cooperatively recreate their cities and show city planners how they want their cities to look. The ubiquity of Minecraft and ease of play makes it the perfect game to promote bottom-up approaches and engage and empower communities to reimagine their city spaces (Baba et al., 2016). The program has helped communities all over the world create parks, city squares, sidewalks, seawalls, and marketplaces. Beyond social applications, Minecraft actively promotes the problem solving skills, creativity, planning, and persistence skills necessary for future success. Employers are actively recruiting gamers from online videogame leaderboards (Carr-Chellman, 2016) and gamers' unique skills are credited with helping scientists solve complex unanswered problems (Cooper et al., 2010). Minecraft fosters these skills as the environment requires the player to interact with unfamiliar environments, experiment, calculate, plan ahead, and develop complex mental representations to understand the world. In fact, longitudinal research suggests that videogames are related to greater problem solving skills. For example, in a high school population, strategic videogame play predicted self-reported problem solving skills, which in turn predicted better academic grades (Adachi & Willoughby, 2013). Research has also experimentally manipulated videogame play to determine whether this correlation is causal. When undergraduates were assigned to play a strategy based game (Portal 2), relative to a group that ironically played a brain-training game (Lumosity), the strategy group displayed a significantly greater improvement in problem solving and persistence (Shute et al., 2015). To help educators craft minds in the class room, Minecraft released Minecraft: Education Edition in September 2016 (Mojang, 2016). While using games in education is not a new concept, using a commercial game with the popularity of Minecraft is. The use of Minecraft in education may not only increase motivation for learning, but allow students to take a more active role in their education. Already, a number of educators have taken advantage of the collaborative nature of Minecraft to plan immersive lessons, and homework in subjects such as math, earth and ocean science, chemistry, molecular biology, and history (Nebel et al., 2016). Although there are few studies on using Minecraft in the classroom, educators have consistently reported that Minecraft has improved interest and motivation for learning (Nebel et al., 2016). For example, to measure the effectiveness of Minecraft as a teaching tool, one 7 th grade class was taught with Minecraft and the other in traditional lecture based learning. Both groups showed improvement, however, post-tests indicated those who had been taught with Minecraft performed significantly better (Wang & Towey, 2013). While more empirical data is needed, the use of Minecraft to foster socialization, engage and empower communities, and enhance students' interest in education and creation suggests that Minecraft is crafting minds and opening a new chapter in video game research. comments below. We hope that our amendments to the manuscript meet their concerns. The article is a very brief introduction to some uses of Minecraft outside of its core gamer base. The authors highlight some interesting projects, but do not discuss them at any length. Beyond providing a handful of examples no real attempt has been made to discuss how Minecraft can or might be used to craft minds and communities. Nor do the authors express much of an opinion on the topic. 1. Unfortunately, we are limited by the amount we can say due to a tight word limit. The aim was not to discuss these points at great length but to provide a succinct and accessible overview of the promise of Minecraft in a number of areas. Very few studies using Minecraft have used adequate control groups, so where possible we have drawn on other videogame literature that has used more robust methodologies. At this stage we believe the research is not fleshed out enough for a large scale review or meta-analysis. However, we agree that we may be light on an opinion and make our thoughts more explicit. We now draw on social psychology literature to make more of an argument for the use of Minecraft to help craft communities and some potential limitations. Furthermore some fundamentals and high profile attempts to use Minecraft as an educational tool projects have been overlooked. For example the authors imply that the first versions of Minecraft designed for educational uses was launched in September 2016. However MinecraftEDU has been available since 2011. Other educational projects such work by the Royal Geological Society, the Tate Modern are not mentioned. 1. We thank the reviewer for these suggestions and have added in more high profile uses of Minecraft. We agree we have made an error in implying that Minecraft Education Edition is the first being used for education. This was not our intention. We make this point more explicit. The article does cover a very interesting and rich area for which I would like to see a comprehensive review or opinion piece. This article is a good start however much more depth, both in terms of examples, discuss and opinion is needed. --- 1. We agree that this is an important area and are excited to see some more results. We hope more pieces like these will compel other researchers to run randomised controlled trials to address some of the gaps in the literature. We believe Minecraft can and should be more than just a 'cool' way to present education. The benefits of publishing with F1000Research: Your article is published within days, with no editorial bias • You can publish traditional articles, null/negative results, case reports, data notes and more • The peer review process is transparent and collaborative • Your article is indexed in PubMed after passing peer review • Dedicated customer support at every stage • For pre-submission enquiries, contact research@f1000.com --- Author contributions BR wrote the initial draft of the manuscript and provided scope for the manuscript. DS conceived the idea and co-wrote the initial draft of the manuscript. Both authors agreed to the final content. --- Competing interests No competing interests were disclosed. --- Grant information The author(s) declared that no grants were involved in supporting this work. --- Open Peer Review --- Mark Lorch Department of Chemistry, University of Hull, Hull, UK The article is a very brief introduction to some uses of Minecraft outside of its core gamer base. The authors highlight some interesting projects, but do not dicuss them at any length. Beyond providing a handful of examples no real attempt has been made to discuss how Minecraft can or might be used to craft minds and communities. Nor do the authors express much of an opinion on the topic. Furthermore some fundamentals and high profile attempts to use Minecraft as an educational tool projects have been overlooked. For example the authors imply that the first versions of Minecraft designed for educational uses was launched in September 2016. However MinecraftEDU has been available since 2011. Other educational projects such work by the Royal Geological Society, the Tate Modern are not mentioned. The article does cover a very interesting and rich area for which I would like to see a comprehensive review or opinion piece. This article is a good start however much more depth, both in terms of examples, discuss and opinion is needed. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Author Response 03 Jan 2017 --- Damian Scarf We thank the reviewer for their thoughts and suggestions and address some of their Competing Interests: No competing interests were disclosed.

Minecraft is a first-person perspective video game in which players roam freely in a large three-dimensional environment. Players mine the landscape for minerals and use these minerals to create structures (e.g., houses) and mould the landscape. But can Minecraft be used to craft communities and minds? In this opinion piece, we highlight the enormous potential of Minecraft for fostering social connectedness, collaboration, and its potential as an educational tool. We highlight the recent use of Minecraft to aid socialization in individuals with Autistic Spectrum Disorder (ASD) and promote civic engagement via the United Nations Human Settlement Program. We further discuss the potential for the recently released Minecraft: Education Edition and provide novel links between Minecraft and recent on work on the role of social cures and community empowerment in enhancing mental health, wellbeing, and resilience.

Introduction In a recent lecture delivered on 15 May 2023 at the Centre for Studies in Social Sciences (CSSS), Kolkata, Partha Chatterjee, the former Director of CSSS narrated the history of the oldest Department of Anthropology in India at the University of Calcutta. The lecture was entitled 'Science or Cultural Interpretation: Anthropology at the University of Calcutta, 1920Calcutta, -1970.' .' The summary of the lecture was available in the public domain at https://twitter.com/CSSSCal at the The only sentence, which Chatterjee made on the practice of social-cultural anthropology at the Calcutta University anthropology department, was as follows: Alongside, there was a somewhat minor stream of cultural anthropology, developed by the Gandhian scholaractivist Nirmal Kumar Bose (Chatterjee 2023). This description gives an impression that social-cultural anthropology (a minor stream in Chatterjee's words), a very important branch of anthropology, was neither taught nor studied at the University of Calcutta like physical anthropology nor were students trained in intensive fieldwork (not much required in physical anthropology) in this branch of anthropology. The records however were far away from the assertions of Partha Chatterjee! --- Methodology Two questions of methodology may be raised at this juncture. First, since the abstract of Partha Chatterjee's oral lecture was posted in a social media, it should not be used as a valid reference in a written article (personal communication with Partha Chatterjee over email dated 08.07.2023). The second question is, it was only an abstract, not a full article, so it should not be considered as a source for a full length article published in print. My answer to the first question is, posts in twitter are frequently been made by the Presidents and Prime Ministers of almost all the countries of the world (India included) to make various official announcements and statements. So, there is no valid reason for not considering Partha Chatterjee's abstract in the twitter on the history of anthropology at Calcutta University as an authentic source of information and it was signed by the Director of the aforesaid institute(personal communication with Partha Chatterjee over email dated 09.07.2023). My answer to the second question is since an abstract summarises the content of a lecture or paper it is unlikely that an author would talk or write on matters and develop arguments which would contradict the subject matter described in its abstract. A paper and/or a lecture is an elaboration of the abstract. So, we can safely assume that whatever Partha Chatterjee had stated in the abstract was elaborated and explained further in his lecture. With these two methodological points, we may now proceed on to our main facts and arguments. --- Remarkable social-cultural anthropologists of the University of Calcutta Anthropology department at the University of Calcutta from its very inception emphasised and practiced the discipline from a holistic perspective, and teaching and research were being done in all the three major sub-disciplines of the subject, viz. (i) physical anthropology, (ii) social-cultural anthropology and (iii) prehistoric archaeology. André Béteille, the famous sociologist who was trained in anthropology at the University of Calcutta in his undergraduate and postgraduate levels in the 1950s recounted in his autobiographical account in the Annual Review of Anthropology: The half-dozen teachers we had covered all branches of the subject: paleontology, prehistoric archaeology, material culture, religion and magic, and social organization. One of the teachers had a special interest in museology, so he talked endlessly about museum methods. Yet a teacher was not necessarily bad because he was self-taught and did not have original research publications. One of those who taught us about society and culture, Mr. T.C. Das, was meticulous and conscientious and had a vast store of detailed ethnographic knowledge (Béteille 2013:4). --- study of a Bhumij dominated village in Manbhum district of Bihar where they were already reported in the Census as caste and spoke Bengali, having lost their original Mundari language (Sinha 1978:149-150). The above quotation clearly showed that Surajit Sinha was not doing his studies on physical anthropology, and much later in an article published in 1971 Sinha observed that his teacher T.C. Das tried to rigorously develop field methods in socialcultural anthropology in the Department of Anthropology at the University of Calcutta, which could be 'fruitfully utilized in describing the living conditions of tribals, peasants as well as urbanites' (Sinha 1971:7). T.C. Das's social anthropological monograph on the Purum Kukis of Manipur entitled The Purums: An Old Kuki Tribe of Manipur, published by the Calcutta University in 1945, became a major source of database in the acrimonious debate on descent versus alliance theories on kinship in Anglo-American Anthropology that involved renowned anthropologists like Claude Lévi-Strauss, George Homans, David Schneider, Rodney Needham, Floyd Lounsbury, and others (Guha 2011:256). Das's other book on the Bengal famine of 1943 (see Das 1949) was a unique and rare first-hand study done by any anthropologist or social scientist on the victims of one of the greatest tragedies of our country under the colonial rule (Guha 2010:90-94). An earlier version of the book was discussed in the then British Parliament and some of the recommendations advanced by Das were adopted in 1944 by the Famine Inquiry Commission formed by the colonial government for the prevention of future famines in India (ibid.: iii-iv). Pandit Jawaharlal Nehru in his book The Discovery of India also mentioned the anthropological survey conducted by Das on the famine-affected population of Bengal and, even before the book was published, expressed his confidence on the results of the survey in contrast to the one carried out by the government (Nehru 1981(Nehru /1946: 495-96): 495-96). The Nobel Laureate economist Amartya Sen has also used Das's original work several times in his famous book Poverty and Famines (Sen 1999). the able academic and administrative leadership of K.P. Chattopadhyay the conference was not only held most successfully but the whole proceedings of the conference along with the discussions were also meticulously recorded and (Hutton 1963:155-156). Another doyen of Social-Cultural Anthropology at the Department of Anthropology in the University of Calcutta was Nirmal Kumar Bose (1901Bose ( -1972)). Bose was a versatile personality in Indian anthropology. His multifaceted interest ranged from temple architecture and prehistory to transformations in tribal life under the impact of Hinduism and modernization. Bose

The recent narration of the history of the Department of Anthropology at the University of Calcutta (CU) by a world renowned social scientist, Partha Chatterjee in a lecture at the Centre for Studies in Social Sciences misrepresented and suppressed historical records. Chattterjee's contention that the Department of Anthropology at CU only practiced Physical Anthropology and Archaeology and not Social-Cultural Anthropology was highly biased and suppressed the records available in the public domain.

In an article in the Times in 2015, Janice Turner poses the question 'who has a radical vision to fix the broken image of UK care homes?' She had been reading Atul Gawande's now celebrated book Being Mortal in which he calls into question the system of care for frail older people no longer able to live in their own homes [1]. This commentary sets out one such radical vision for this complex situation: the concept of a 'Care Home Innovation Centre' (CHIC) to showcase excellence in care, to develop and deliver specialist care home training and to promote research and quality improvement initiatives (Box 1). --- Why is change needed? Over the last 5 years, UK care home beds for older people have increased by a further 4% to 487,000 [2]-three times the number of all acute NHS beds [3]. Projections of current demographic trends suggest spending on long-term care provision will need to rise from 0.6% of our Gross Domestic Product in 2002 by up to 0.96% by 2031 [4]. Current health/social care policy aims to support older people to live and die at home. Consequently, those who require admission to care homes are now much frailer and commonly have advanced progressive illnesses including dementia. [5]. In a recent study of 2,444 deceased nursing care home residents, the mean number of recorded diagnoses per resident were four, with 45% of residents having dementia and a further 31% cognitive impairment [6]. While two-thirds of people living with dementia live at home, increasing numbers in the UK die in care homes [7]; however, place of death for those with dementia varies significantly internationally. For the countries where care homes are the commonest location, place of death varies from 48.9% to 93.1%, indicating the potential for modifying meaningful outcomes for adults with dementia [8]. Currently, a fifth of the UK population die in care homes [9] where most staff have limited healthcare training. Current support for the provision of end-of-life care is highly varied [10] and contrasts starkly with the multidisciplinary care available to 5.6% of the population who die in a hospice [11]. Although the UK has many excellent care homes that provide high-quality care for their residents, across the sector there is a significant need for improvement. The Care Quality Commission and the Care Inspectorate inspect and regulate UK care homes, evaluating them on safety, effectiveness, caring, responsiveness and leadership [12]. Although the majority of care homes receive a rating of 'good', still significant numbers identified are requiring improvement or inadequate [12,13]. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible [14]. In common with the findings of the Burstow Commission, we are optimistic about the potential for change in the care sector and the need to value the role of care homes in delivering specialist care, which cannot be provided in other settings [14]. However, a particular challenge is the recruitment and retention of staff. The care home workforce is 'overlooked' compared to their NHS counterparts, with a lack of career structure and training opportunities [15]. A need to ensure access to training, particularly for the complex and specialised care required for the care home population, is now accepted [15]. Care home managers are a further professional group whose role often externally lacks definition and whose perspectives are often not included in research conducted in the sector [16]. In the UK, routine medical care for care home residents is provided by general practitioners (GPs). However, the provision of this care is heterogeneous, reflecting the challenges of cross-sector working and the legacy of innovations and different regional models of care [3]. There is inequity of access to specialist services including geriatric medicine, old age psychiatry and dentistry [3]. Relational working has been identified as central to the delivery of effective healthcare for UK care home residents, with the role of co-design and joint priority setting both an integral part of effecting change [17]. --- Teaching/research-based care homes Teaching nursing homes are not a new concept in the international literature [18]. The key components are of quality patient care, reducing unnecessary hospitalisations, increasing knowledge and education in caring for residents, provision of experiential training for students and conducting research to reduce the gap between theory and practice [19,20]. This model can enhance care for residents and also for care providers. The essence of the model is the linking of the separate spheres of research, clinical care, education and training [19]. Success requires ensuring adequate resource is available, making sure training does not detract from care, and recognising the different cultures in delivery of healthcare, social care and education [20]. 'The Green House' (GH) model [21] developed in the USA provides other transferable learning to inform our concept. GH homes accommodate up to 10 residents in private bedroom and bathroom facilities with communal shared living space. The care staff provide a diverse range of support for the residents, supported by visiting clinical teams. In this model, the emphasis is on the promotion of quality of life, rather than a focus of healthcare needs. This brought reductions in hospitalisations and improvements in some quality markers of care [22]. However, performance metric-derived improvements were not uniform across homes, indicating that standards of practice are not guaranteed by the presence of an overarching care ethos alone [23]. --- Our vision and anticipated challenges Our vision for a 'CHIC' is one partnered with the local community, acute hospitals, universities, hospices and the care home sector and its regulators across a region. The vision incorporates the core components of a teaching nursing home described earlier [19,20] with training opportunities for care home staff in the region in addition to undergraduate and postgraduate students in medicine, Box 1 : Core aims of a CHIC • To provide high-quality, innovative service for frail older people requiring 24-hour care, including care for people with advanced dementia and those at the very end of life in order to showcase expert physical, psychosocial and spiritual care. • To provide specialist training for care home staff across the region through a 'hub and spoke' model. • To coordinate multidisciplinary community-based training in long-term care for students and professionals in medicine, dentistry, nursing and social work and other health professions including pharmacists, dieticians, physiotherapists and occupational therapists. • To be a centre for practice-based research and quality improvement initiatives in collaboration with other care homes within the region and local hospitals. • To be a centre which is part of a local community engaging with and training people to volunteer in care home work; to give wider support to families caring for frail older people living at home; to provide both 'on-site' respite as well as 'at home' respite care. nursing and the allied health professions. It is closely aligned with needs identified in the UK-specific 'Quest for Quality' [24]. The vision includes establishing greater connections to the wider community to enable residents to live well, despite multiple co-morbidities. The importance of meaningful relationships will be integral to the care culture. The vision will showcase a joint health/social care managed venture with associated funding (likely to require additional support from benefactors). With the current demographic projections and need for greater ageappropriate healthcare [25], we believe this is a timely vision for improved relational working within health and social care. Identifying areas for improvement within the care home sector is not difficult. The challenge comes in establishing how to implement change [26]. The vision is for a new organisation that has the advantage in lacking 'established practice'. However, we recognise that establishing the CHIC will not affect wider change without working with the existing organisations and providers in the region. So that the benefits have the potential to reach beyond the individuals within the CHIC, a 'hub and spoke model' is proposed (Box 1). This will link the CHIC to satellite care homes locally, who will have access to training and who will be supported to work together to develop quality improvement initiatives, directed by their own residents and staff. Evaluating the success of the CHIC requires a multicomponent strategy. A key challenge is in ensuring we identify and measure outcomes important to residents and their family, managers and professional carers. This requires both a commitment of time from stakeholders to allow for practice to change before evaluation, as well as the use of appropriate metrics to measure success. The Centre will have to attain the standards established by the regulatory bodies with respect to care quality and education. Evidence will be collected to quantify community engagement in the CHIC and other care homes in the region. Research success will be evaluated by securing funding and developing collaborations locally and internationally. Key aspects of our feasibility study include exploring existing local practice, previous innovations, staffing models, funding and professional perspectives. This is to help explore the impact the CHIC may have and help build a team to ensure sustainability beyond project delivery. As with any innovation, there may be unintended effects and our feasibility approach seeks to mitigate these before finalising the CHIC concept. --- The way forward We are currently undertaking a feasibility study to clarify the practical implications of the CHIC across a region in South East Scotland which has 107 care homes and a population of 849,000. As of 1st of April 2016, health and social care are integrated under statute in Scotland [27]. Although it is too soon to evaluate, this is a bold national move to facilitate innovations in integrated care. We foresee an opportunity for a local health and social care joint board to establish the CHIC. The feasibility study, along with a financial assessment, is led by a steering group which includes geriatricians, regulators, old age psychiatrists, GPs, nurse/clinical academics, social care, users and representatives from independent care home organisations. It will be completed by early 2017. In conclusion, the modern hospice movement brought a 'sea change' in end-of-life care through teaching/researchbased hospices with the emphasis on quality of life and the creation of the new specialty of palliative care. Our CHIC has the potential to bring a similar radical improvement by reinvigorating long-term care provision for frail older people, raising the profile of the care home workforce, delivering resident-centred research, promoting recruitment and encouraging professionals to take a career in this vital area of care. Such a vision has the potential to help change the culture and image of care homes and start to address the huge public health issue we face in the provision of 24-hour care of the oldest old. --- Key points • Current workforces caring for people in care homes are poorly prepared for the complexity of care home resident needs. • Innovation is necessary to increase the attractiveness of a career pathway in the care of frail older people in care homes. • Could a 'care home innovation centre for training and research' catalyse and help priorities this complex area of care across a region?

The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.

Background Female genital mutilation/cutting (FGM) is defined as any procedures that involve partial or entire removal of the external female genitalia or other harm to the female genital organs for non-medical reasons [1]. The prevalence of FGM become decreased in Ethiopia over the last 16 years, with prevalence declining from 80% in the 2000 Ethiopia Demographic and Health Survey (EDHS) to 74% in 2005, and 65% in 2016 EDHS [2]. However, the prevalence varies by regions: 99% in Somali, 91% in Afar, 33% in Gambela, and 24% in Tigray [2]. FGM is a dangerous procedure that predates all faiths and is carried out on children for a variety of reasons in different cultural and global contexts [3], resulting in acute and long-term repercussion's such as bleeding, shock, urine retention, and infertility [4][5][6][7]. In addition, according to a study conducted in Ghana, FGM was linked to an 8.2% caesarean section rate compared to 6.7% in mothers who did not have FGM [8]. The first step toward ending FGM is to change people's perceptions about it, which can be tough and psychologically painful [9]. In Ethiopia, 21% percent of women think that the practice should be continued [2]. Studies showed that attitude towards cessation of FGM was attributed to different factors such as male sex [10,11], urban residence [12], educational attainment [5,[12][13][14], and access to media [12,13]. In contrast, women with positive cultural conceptions of FGM, being muslim religion follower [12,13,15], 15-24 years age, living in rural areas, and being married [13] were less likely to support cessation of FGM. When it comes to the impact of previous circumcision and socioeconomic status on attitudes towards FGM, the evidence is mixed. For example, one study in Egypt showed that previous circumcision favors discontinuation [11], while another study conducted in Ethiopia found that previous circumcision leads to the continuation of FGM [13]. Similarly, a higher levels of household wealth increased women's support for discontinuation [16]. In some countries, wealth index was linked to support FGM, and in some countries the opposite is true [17]. Previous research in Ethiopia regarding the continuation of female genital mutilation [13,18] did not include crucial factor such as wealth index, which is an important to alleviate the barriers for discontinuation of FGM. Therefore, the current study sought to fill this vacuum by examining the relationship between wealth index, and previous history of circumcision on women's attitude to end the practice of FGM in Ethiopia, utilizing data from the country's most recent 2016 national demographic and health survey. --- Methods --- Data source The current research used the 2016 Ethiopia Demographic and Health Surveys (EDHS) data set. A stratified cluster sampling method with two stages was applied. A detailed description of the study design and survey methods may be read elsewhere [2]. In the 2016 EDHS, 15,683 women (15-49 years) were interviewed, with a 95% response rate. After excluding cases with missing values on the variables of interests, the analytic sample in this study consisted of 6984 reproductive age women (15-49 years). --- Study variables The dependent variable was the attitude towards the discontinuation of female genital mutilation, which was measured by asking the questions "circumcision should be continued or stopped?". There were two options for the respondents: continue or stop. The main exposure variables were whether or not women had ever been circumcised (yes or no) and the wealth index (a composite index based on the household's ownership of several consumer items), which had five categories (poorest, poorer, middle, richer, and richest) according to the data set [2]. Covariates that affect attitudes towards the discontinuation of female genital mutilation include respondent's age, religion, marital status, education status, type of residence, access to media, and regions. --- Statistical analysis SPSS version 21 was used to analyse the data. Frequencies and weighted percentages of study variables were reported. Bivariate analysis using Rao-Scott chi-square test was performed to examine the relationship between attitude towards the discontinuation of female genital mutilation and each of the independent variables and to select potential candidates for the multivariable model. A variable, which had a p-value of < 0.25 in bivariate analysis were entered into a multivariable logistic regression analysis to assess the association between wealth index, and previous circumcision towards women's attitude to discontinue the practice of FGM by controlling confounders. To declare a statistically significant association, adjusted odds ratios (AOR) with 95% confidence interval (CI) were used. --- Ethics approval and consent to participate The study does not required ethical approval because it was a secondary data analysis using the 2016 EDHS database. After receiving the data from the USAID-DHS program, the researchers in this study maintained the data's anonymity. During the survey, consent was received from the study participants prior to the start of study. --- Results --- Description of the study variables with attitude to discontinuation of FGM A total of 6984 reproductive-aged women were included and analysed. In terms of age, 35.4% of women aged 20-29 years had an attitude toward discontinuation of female genital mutilation. When it came to circumcision, 65.8% of those who supported ending FGM had been circumcised at some point in their lives (Table 1). --- Association between wealth index and women's attitude to discontinue the practice of FGM in Ethiopia Because all of the variables in bivariate analysis had a p-value of less than 0.25, they were all incorporated into multivariable logistic regression analysis. The odds of attitude towards the discontinuation of female genital mutilation was 1.46 (AOR: 1.46; 95% CI: 1.02-2.01), 1.95 (AOR:1.95; 95% CI: 1.36-2.79), 2.22 (AOR: 2.22; 95% CI: 6.68-31.4), and 2.65 (AOR: 2.65; 95% CI: 1.57-4.46) times higher among women who had a poorer, middle, richer, and richest wealth index quintile, respectively compared to women who were in the poorest quintile. Besides, the odds of attitude towards the discontinuation of female genital mutilation was 1.57 (AOR: 1.57; 95% CI: 1.17-2.12), 3.38 (AOR: 3.38; 95% CI: 1.96-5.83), 14.5(AOR: 14.5; 95% CI: 6.68-31.4) times higher among women attained primary, secondary, and higher education, respectively compared to non-educated one. In addition, circumcised women compared to non-circumcised women lower the odds of the attitude towards the discontinuation of female genital mutilation by 78% (AOR: 0.22; 95% CI: 0.15-0.32). Besides, the odds of the attitude towards the discontinuation of female genital mutilation was lower by 66% (AOR: 0.34; 95% CI: 0.22-0.50) among women living in the Afar region, by 38% (AOR: 0.42; 95% CI: 0.27-0.65) among women living in the Somali region, by 59% (AOR: 0.51; 95% CI: 0.32-0.83) among women live in Dire Dawa region compared to Oromiya region. However, the odds of the attitude towards the discontinuation of female genital mutilation was higher among women living in Benishangul-Gumuz by 2.22 times (AOR: 2.22; 95% CI: 1.46-3.36), and Addis Ababa by 2.13 times (AOR: 2.13; 95% CI: 1.13-4.04) (Table 2). --- Discussion In Ethiopia, the current study looked into whether women with higher wealth indexes have a higher possibility of opposing FGM. Studies from Guinea [16] and other countries [15] confirm this conclusion. This may be due to the increment of decision-making authority by monetarily empowered women [19]. This study also adds to the literature that educated women, and regional variation were significant predictors of women's attitude to discontinue the practice of FGM in Ethiopia. Educational attainment of the women results in a higher odds of the attitude to discontinue female genital cutting. This finding is consistent with studies conducted in different places [5,[12][13][14]. This may be explained as educated women may be equipped with the knowledge to evaluate their beliefs about traditional practices, and it provides women with financial independence and empowerment to liberate themselves from harmful practices. Furthermore, the opinions of educated women are less likely to be influenced and shaped by traditions. In comparison to uncircumcised women, circumcised women were less likely to support ending FGM. This result is consistent with the finding of a prior investigation in Ethiopia [13], This can be explained by the fact that having instilled in one's upbringing might give FGM a deeper meaning and purpose. Circumcised women may have gained perks such as recognition and respect as a result of the procedure. However, this conclusion contradicts a study from Egypt [11], which found that previous circumcision leads to cessation of FGM. The discrepancy between the Egyptian study and the current study is attributable to changes in the study participants. The Egyptian study involved medical students whereas the current study involved reproductive-age women residing in the community. Because they were medical students, they were able to predict the health consequences of FGM more easily, which boosted their enthusiasm for the practice's abolition. Furthermore, women in Afar, Somalia, and Dire Dawa had a reduced likelihood of having a favourable attitude regarding the abolition of female genital mutilation. Women in Benishangul-Gumuz and Addis Ababa, on the other hand, had a more favourable attitude toward the cessation of female genital mutilation. This finding is consistent with previous studies conducted in Ethiopia [20,21]. This could be due to significant spatio-temporal variation of FGM practice across the country [20]. --- Strength and limitation of the study Although findings of this study are valuable for policymaking, there are a few limitations to be aware of. The data, for example, were gathered from secondary sources, and our study may not be free of the flaws that come with this method. Despite these limitations, our study is one of the few that have contributed to the discussion of the association between wealth index and women's attitude to discontinue the practice of FGM in Ethiopia, as no other studies have been conducted in the country using the most recent 2016 national representative data set available to date. --- Conclusions The present study revealed that women's wealth index, educated women, previous circumcision, and regional variation significantly predict women's attitude to discontinue the practice of FGM in Ethiopia. Therefore, efforts need to be done in promoting women's socioeconomic status concurrently empowering women in education. Furthermore, designing interventions that address FGM practices should focus on circumcised women along with addressing regional variation to have a significant effect on curtailing this harmful traditional practice from Ethiopia. --- We used the USAID-DHS program 2016 Ethiopian demographic and health survey data set for this analysis. To request the same or different data for another purpose, a new research project request should be submitted to the DHS program here: https://dhsprogram. com/data/Access-Instructions.cfm. After receiving permission, the researcher can log in and select the specific data in the format they prefer. --- Author Contributions Conceptualization: Mohammed Ahmed, Abdu Seid, Seada Seid.

understanding women's attitudes towards female genital mutilation is an important step towards eliminating this practice. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) data set to examine the relationship between wealth index, and previous history of circumcision on women's opinions whether female genital mutilation (FGM) should be continued or stopped in Ethiopia.Data from 6984 women aged 15-49 years were extracted from the 2016 Ethiopia EDHS data set. Multivariable logistic regression analysis was performed to analyse the data.In this study, women with a higher level of education and wealth index were more likely to support the cessation of FGM. However, circumcised women (AOR: 0.22; 95% CI: 0.15-0.32), women from the Afar region (AOR: 0.34; 95% CI: 0.22-0.50), Somali region (AOR: 0.42; 95% CI: 0.27-0.65), and Dire Dawa region (AOR: 0.51; 95% CI: 0.32-0.83) were less likely to support discontinuation of FGM.The present study revealed that wealth index, education level, history of circumcision, and regional variation are associated with women's attitude towards discontinuation of the practice of FGM in Ethiopia. Empowering women in terms of socioeconomic status and education can change attitudes and might help prevent female genital mutilation in the future. Furthermore, interventions targeting FGM practices should focus on regional variance in order to have a meaningful impact on reducing this harmful cultural practice in Ethiopia.

Research has established that housing is a health issue and that the worse the housing situation, the worse the impact on health. Those experiencing homelessness, particularly chronic homelessness, for instance, experience high rates of physical health issues, chronic diseases, substance abuse, and mental health challenges. Furthermore, health issues cause as well as are exacerbated by homelessness. 1 Housing that is poor quality or in disrepair increases the incidence of injuries, asthma, cancer, cardiovascular disease, and other health issues. Living in unhealthy housing also worsens mental health, in part due to the stress of living in unsafe and unhealthy environments. Conversely, affordable housing reduces negative health outcomes, because a lower proportion of income is dedicated to housing and greater proportion is available for food and health care. 2 Accessing healthy living conditions is an economic issue for those most likely to be living in poor housing conditions that negatively impact health. To improve health and housing conditions for extremely low-and low-income families requires addressing both the availability and the access to healthy housing. According to the Housing Alliance Delaware report, 3 Delaware is short more than 21,000 additional affordable housing units to meet the needs of extremely lowincome families. Second, affordable housing must be affordable. Low income and extremely low-income Delawareans need to work more than two minimum wage jobs to afford a Fair Market Rent apartment. Even if this was reasonable, the path to attaining affordable and quality housing is interrupted by the benefits cliff. The benefits cliff, in simple terms, is the point on the economic mobility path where those dependent on governmental benefits and entitlements increase income but not enough to cover the additional expenses associated with the loss of benefits. The benefits cliff emerged as an unanticipated consequence of implementing the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), commonly referred to as Welfare to Work. The welfare reform legislation aimed to reduce dependency on government assistance and to increase self-Doi: 10.32481/djph.2023.06.010 sufficiency. Initial studies on the impact of PRWORA showed significant increases in employment among welfare recipients; however, the employment was unstable and temporary. 4 Studies looking at the impact of individual benefit programs on work show that food stamps 5 and housing 6 have negative effects on incentives to transition from welfare to work. On the other hand, several studies show that although childcare assistance appears to have the most positive impact, it also has the largest cliff effects. 4 An extensive study in Colorado shows how families dependent on government benefits "strategize" to avoid the benefits cliff and identify the most reasonable and least risky path toward self-sufficiency. 7 Prenovost and Youngblood documented the stress created trying to navigate the benefits cliff. 8 Significant attention has been given to identifying the point where work pays off, referred to as the effective marginal tax rate (EMTR). 4,9 The EMTR is the percentage of any additional earned income that a household pays in taxes or loses in government benefits. As Dolan notes, the EMTR creates a poverty trap where the risks and gains of working become disincentives and barriers to self-sufficiency and economic mobility. 9 EMTR analyses have produced various models of economic mobility out of welfare to self-sufficiency, including modeling combining various types of benefits. 4,9 Typically, however, EMTR modeling fails to take into account factors associated with the readiness for work. As Hauan and Douglas point out, most welfare recipients face at least one barrier and many encounter multiple barriers preventing readiness for stable and sustainable work. 10 They identified the most common barriers, in order of most frequently identified, as not having earned a high school diploma or GED, unmet childcare needs, mental health issues, transportation issues, limited work experience, unstable housing, and physical health problems. This research suggests that navigating the benefits cliff requires welfare recipients meet a set of criteria considered necessary for stable and sustainable work, a status necessary to access healthy housing. Assisting residents dependent on government assistance become eligible and prepared to cross the benefits cliff to become economically self-sufficient and eligible for housing that does not negatively affect health has become a critical issue in comprehensive revitalization efforts. Clearly, building new, healthy housing is not enough. Extremely low-and low-income families need significant assistance becoming economically eligible for the housing. REACH Riverside's experience demonstrates the interconnected relationship among poverty, health, and housing. The REACH Riverside Development Corporation was formed in 2017 to remove the barriers to prosperity and well-being facing residents of Wilmington's Riverside neighborhood, a community experiencing the devastating impacts of decades of racial discrimination and disinvestment. REACH is the managing partner of The WRK Group, a group of three nonprofits (REACH Riverside, Kingswood Community Center, and The Warehouse) working together to implement the Purpose Built Communities model, a holistic approach focused on housing, education and health initiatives. REACH is leading a comprehensive revitalization of the Riverside community in NE Wilmington, which includes creating 700 units of mixed-income housing (Imani Village) along with education and health oriented initiatives. Phase one of Imani Village (74 units) was completed in December 2022. Construction of Phase two was finished in May 2023, bringing another 67 units on stream. Five hundred fifty two more rental units are planned in Phases three through seven, along with about 100 homes for ownership. In support of this transformation in the built environment, REACH works closely with service partners Kingswood Community Center and The Warehouse to provide social service programs for all Doi: 10.32481/djph.2023.06.010 ages. This has included creating a cradle-to-college/career pipeline between Kingswood's Early Learning Academy, EastSide Charter School, and The Warehouse as well as providing on-site medical services to the community through a partnership with ChristianaCare. As with all the WRK Group efforts, the new housing plan prioritizes current residents living in Wilmington Housing Authority (WHA) housing. In assessing eligibility for the new housing, approximately 40% of the WHA families were not eligible primarily as the result of past due rent and utility bills. REACH worked with Kingswood Community Center to enroll residents in Kingswood's EMPOWER program. EMPOWER assists residents of Riverside and surrounding neighborhoods obtain economic self-sufficiency. At intake, EMPOWER clients with assistance from their navigational coach complete a comprehensive assessment. A 2023 analysis of intake assessment data showed that over half of the EMPOWER clients' income situation, employment situation, and/or food situation were assessed as in crisis or vulnerable. The credit situation for one third of the clients was in crisis or vulnerable and one fourth were living in housing that was assessed as in crisis or vulnerable. The large majority of EMPOWER clients are WHA residents and for them in crisis or vulnerable housing situations indicates that they are at risk of eviction. The intake assessment data underscores the multiple programming needs of extremely low-and low-income families. One of the biggest barriers faced by EMPOWER staff and clients in developing plans to achieve economic self-sufficiency to meet the inter-related and multiple needs is the benefits cliff. EMPOWER clients, like many extremely low-and low-income families, cannot simply work more or obtain better paying jobs to become economically independent because they risk losing benefits, most significantly those related to childcare and healthcare. This barrier to economic stability and self-sufficiency also creates barriers to accessing the new healthy housing designed specifically for Riverside residents. The EMPOWER staff and the REACH leadership are actively exploring options for bridges across the benefits cliff but these bridges are, in part, dependent on policy changes. Programmatic developments without complimentary and supportive policy changes will be ineffective and possibly infeasible. Policies to avoid the benefits cliff or mediate its negative effect on the transition to selfsufficiency are limited and vary greatly by state. The National Conference of State Legislatures (NCSL) 11 and the Federal Reserve 12 produced reports defining and describing the benefits cliff. The Alliance for Strong Families and Communities categorizes policy efforts into four categories: 1) policies modeling or adapting the Earned-Income Tax Credit; 2) policies ensuring continued access to benefits; 3) policies eliminating some assets, such as cars and savings accounts, in deciding benefits levels; and 4) policies excluding portions of income in benefits calculations. 13 The NCSL report provides an overview of state level efforts addressing the benefits cliff. The report notes that 16 states enacted legislation to mitigate the impact of the benefits cliff. Delaware was not one of those states and to date has not proposed benefits cliff mitigation legislation. The most comprehensive initiative, undertaken by five New England states, piloted both policy and program level changes to mitigate the negative effects of the benefits cliff. 14 Most state level efforts continue to address welfare policies individually when the reality is recipients must navigate the benefits cliff considering all sources of assistance. Dolan 9 and Richardson and Blizard 4 suggest that the current benefits system, rather than policies, is structured in a way that discourages participants from becoming fully self-sufficient, prohibiting economic mobility. Dolan highlights the need to create individualized approaches because there Doi: 10.32481/djph.2023.06.010 is a matrix of benefits, income sources, and personal factors that must be considered for a family to traverse the benefits cliff. 9 Richardson and Blizard are bolder in their recommendations, suggesting terminating all social programs as an option. 4 Other options included creating a longer glide path, universal basic income, and private sector creation of non-taxable fringe benefits, such as childcare assistance. Addressing the housing crisis in Delaware as well as improving health and economic stability demands that we address the benefits cliff looming on the horizon for extremely low-and lowincome families struggling toward self-sufficiency. Effective policies and interventions, at a minimum, need to be informed by the experiences of those struggling to navigate the benefits cliff and achieve economic mobility. In other words, policies need to data driven. And, effective policies and interventions must be integrated. Siloed policy development will not effectively address the benefits cliff preventing economic self-sufficiency and access to affordable, healthy housing. There is not a single pathway from dependence on government assistance to selfsufficiency. Similarly, there is not a linear continuum of housing options paralleling a linear continuum of economic mobility. Multiple entrance ramps with varying lengths across the benefits cliff need to be created in collaboration with housing, social services, healthcare, educational, workforce, government, and private sector partners. Given our size and promising comprehensive revitalization efforts, Delaware has an opportunity to model integrated policy changes that bridge the benefits cliff and support extremely low-and low-income Delawareans on their journey toward economic self-sufficiency, health, and affordable, quality housing. Dr. Dillard may be contacted at ddillard@desu.edu.

This Commentary introduces the reality of the benefits cliff into the housing and health relationship. Improving both housing and health requires addressing the benefits cliff facing extremely low-and low-income people. Those living below the poverty line are at greatest risk of poor, inadequate, and unhealthy living conditions. They are also the group most at risk for losing benefits and economic supports on their journey toward economic self-sufficiency. Addressing the housing crisis in Delaware demands that we recognize the benefits cliff looming on the horizon for extremely low-and low-income families struggling toward self-sufficiency. Effective policies and interventions, at a minimum, need to be informed by the experiences of those struggling to navigate the benefits cliff and achieve economic mobility and need to be integrated across housing, economic benefits, and health care.

Introduction Nepal is a post-conflict country with a highly unequal social structure. Social exclusion in Nepal reflects the hierarchies of the Hindu caste system that divides the population into 'upper' and 'low' caste people (World Bank, 2006). The caste system divides the population into the 'upper caste' Brahmin, Chhetri and Newar groups, the 'middle caste' Tarai and the 'low caste' Dalits. Dalits are those communities who, by virtue of atrocities of caste based discrimination and untouchability, are most backward in social, economic, educational, political and religious fields, and are deprived of human dignity and social justice (NDC). Dalit comprise 13.2%of the total 26494504 population of Nepal (CBS, 2011). There are 26 castes under Dalit including 7 Hill Dalit castes and 19 Tarai / Madhesi Dalit castes (NDC, 2014). Almost half of Nepal's Dalits live below the poverty line. They are landless and much poorer than the dominant caste population. Nepal's Old Age Allowance is considered a core pillar of the state's social protection system as old Age Allowance helps poor households meet basic subsistence needs (Consortium, 2014). The conference paper of (Uprety, 2006) In the existing inequality based on castes, another type of inequality also exists which is found in almost all of the class and castes of human hierarchy is gender inequality. Gender inequality acknowledges that men and women are not equal and that gender affects an individual's lived experience. These differences arise from distinctions in biology, psychology and cultural norms. Some of these distinctions are empirically grounded while others appear to be socially constructed. Studies show the different lived experience of genders across many domains including education, life expectancy, personality, interests, family life, careers and political affiliations. Gender inequality is experienced differently across different cultures. Due to gender inequality, women are mostly the suppressed and dominated group in the context of our country. Women experience inequality in various aspects like education, access to financial and other resources, decision making in various aspects of their life etc. All these aspects play an important role in enhancing gender inequality. According to the Nepal Demographic and Health Survey (2011), husband or male counterparts are heavily involved in decision-making on issues related to women. In the case of women's health care, the decision is made jointly by husband and wife, while for men's health care; it is largely the husband who makes the decision (MoPH, 2011). The participation of women in decision-making roles as members of the Constituent Assembly has increased dramatically from 2000 to 2012, in line with the constitutional provision of 33 percent female representation. The percentage of women in parliament in 2000 was only 6 percent which has increased after 2007, the revolutionary movement in the country. By the year 2012 the representation has become 33.2 percent (UNSC, 2017). In Nepal, due to various reasons like lack of higher education, access to employment and other skill development activities gender inequality is in higher rate in Dalit communities in comparison to the higher castes. Poverty also plays an important role to enhance the gender inequality by depriving the Dalit from education and to understand the importance of equality in the upliftment of their lifestyle and livelihood. This study aims to explore gender inequality in decision making role among Dalit community getting Old Age Allowance (OAA) in Pokhara. --- Data and Methods Multistage sampling technique was applied for the selection of samples. At first Pokhara Metropolitan city was selected purposively. At second stage, out of 33 wards of Pokhara Metropolitan city, four wards i. e. 13, 16, 26 & 29 were selected randomly. At final stage, out of 553 respondents, 131 respondents (at 7.5% margin of error and 5% level of significance) have been proportionately distributed in four wards (Table 1) for further study. The respondents from each ward were selected purposively (Dalit who are receiving old age allowance). Then the information was collected by using structured questionnaire. The sample size from each ward is as follows: Mala Ranabhat & Ananta Raj Dhungana --- Findings Based on the information collected from 131 respondents, this studyhas the following findings: It is found that the proportion of male is high for the positive reply of the statement that their voice is heard more and given more importance among friends, in family and in society before and after getting old aged allowance (OAA). Statistically it is not significant. However, the percentage of male and female under these indicators has been increased after getting OAA. The proportion of male is higher than the female in the positive response of the statement that their advice is sought on important affairs among friends and in family before and after getting OAA. Statistically it is not significant. However, the percentage of male and female under these indicators has been increased after getting OAA. The proportion of male is higher than the female in the positive response of the statement that their advice is sought on important affairs in society before and after getting OAA. Statistically before getting OAA is not significant with gender and after getting OAA is significant at 5 percent level of significance. However, the percentage of male and female under this indicator has been increased after getting OAA. The proportion of male is higher than the female in the positive response of the statement that they are actively involved in the decision making among friends before and after getting OAA. Statistically before getting OAA is not significant with gender and after getting OAA is significant at 5 percent level of significance. However, the percentage of male and female under this indicator has been increased after getting OAA. The proportion of male is higher than the female in the positive response of the statement that they are actively involved in the decision making in family before and after getting OAA. Statistically it is not significant. However, the percentage of male and female under this indicator has been increased after getting OAA. The proportion of male is higher than the female in the positive response of the statement that they are actively involved in the decision making in society before and after getting OAA. Statistically it is also significant at 5 percent level of significance. However, the percentage of male and female under this indicator has been increased after getting OAA. Mala Ranabhat & Ananta Raj Dhungana --- Conclusion It is concluded that the proportion of male is higher than the female in all the indicators of decision making role of the respondents before and after getting OAA. However, the percentage of the male and female under these indicators has been increased after getting OAA. Further, the decision making indicators like actively involved in the decision making in Society before and after getting OAA, actively involved in the decision making among friends after getting OAA, and advice is sought on important affairs in society after getting OAA have significant association with gender.

The main aim of this paper is to explore gender inequality in decision making role among Dalit community getting Old Age Allowance (OAA) in Pokhara. For this purpose, out of 553 Dalit respondents who were getting OAA, 131 respondents have been proportionately distributed in randomly selected four wards (13, 16, 26 and 29) of Pokhara. Information was collected from these respondents using structured questionnaire. A multistage sampling technique was applied during the sample collection. Chi-squared test was applied to find the association of different decision making role of the respondents with gender.The indicators of the decision making role of the respondents taken in this study are 'The voice is heard more and given more importance', ' Advice is sought on important affairs' and ' Actively involved in the decision making'. The information of these indicators of decision making role of the respondents was collected before and after getting OAA among friends, in family and in society. It is found that the proportion of male is higher than the female in all the indicators of decision making role of the respondents before and after getting OAA. However, the percentage of the male and female was increased after getting OAA. Further, the decision making indicators like actively involved in the decision making in Society' before and after getting OAA, actively involved in the decision making among friends after getting OAA, and advice is sought on important affairs in society after getting OAA have significant association with gender.

INTRODUCTION Among the 1.9 billion women of reproductive age group (15-49 years) worldwide in 2019, 1.1 billion have a need for family planning; of these, 842 million are using contraceptive methods, and 270 million have an unmet need for contraception (Kantorová, 2020). There are various types of natural family planning methods, this includes based body temperature, cervical secretion (Billing's ovulation method), calendar method, symptom-thermal method, standard day's method, lactational amenorrhea method, cycle beads, coitus interrupts (withdrawal method).Natural family planning and preventing pregnancies by observation of naturally occurring signs and symptoms of the fertile and infertile phases of the menstrual cycle, with avoidance of intercourse during fertile phase can be used to prevent pregnancy (WHO, 2012). In this method no drugs, devices, or surgical procedures are used to avoid pregnancy. Most people who choose NFP do so for religious or personal reasons. Natural methods are also known as fertility awareness-based methods. Based on observation, family planning is to certain degree utilized in Shinkafi Town but some are not practicing the natural method especially among people with non-formal education due to cultural beliefs, norms, taboos and religious factors. Therefore, this research is designed to access the awareness and utilization of natural method of family planning among married women of reproductive age in Shinkafi Town. Specifically, to determine the proportion of married women of reproductive age who practice natural method of family planning, identify common method of NFP methods practice by the women, determine the factors hindering married women of reproductive age from utilizing natural method of family planning and to identify methods of improving utilization of NFP. --- METHODOLOGY The research is descriptive in nature and the study was conducted in Shinkafi town. Shinkafi town is one of the rural towns in Katsina State, North West, Nigeria. It is bounded by Dustin Safe 6 km Northwest, Yan Daki 7 km Northwest, Dandagoro 10km South and Makurda 10km East. The populace is predominantly Hausa and Fulani and others who came to the town on government duties or businesses. According to the 2016 population census, the population of Shinkafi is 8,200; married women 1, 600, unmarried women 1,800. The study target population are all married women of reproductive age, ranging from 14-49 years (those who are within the age of giving birth in Shinkafi Town), so as to obtain their views and opinions on the awareness and utilization of natural method of family planning. Krejcie and Morgan table of sampling is used in determining number of the study respondents in which out of 1,600 married couple 310 were selected as sample. Self-constructed questionnaire and check list for structured interview were used as data collection instruments. Data obtained from the respondent were analyzed using appropriate descriptive statistical tools which include frequency distribution table and figures based on the responses of respondents after the questionnaire and structured interview were retrieved. --- RESULTS AND DISCUSSION --- Results The responses of the respondents were analyzed, summarized and presented in the tables. Table 1 shows that 35% of the respondents practice one of the methods of NFP, while 65% do not. Table 3 shows that 30% of the respondents expressed that the factor that hinder them from using NFP are lack of awareness and illiteracy respectively, while 20% stated that the factor is lack of cooperation from husband. Table 4 shows that 30% of the respondents agreed that utilization of NFP can be improved through counselling and peer influence respectively, 26% agreed with health awareness, while 14% agreed with public enlightenment. --- DISCUSSION In the study 35% of the married women of reproductive age that participated in the study practice various methods of natural family planning. This is similar to the findings of the study conducted in the Urban Hall Community, Northern Saudi Arabia which revealed that most women were aware and have a positive attitude towards NFP (Alenezi, & Haridi, 2021). More so, the proportion of married women of reproductive age who practice natural method of family planning was low. This can be related to the findings of the study by Matthias, et al. (2017) in which out of 2560 respondents that -cut across different western countriesparticipated in his study and filled an online questionnaire revealed that forty-seven percent had previously used contraceptives. Ninety-five percent of women and 55% of men said using NFP has helped them to know their body better. Large majorities of men (74%) and women (64%) felt NFP helped to improve their relationship while <10% felt use of NFP had harmed their relationship. Most women (53%) and men (63%) felt using NFP improved their sex life while 32% of women and 24% of men felt it was unchanged from before they used NFP. Seventy-five percent of women and 73% of men said they are either "satisfied" or "very satisfied" with their frequency of sexual intercourse. Also, according to Ajayi, et al. (2018), of the current users of any contraceptive methods, in the Southwestern Nigerian States, about half (44.3%) were using a traditional contraceptive method which include withdrawal, periodic abstinence and standard day/rhythm and lactational amenorrhea. This is contrary to this research findings where all the women who practice Natural Family Planning, practice the olden traditional types of the method like Kiri, Laya, Gurya, Rimi, Paro, and Herbs, among which the most common is Kiri tie on waist, practice by 86% of the women. The natural method of family planning was found to be effective among those who practice it in the area. This is in agreement with National Health Scheme (2021) which categorically stated that "if natural family planning instructions are carefully followed, this method can be up to 99% effective. In this study, lack of awareness and illiteracy about NFP methods were seen as the factors hindering married women of reproductive age from utilizing natural method of family planning. This is similar to the study conducted by Umar et al (2019) at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria which revealed that lack of awareness (24%), been single (17%), unknown reason (17%), irregular menstrual cycle (10%), and fear of method failure (8%) are the major factors that hinder practice of NFP. Similarly, Gonie (2018) shared similar view that low contraceptive prevalence rate might be attributed by husband opposition, religious beliefs, concern and fear of side effects. Having more than seven deliveries and birth interval less than 24 months between the last two children were determinants of contraceptive use. In alignment to this study some of the above factors are right but others in this study include lack of awareness , illiteracy ,religious beliefs and lack of cooperation from the husband or lack of interest from the women herself and fear of failure. --- CONCLUSION In conclusion, it is a vital and essential aspect of life as it's the only method that enables couples to plan the desired family size that they can take good care of which result in the upbringing of reliable children with good potentials. The study revealed the assessment of awareness and utilization of natural method of family planning among married women of reproductive age in Shinkafi Town. Findings revealed that the women are aware but did not practice them, instead they practice the olden traditional ones except for LAM which some practice. However, some factors that hinder the practice of natural method of family planning were identified and also the factors that can improve the practice of natural method of family planning were discovered and the following recommendations were made. i. Nurses should explain the benefits and importance of natural method of family planning to the married women of reproductive age and their husband during health talk and community interactions. ii. Nurses should correct myth and misconception about natural method of family planning. iii. Health care givers should counsel the married women on the utilization of natural methods of family planning and allow them to choose the method of their choice.

The study was conducted on assessment of awareness and utilization of natural method of family planning (NFP) among married women of reproductive age in Shinkafi town. Specifically, to determine the proportion of married women of reproductive age who practice natural method of family planning, identify common method of NFP methods practiced by the women, determine the factors hindering married women of reproductive age from utilizing natural method of family planning and to identify methods of improving utilization of NFP. The research was descriptive in nature, convenience sampling technique was used and 310 respondents were sampled out of 1600 target population. The instrument used for this study was self-structured interview of which 310 were distributed. The data was analyzed using frequency distribution tables. The findings of the study shows that 35% of the respondents practiced NFP, the common method that is practiced is olden natural methods (such as 'Laya', 'Guru/Kiri'), lack of awareness and illiteracy were identified as factors hindering the practice of NFP and the ways of improving utilization are counselling and peer influence. It is recommended that the nurses should explain the benefits and importance of natural method of family planning to the married women of reproductive age and their husbands. Therefore, government should be involved in creating awareness about natural method of family planning through all means that will reach the community in a comprehensible and understandable ways.

Problem definition. Methodology for life quality and safety policy of sociocultural forms for sustainable development -the academic potential for ensuring territorial integrity and sovereignty of the state which roots from national identity of Ukrainians (without territorial, linguistic, ethnic and political prejudice), cosmopolitans and philanthropists with noospherical thinking, and on implementing developments focused on classifying polyvariant sociocultural forms (enlightenment, rehabilitation, continuous learning and cognition with prolonged employment, with a preliminarily forecasted and modelled basis for multimodal patterns of continuous noospherological education); socializing categories of recipients of educational and scientific innovative services which are oriented, in terms of Paradigm of Knowledge № 4(54), 2022 quality and safety, to biosocial civilizational needs for life quality and safety with a strategic goal of advocating the value of balanced dynamics between life and death, with the right and social standards that guarantee protection of academic social and biological mobility, and axiology of the "I-Universe", "I-Development" and "I-Interaction in the system of nature-socium-socialprofessional and personal environment" as well as ensuring safety and protection of biological and landscape diversity for the sake of developing a recreational-aesthetical core group of "those who need" without sociocultural restrictions concerned with their belonging to a certain strata of society, and on the basis of sustainability. The methodology for life quality and safety policy of sociocultural forms for sustainable development is actualized by the strategy of prevalent paradigm of noospherity, interdisciplinary cognition, their multi-level typification, and fundamental, For the first time, a polyvariant range of neomodels for the policy of continuous education, science and innovation theory, and enlightenment with recreational-rehabilitational assets of noospheric education in such fields as "Ecology and ecological safety", "National security", "Engineering sciences", "Pedagogy" will be developed, substantiated and implemented. It is planned to improve methodological approaches and the methodology used for expert assessment of functioning and system management of noospheric education, with traits of life quality and safety of sociocultural forms. It is also envisaged to develop semantically oriented methods of academic services in formation of noospheric education system and neomodels for special conditions. Plans also include creation of a scientific-

Multibranch scientific and technological multi-project activity that consists in forming a methodology for life quality and safety policy of sociocultural forms for sustainable development -theoretical methodological justification, cognition, development and implementation of approbated viable models of public administration of life quality and safety policies for education and scientific systems in special conditions of bifurcations of civilizational sustainability prospects, territorial integrity and sovereignty of Ukraine (academic potential of mobility, preservation and reproduction of environmental protection scientific heritage, ensuring free access to information on the state of life safety and quality by designated purpose on different categories of recipients of education and scientific Paradigm of Knowledge № 4(54), 2022 services, users of continuous learning and prolonged employment social services, for interested and worthy applicants, without restrictions, who are capable of withstanding global challenges).

The Cultural Divide Between Military and Civilian Life Military life is foreign to most civilians. Early in my military career, my wife shared this with me, "When I go through the gates of the base to visit you, I feel like I am entering a foreign country." Being a "citizen" of both worlds, I did not understand this. To me, U.S. military and civilian cultures seemed the same. However, my wife was right. The U.S. military and civilian cultures do differ in their language, customs, traditions, and laws, much like foreign cultures differ from one another. First, military and civilian language differ. Both use English, but military language is unique, using the phonetic alphabet, vernacular, and uniquely military expressions. Second, military traditions and customs are also unique. A well-recognized symbol of military culture is the salute, a formal greeting given to senior ranking officers. Enlisted military personnel must also greet an officer as "Ma'am" or "Sir." Civilians are greeted formally by military personnel as a reminder that the U.S. military serves under civilian leadership, a unique aspect of the U.S. Constitution. Military personnel are not merely being polite-failure to use these greetings is punishable by law. In civilian culture, such formal greetings are out of place and often unwelcome, misinterpreted as a comment on one's age. VA physicians without military backgrounds have shared this with me, "I feel awkward when veterans call me 'Sir' [or 'Ma'am']." From the veteran's point of view, however, all physicians in the military are officers. There-fore, it is natural for veterans to address physicians this way. A veteran likely believes that it is inappropriate to address a physician without these courtesies. Understanding such cultural differences that define a veteran may help avoid awkward moments. Third, the military has its own laws. Members of the U.S. Armed Forces are sworn to defend the U.S. Constitution but are not protected by it. They are subject to the Uniform Code of Military Justice (UCMJ), a different system of laws whose purpose is to maintain order and discipline within the military. For example, malingering, or feigning an illness to avoid one's duties, is illegal under the UCMJ (1) and punishable by court martial, which is equivalent to a federal felony. Under civilian law, faking an illness and falsely "calling in sick" is not illegal. In addition, the rights to privacy are greatly curtailed under the UCMJ. Active duty service members' belongings are routinely inspected and searched. I believe most civilians would dislike routine inspections of their homes and belongings. Although a largely unexplored area, I also suspect that veterans' perspectives of the Health Insurance Portability and Accountability Act and rights to privacy of medical information are skewed by their military experience. --- Veteran's Views and Trust of Physicians I believe one unfortunate aspect of military culture may be the inherent distrust of physicians. Most Americans grow up believing that the physician is someone you see when you are sick with the hope of feeling better. In contrast, military recruits' first encounter with a physician is at a Military Entrance Processing Station, where a physician can exclude candidates from military service if they are found to be unfit. During periods of drafted service, one might consider it "lucky" to be excluded for medical reasons; however, in times of voluntary service, medical exclusion denies eager volunteers the benefits of military service (for example, college benefits, vocational training, and future VA health care). This initial physician's examination may be viewed as an obstacle rather than a screening. In addition, a negative perception of physicians may be reinforced later in one's service. Military personnel with special duty status (pilots, paratroopers, divers) require routine medical examinations. These physicals may be perceived as potential threats. For example, failing a flight physical can ground a pilot and terminate his or her career. This perception might also impede receipt of medical care. Soldiers and Marines returning from Iraq and Afghanistan reported fearing "the perception of stigma," potentially threatening their careers, as a major reason for not seeking medical support for posttraumatic stress disorder (2). Military experience results in a physician-veteran relationship that differs from the physician-patient relationship for which physicians have been trained in medical school. Veterans may perceive physicians as threats rather than as allies or confidants and may extend this distrust to their VA physicians (3). Physicians caring for veterans must acknowledge this potential barrier to health care. After military service, the transition back to civilian life, and becoming a veteran, is not easy. Veterans quickly discover that they are different from civilians. They are also in the minority-less than 7% of the U.S. population has served in the armed forces (4). The VA becomes a sanctuary where veterans gather, a place to express the never-fading impressions imprinted by military culture. --- Crossing the Cultural Divide for Better Veteran Health Care As physicians caring for veterans, we must recognize that they are a culturally unique population and learn more about the culture that defines them. Although most physicians train at a VA hospital (5), a veteran's perception of physicians may differ greatly from those discussed and addressed during medical school and residency. It is crucial to recognize that military service is a key component of social history that influences every aspect of a veteran's life. It may, therefore, be beneficial for physicians to undergo a brief orientation, or "boot camp," where some of these foundations of military culture are explained, such as the different service organizations and military specialties, rank structure, and experiences of service members during training and combat. Lectures at VA-affiliated academic centers or during VA orientation, when feasible and when provided by those with military experience, might be appropriate venues. A better understanding of a veteran's experience will, of course, come from our veteran patients them-selves. It behooves the civilian physician to ask the veteran patient, "Can you tell me about your military service?" Expressing a desire to learn more about military life and accepting the potential cultural discomfort that may arise may earn your veteran patients' trust. Potentially helpful questions to ask are presented in the Table . Empathizing with a veterans' view of their military experience is a critical step in personalized medicine for this population and in creating a veteran-centric approach. Better understanding of military culture may serve as a bridge for physicians to cross the military-civilian cultural divide and strengthen the physician-veteran relationship.

I served as a Marine Corps officer for 10 years before becoming a physician-scientist. My perspectives on military life and medicine, therefore, developed independently. These 2 worlds crossed paths during residency at the Philadelphia Veterans Affairs (VA) Medical Center. Here, my military service helped me be a better physician. It was also where I first shared my military experiences with my fellow VA physicians, most of whom lacked this experience. Many aspects of the military seemed foreign to them, despite their years of service caring for veterans. As a physician and veteran, I have learned that a better understanding of military culture and its effects on veterans' perceptions of health care strengthens the physician-patient relationship. Failing to appreciate these differences can result in veterans' and physicians' perspectives being misaligned when managing a veteran's health.

Introduction --- Background Amid global discourse surrounding LGBTQ+ rights and well-being, understanding their mental health nuances is becoming more significant. Studies on mental health are becoming even more pertinent when considering the profound ramifications of adolescence. Family acceptance and support can often be affected by Confucian values, which emphasize familial bonds and harmony [1]; so, cultural expectations combined with individual identity can either enhance or weaken mental health outcomes. This research integrates positive psychology to understand, nurture, and enhance human strengths and virtues [2]. Empirical data supports these relationships, so this study uses the Multidimensional Scale of Perceived Social Support (MSPSS) and General Health Questionnaire-12 (GHQ-12) instruments to substantiate them. --- Literature Review --- Studies About the Mental Health of LGBTQ+ Adolescents in China The term LGBTQ+ refers to an array of marginalized sexualities and gender identities, an umbrella term representing Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning. According to Meyer's Sexual Minority Stress Model (SMSM) [3], these individuals often encounter exogenous and endogenous pressures relating to discrimination, stigmatization, and homophobia related to their sexual orientation [4]. In China, Hua et al.'s study revealed that sexual minority adolescents had elevated suicidal risks and faced substantial mental health challenges [5]. --- The Importance of Social Support to The Mental Health of LGBTQ+ Adolescents Abbey et al. [6] established that LGBTQ youths in communities with inadequate support exhibit higher risks for adverse mental health outcomes [7]. In Chinese society, emphasizing the necessity of maintaining and expanding family lineages is crucial [9]. However, such social constructs often result in families [9], particularly parents, disapproving of LGBTQ+ children. --- Review Summary and Research Gap Existing literature underscores the significant mental health challenges experienced by LGBTQ+ adolescents in China. Social support is revealed as a crucial element in mental well-being [10], but there is still an apparent gap in research regarding this demographic. --- Hypothesis Development Mental health for LGBTQ+ adolescents in sociocultural contexts such as China is closely connected with social support and is identified as one of the primary determinants of psychological well-being [10]. Given these establishments, the study holds three initial hypotheses: H1: Perceived social support influences LGBTQ+ adolescents' mental health positively in China. H2: Family acceptance positively impacts LGBTQ+ adolescents' mental health in China. H3: Peer acceptance positively impacts LGBTQ+ adolescents' mental health in China. --- Methodology --- Research Philosophy Using the positivism philosophy, this study operates under the assumption that objective truths exist in the world and can be assessed objectively using empirical and observational methods [11]. --- Research Approach This research adopted a deductive methodology, so it began with an overarching theory about LGBTQ+ adolescents' mental health in China before narrowing it down further into hypotheses tested empirically against this initial theory [12]. --- Research Method A quantitative method was utilized, employing structured mechanisms to collect and analyze numerical data. The quantitative techniques helped facilitate statistical, mathematical, or computational approaches to establish relationships among various constructs [17]. --- Research Strategy Given the delicate nature of LGBTQ+ identities and mental health, an online questionnaire was selected as the primary data collection method. The format offered greater anonymity for participants while creating an environment conducive to honest responses. --- Sampling To reach China's LGBTQ+ community, the study recruited through referrals, where first recruits reached out to acquaintances aged between 13 and 18. --- Distribution and Duration An online survey was distributed via Chinese platforms, including WeChat, QQ space, Weibo, and TikTok China, to maximize reach and response. This strategy ensured a broad pool of potential participants for optimal reach and response rates; once response rates reached plateau status [13], closing procedures took place to protect data integrity and manageability. --- measurements --- Measurement of Social Support This research took inspiration from the Multidimensional Scale of Perceived Social Support (MSPSS) by Zimet et al. 1988. It is a 12-item questionnaire measuring perceived social support from three key sources -families, friends, and significant others. A 7-point Likert scale was chosen due to its validation in prior LGBTQ+ research and being reliable and brief enough for online surveys. --- Measuring Mental Health This study used David Goldberg's 1970s GHQ-12 questionnaire to assess psychological distress [15]. Utilizing a scoring mechanism (0-1-1-1-2-2-3), higher scores correlate to increased distress levels; its short length, appropriateness for adolescents, and empirical validations made it the ideal candidate for use in this research [15]. --- Data Analysis The raw data were initially processed using Excel to generate MSPSS and GHQ-12 scores and create visual representations such as bar charts. In-depth analyses were then completed in SPSS. Correlogram analysis was then employed to examine correlational relationships between scores on MSPSS and GHQ-12 questionnaires and scatter diagrams, with lines of best fit utilized to illustrate such associations, and descriptive statistics, like means, standard deviations, and frequency distributions calculated to provide a complete picture of this dataset. --- Ethical Considerations Before undertaking the questionnaire, participants were made fully aware of its objectives and rigorous confidentiality measures in place. Participation was entirely voluntary. --- 3. --- Findings --- Descriptive Statistics The study first had 75 respondents aged 13-18, but 21 were excluded after failing to meet the inclusion criteria. Exclusion criteria regarded consistency and logic of responses and duration required to complete the questionnaire; quality control ensured more reliable data collection. Figure 1 shows how the participants identified. The figure shows the diverse representation within the LGBTQ+ sphere, with Bisexuals comprising the largest subgroup, followed by Transgender individuals. Most participants fell within the upper end of adolescence (Figure 2); 40 were 18, and 27 17-year-olds. --- Correlational Analysis The Pearson correlation analysis was used to measure linear relationships between two variables. A correlation coefficient value typically ranges between -1 and 1. A value near 1 indicates a strong positive correlation. A value near -1 suggests a strong negative correlation. Finally, values closer to zero represent weak or no linear relationships between variables. If correlations are significant at 0.01 level or lower, there's less than a 1% chance they are due to random variation, providing strong evidence of genuine relationships. As seen in Table 1, the correlation coefficient between GHQ-12 and MPSS was found to be -0.444, indicating a moderate negative correlation (Figure 3) that suggests that as perceived social support (measured by MPSS) increases, psychological distress (as measured by GHQ-12) decreases, supporting the hypotheses. GHQ-12 and family support showed a correlation coefficient of -0.407, statistically significant at the 0.01 level (Table 2). This indicates a moderate negative correlation, suggesting that as family support increases, psychological distress tends to diminish (Figure 4). As for GHQ-12 and friend support (Table 3), its correlation coefficient stands at -0.462; this number is statistically significant at the 0.01 level and indicates a slightly stronger negative relationship (Figure 5). This data suggests that increasing social support helps decrease psychological distress more rapidly than increased family support does. --- Discussion The study identifies significant negative correlations between perceived social support measured using the MPSS and psychological distress measured by GHQ-12 [8]. Many studies have confirmed this relationship, including positive correlations between MPSS and GHQ-12 scores and decreased psychological distress levels [14]. Family is the primary socialization agent for LGBTQ+ adolescents. Therefore, familial acceptance could reduce psychological distress levels as an external stigmatization can have on those experiencing internalized stigmatization. Friends also play an essential role in providing peer validation and providing a sense of belonging for LGBTQ+ individuals in unsupportive or hostile family environments [16]. --- Conclusion The study's findings are consistent with other studies' findings that there exist significant negative correlations between perceived social support and psychological distress. The paper underscores the role of schools, families, and communities, emphasizing creating inclusive spaces that promote psychological well-being. However, this study has limitations. The online survey may exhibit selection bias, given the likelihood that participants with internet access and active accounts on platforms like WeChat may have more influential socio-economic or educational backgrounds than those without access. Furthermore, its reliance on self-reported data may lead to potential biases given the sensitive topics explored; furthermore, its cross-sectional design prevents conclusions regarding causality. Nonetheless, future research can take advantage of adopting a longitudinal approach to understand the shifting dynamics of social support and psychological well-being among LGBTQ+ adolescents. Also, expanding sample size and diversifying data collection methods could yield richer, multifaceted insights into LGBTQ+ adolescents' lived experiences in China and beyond.

Given the global discussion surrounding LGBTQ+ rights and welfare, this research addresses mental health nuances specific to Chinese adolescents who identify as LGBTQ+. Understanding how perceptions of social support work within Chinese societal structures shaped by historical and Confucian values is paramount. Adolescence, which is already a challenging stage of identity formation, becomes even more so for LGBTQ+ individuals due to society's recognition and acceptance that can directly impact their mental well-being. Utilizing positive psychology, this research investigates the protective role that social support has for its recipients. Through the Multidimensional Scale of Perceived Social Support (MSPSS) and General Health Questionnaire-12 (GHQ-12), this research seeks to understand the relationship between perceived social support and mental health in this demographic. Due to the sensitivity surrounding LGBTQ+ identities in China, an online survey method was selected and distributed via key Chinese platforms. Our findings indicated a striking negative correlation between perceived social support and psychological distress -emphasizing the significance of peer and family acknowledgment for individual well-being. This study provides a platform for understanding LGBTQ+ experiences in China and developing interventions that address their mental well-being.

Michael Hodgins 1 , Katarina Ostojic 1 , Si Wang 1 , Kim Lyle 2 , Kenny Lawson 4 , Tania Rimes 3 , Sue Woolfenden 1.5 1: The Population Child Health Research Group, UNSW, Randwick, NSW, Australia Evidence is emerging on the efficacy of Integrated Health and Social Care (IHSC) hubs to improve the early detection and intervention of developmental vulnerability in children from culturally and linguistically diverse and/or socioeconomically disadvantaged backgrounds. IHSC hub models typically involve co-located child and family health services and non-government organisations, which deliver a range of psychosocial services, for example playgroups, domestic violence support, mental health support, early childhood education. However, there remains a dearth of evidence on how to successfully implement and sustain the integration of health and social care. Our project aimed to evaluate the impact and implementation of IHSC hub s for migrant and refugee populations in three sites in New South Wales, Australia with high proportions of migrant and refugee communities. To help implement and sustain IHSC hubs, we developed an orientation model detailing the operational principles required for successful integration of IHSC hubs. This presentation is based on a qualitative exploration of the barriers and enablers to implementing IHSC hubs in three sites in New South Wales, Australia guided by the Consolidated Framework for Implementation Research. Development of the orientation model involved semistructured interviews and five workshops with 25 participants including clinicians, providers, and managers from child and family health services and non -government social services to understand their perspectives on the barriers and facilitators to implementing an IHSC hub. Important findings from this work included the need for tangible guidelines that detail the activities that best enable the successful integration of services within a hub model. Our orientation model details the operational principles of integrating health and social services for early childhood health. These include the setting up phase activities of buy-in which details approaches for developing a common agenda and partnership development, which outlines mechanisms for fostering collaboration between health and social services. Following this, our orientation model articulates the need to establish connecting support, including infrastructure governance and resources that support integration between services; ongoing integration activities such as the feedback mechanisms and ongoing communication channels necessary for successful integration; and activities that enhance a hubs relevance for the community it services. This model establishes key components for implementing IHSC hubs, which are Hodgins: An orientation model for implementing and sustaining integrated health and social care hubs for early childhood development garnering increasing attention in early childhood contexts globally. Future work will involve disseminating the orientation model broadly across child and family health and social servic es and evaluating the uptake of the model in broader contexts.

An orientation model for implementing and sustaining integrated health and social care hubs for early childhood development.

Introduction The education sector plays a crucial role in a nation's development. Government policies aimed at providing equal educational opportunities for all segments of society and promoting community involvement in education, while also considering economic principles within the context of the Indonesian Republic, have led to an increase in the number of educational institutions, particularly universities. To address the challenges in the industrial world, the Ministry of Education and Culture is actively promoting the transformation of higher education through the "Merdeka Belajar Kampus Merdeka (MBKM)" policy. This program offers students extensive opportunities to enhance their insights and competencies in the real world, aligning with their passions and ideals. In North Maluku Province, a key hub for education in Eastern Indonesia, there is a strong emphasis on the development of the education sector, spanning from basic education to higher education. Every year, a growing number of prospective students enroll in various universities, both public and private, in North Maluku Province. The expansion of universities and academic programs in the region has heightened competition among institutions for recruiting prospective students. Consequently, every private university in North Maluku Province must continually enhance the quality of their graduates. Understanding the evolving external factors and changing behaviors of prospective students in selecting higher education programs is an intriguing subject for university administrators. They aim to investigate the factors that significantly influence students' choices in higher education programs, enabling program managers to proactively create offerings that align with the interests and needs of prospective students. The shifts in student behavior regarding program choices appear to be shaped by economic, socio-cultural, and technological developments, as well as family influences, which increasingly prioritize practical needs such as job opportunities and social status in the community. This issue warrants in-depth study and the development of solutions because if these trends persist, there may be a future shortage of qualified human resources in specific fields, impacting scientific advancement in those areas. Based on these considerations, this study seeks to identify both internal and external factors that influence students' decision-making processes when selecting university programs. The outcomes of this research are expected to provide valuable insights for program management and higher education institutions, helping them create new programs that cater to the preferences and interests of students. --- Literature Review Research by Pratiwi and Mandala (2015) revealed that cultural factors positively influence purchasing decisions, as do social factors. Similarly, Ghoni and Bodroastuti (2011) underlines the importance of cultural and social factors, suggesting that improving these factors can lead to increased consumer behavior in buying decisions. However, Adhim (2020) found that cultural factors have a negative and significant impact on consumer behavior in purchasing decisions, while social factors have a positive and significant effect. In contrast, research by Darmawan (2018) found that social factors have positive and significant effects on purchasing decisions. It's noteworthy that various factors, including cultural, social, personal, and psychological variables, significantly affect purchasing decisions. This implies that these influences, when channeled through consumer satisfaction, can enhance purchasing decisions. Putri and Suhermin (2022) indicated that cultural factors have a positive and significant impact on purchasing decisions, but social factors do not significantly influence them. Therefore, based on this literature, the following hypothesis is proposed in this study: H1: Socio-Cultural factors influence decision-making. Marketing communication can influence consumer motivation, attitudes, and behavior. Motivation, as defined by Schiffman and Kanuk (2008), is the driving force within individuals that compels them to take action. In other words, motivation is the internal force that drives individuals to act, motivated by their desires to achieve goals. Pratiwi and Mandala (2015) found that the marketing mix has a positive impact on purchasing decisions. Hidayat (2017) revealed that indicators of marketing communication, particularly price, have a positive and significant effect on purchasing decisions. Consequently, this literature leads us to formulate the following hypothesis for this study: H2: Marketing Communication Influences Decision-Making. Pratiwi and Mandala (2015) found that personal factors positively influence purchasing decisions. Similarly, Ghoni and Bodroastuti (2011) demonstrated that personal factors have a positive and significant impact on consumer behavior. This implies that improving personal factors can lead to increased consumer behavior in purchasing decisions. Adhim (2020) also found that personal factors have a positive and significant influence on consumer behavior in purchasing decisions. This suggests that these influences, when channeled through consumer satisfaction, can enhance purchasing decisions. In contrast, Putri and Suhermin (2022) indicated that personal factors did not significantly affect purchasing decisions. Thus, on account of this literature, we posit the following hypothesis in this study: Surabaya, October 28-29 th , 2023 H3: Personal Factors Influence Decision-Making. --- Method The analysis approach employed in this study is causal analysis, which aims to investigate the factors that influence certain variables. The study's target population consists of students attending private universities on Morotai Island in North Maluku. Based on the previous study, it was determined that 53 respondents were required to achieve a statistical power of 80% in a study with a maximum of four factors affecting one variable (Hair, et al., 2014). This calculation was based on an R 2 value of 0.25 and a significance level of 10%. Therefore, purposive sampling was conducted to gather data from students hailing from Morotai Island until the desired sample size was attained. The collected data was then processed using the Partial Least Square method with the assistance of SmartPLS software. The questions used in this study to measure different aspects were adopted from earlier research that focused on socio-cultural factors, personal factor, marketing communication, and decision-making. --- Result and Discussion This study gathered a total of 53 respondents by distributing questionnaires via Google Form. Among these respondents, 28 were men (53%), and 25 were women (47%). Importantly, all respondents were from Morotai Island. The study was deemed to be valid and have discriminant validity because the Heterotrait-Monotrait Ratio did not surpass 0.90. All variables are considered reliable since the composite reliability is above 0.70. The R 2 value for the decision-making variable, which is 0.712, indicates that 71.2% of the variation in the decision-making variable is explained by the variables in this study, while the remaining 28.8% is influenced by factors outside the scope of this study. As shown in Table 3, it was observed that marketing communication had a positive impact on student decision-making on Morotai Island, with an original sample value of 0.110. However, this positive effect was not statistically significant, as indicated by a T Statistic value of 0.760 (below 1.65) and a p-value of 0.447 (above 0.1). On the other hand, personal factors were found to have a positive and significant impact on decision-making, with an original sample value of 0.810. This impact was supported by a T Statistic value of 8.355 (above 1.65) and a p-value of 0.000 (below 0.1). Finally, socio-cultural factors had a positive effect on decision-making, with an original sample value of 0.187, but this effect was not statistically significant, with a T Statistic of 1.152 (below 1.65) and a p-value of 0.250 (above 0.1). Based on these findings, H1, H2, and H3 in this study were accepted. In conclusion, among the variables influencing students' decision-making in university selection, including marketing communication, personal factors, and socio-cultural factors, personal factors have the most substantial influence. --- Conclusions In conclusion, the education sector in Indonesia, particularly in North Maluku Province, plays a pivotal role in the nation's development. Government policies aimed at fostering equal educational opportunities and community involvement, within the framework of the Indonesian Republic, have led to a surge in the number of educational institutions, notably universities. The Ministry of Education and Culture's proactive promotion of higher education transformation through the "Merdeka Belajar Kampus Merdeka (MBKM)" policy underscores the commitment to providing students with opportunities to enrich their insights and competencies in alignment with their passions and ideals. This is especially significant in North Maluku Province, a key educational hub in Eastern Indonesia, where competition among universities for prospective students is intense. Understanding the evolving dynamics of student behavior in program selection, shaped by economic, socio-cultural, and technological factors, as well as family influences, is crucial. Failure to address these trends could result in a future shortage of qualified human resources, potentially impacting scientific advancement. This study's findings indicate that personal factors wield the most significant influence on students' decision-making in choosing university programs. While marketing communication and socio-cultural factors also have an impact, they are not as pronounced in this context. These insights can guide program management and higher education institutions in tailoring offerings to better meet the preferences and interests of prospective students, ultimately contributing to the enhancement of the education sector and the nation's development.

Understanding the evolving dynamics of student behavior in program selection, influenced by economic, socio-cultural, technological factors, and family influences, is of utmost importance. This study aims to explore the factors that shape students' decision-making when it comes to choosing a college. A purposive sampling method was employed, gathering responses from 53 students hailing from Morotai Island, North Maluku. The study utilized the Partial Least Square statistical analysis technique with the assistance of SmartPLS software. The findings of this research highlight that among the factors affecting decision-making, such as marketing communication, personal factors, and socio-cultural aspects, personal factors exert the most significant influence on student decision-making. This result emphasizes the significance of tailoring educational offerings to align with individual preferences and needs.

INTRODUCTION In the intricate tapestry of a child's development, the family unit serves as a foundational element, shaping not only their emotional well-being but also profoundly influencing their educational journey. This study, titled "Breaking Ties: A Comprehensive Analysis of Familial Fractures and Their Impact on Children's Education," ventures into the complex terrain where family conflicts intersect with the educational trajectories of children. As the bonds within a family are strained and fractured, the study seeks to unravel the multifaceted ways in which these familial fractures reverberate through a child's academic performance, Family conflicts can manifest in various forms, from parental discord to sibling rivalries, and their impact on children's education can be profound. The introduction of this research endeavors to set the stage for understanding the intricate dynamics involved. It recognizes that familial fractures extend beyond the immediate family structure, permeating the educational environment and influencing the child's engagement with learning. --- Research The significance of this study lies not only in recognizing the existence of familial fractures but also in comprehensively analyzing their repercussions. The exploration encompasses the examination of academic performance metrics, the socioemotional well-being of children, and the trajectories that shape their educational experiences. By adopting a holistic perspective, this research aims to provide insights that extend beyond traditional academic assessments, delving into the psychosocial dimensions of a child's educational journey. As we embark on this exploration of "Breaking Ties," it is essential to acknowledge the contextual nuances that define familial fractures. The introduction delineates the scope of the study, outlining the key objectives and questions that will guide the research process. Additionally, it emphasizes the potential implications of the findings, hinting at the broader significance for educators, parents, and policymakers vested in the welfare and academic success of children navigating familial challenges. With the intricate interplay between family dynamics and educational outcomes as its focal point, "Breaking Ties" aspires to contribute not only to the academic discourse but also to the development of targeted interventions and support systems. By understanding the complex relationships between familial fractures and children's education, this study aims to pave the way for informed strategies that nurture resilience, foster positive coping mechanisms, and ultimately break the cycle of adverse impacts on the educational landscape. --- METHOD The research process for "Breaking Ties: A Comprehensive Analysis of Familial Fractures and Their Impact on Children's Education" unfolds as a methodical journey, integrating qualitative and quantitative methodologies to unearth the intricate dynamics between family conflicts and educational outcomes for children. Initiating with a thorough literature review, the research team delves into existing scholarship, synthesizing theories and empirical findings to shape the foundational understanding of familial fractures and their potential implications on children's education. This phase provides a theoretical framework, guiding the subsequent stages of the research. Qualitative interviews emerge as a central element in capturing the lived experiences and diverse perspectives surrounding familial fractures. Engaging with parents, educators, and children, the qualitative data collection process unfolds organically through open-ended conversations. These narratives bring forth the emotional nuances, coping mechanisms, and familial dynamics that may influence a child's educational journey amidst familial conflicts. Simultaneously, quantitative data is gathered through surveys and questionnaires distributed to a diverse sample of participants. These instruments are Ethical considerations are carefully woven into every phase of the process, ensuring the well-being and rights of participants. Informed consent is secured, and measures are implemented to protect the privacy and confidentiality of those involved, particularly given the sensitive nature of the research topic. The convergence of qualitative and quantitative data sets the stage for a comprehensive analysis. Employing a mixed-methods approach, the research team embarks on a rigorous data analysis process, utilizing techniques such as thematic coding and statistical analyses. This iterative process involves the identification of emerging patterns, correlations, and themes, guiding the interpretation of findings. As the research process unfolds, it aims not only to contribute to the academic discourse surrounding familial fractures and children's education but also to provide actionable insights for educators, parents, and policymakers. Through this multifaceted and ethically guided approach, "Breaking Ties" aspires to illuminate the complex dynamics at the intersection of family conflicts and educational outcomes, ultimately fostering a deeper understanding that can inform interventions, support mechanisms, and educational policies. The methodology employed in "Breaking Ties: A Comprehensive Analysis of Familial Fractures and Their Impact on Children's Education" is meticulously designed to capture the multifaceted and nuanced dimensions of the complex interplay between family conflicts and children's educational outcomes. Literature Review: The research commences with an extensive review of existing literature on family conflicts and their potential impact on children's education. This foundational step seeks to understand the prevailing theories, methodologies, and key findings in the field. The literature review forms the basis for the development of research questions and informs the selection of relevant variables to be explored. --- Qualitative Interviews: A qualitative approach is adopted to capture the rich narratives surrounding familial fractures and their effects on children's education. In-depth interviews are conducted with parents, educators, and, where appropriate, the children themselves. The qualitative data generated through these interviews provide nuanced insights into the lived experiences, coping mechanisms, and psychosocial dynamics within families facing conflicts. Open-ended questions facilitate a holistic exploration of the multifaceted aspects of familial fractures. --- Surveys and Questionnaires: Quantitative data is collected through surveys and questionnaires administered to a diverse sample of parents, teachers, and, where ethical and ageappropriate, the children. This multifaceted approach provides a comprehensive understanding of how family conflicts may manifest in the educational sphere. --- Ethical Considerations: Ethical considerations play a central role throughout the research process. Informed consent is obtained from all participants, ensuring transparency and respect for their autonomy. Steps are taken to guarantee the confidentiality and privacy of participants, particularly when exploring sensitive topics related to familial conflicts. Ethical guidelines are adhered to in the collection, analysis, and dissemination of data, prioritizing the well-being and rights of all involved parties. --- Data Analysis: A mixed-methods approach is employed, integrating qualitative data analysis techniques such as thematic coding with quantitative statistical analyses. This comprehensive strategy enables a holistic interpretation of the findings, allowing for a nuanced understanding of the intricate relationships between familial fractures and children's educational outcomes. Through the convergence of qualitative and quantitative methods, the methodology of "Breaking Ties" aims to provide a robust and multifaceted analysis of familial fractures and their impact on children's education. The triangulation of data sources contributes to the depth and reliability of the findings, facilitating a comprehensive exploration of the research questions and offering valuable insights for educators, parents, and policymakers. --- RESULTS The results of "Breaking Ties: A Comprehensive Analysis of Familial Fractures and Their Impact on Children's Education" illuminate the intricate interplay between family conflicts and the educational trajectories of children. Qualitative interviews unveiled a spectrum of experiences, revealing that familial fractures can manifest in diverse ways, from parental discord to sibling rivalries, profoundly influencing children's emotional well-being and academic engagement. The narratives underscored the resilience exhibited by some children, while others grappled with the psychosocial impacts of familial conflicts, often reflected in altered academic performance. Quantitative data reinforced and complemented the qualitative insights, providing statistical evidence of correlations between familial fractures and variations in academic achievement. Surveys and questionnaires highlighted shifts in school engagement, socioemotional well-being, and perceptions of the educational environment among children facing family conflicts. Academic performance metrics further supported these findings, demonstrating a discernible relationship between the intensity of familial fractures and fluctuations in standardized test scores and overall academic outcomes. --- The American --- DISCUSSION The discussion delves into the nuanced dimensions revealed by the results, exploring the implications of familial fractures on children's education. The qualitative narratives and quantitative data converge to paint a comprehensive picture, emphasizing that the impact of family conflicts extends beyond academic metrics to shape a child's overall educational experience. The discussion addresses the complexity of the relationships identified, acknowledging that familial fractures may not uniformly lead to negative outcomes; rather, individual resilience and coping mechanisms play crucial roles in shaping a child's response. Moreover, the discussion delves into the potential mediating factors that could influence the observed correlations. Factors such as the presence of a support system, access to counseling services, and the effectiveness of conflict resolution strategies within families emerge as critical variables. By scrutinizing these factors, the study seeks to provide a more nuanced understanding of how interventions and support structures might mitigate the negative impacts of familial fractures on children's education. --- CONCLUSION In conclusion, "Breaking Ties" underscores the intricate and multifaceted nature of the relationship between familial fractures and children's education. The comprehensive analysis, integrating qualitative narratives with quantitative metrics, contributes to a holistic understanding of the diverse ways in which family conflicts permeate the educational landscape. Recognizing the heterogeneity of experiences, the study advocates for tailored interventions that consider individual coping mechanisms, support structures, and the unique psychosocial needs of each child. The findings of this research carry implications for educators, parents, and policymakers. By acknowledging the potential impact of familial fractures on a child's educational journey, stakeholders can work collaboratively to implement targeted interventions, support mechanisms, and educational policies that foster resilience and mitigate adverse outcomes. The study underscores the importance of a holistic approach that integrates academic and socioemotional support to create an educational environment conducive to the well-being and success of children navigating familial challenges. As "Breaking Ties" concludes, it does not merely mark the end of a research endeavor but serves as a catalyst for ongoing discussions, informed interventions, and continued exploration into the complex dynamics shaping the educational experiences of children facing familial fractures.

This study, titled "Breaking Ties: A Comprehensive Analysis of Familial Fractures and Their Impact on Children's Education," delves into the intricate dynamics between family conflicts and children's educational outcomes. Utilizing a multidimensional approach, the research explores the varied manifestations of familial fractures and their repercussions on academic performance, emotional well-being, and overall educational trajectories. Through a synthesis of qualitative narratives and quantitative assessments, the study aims to provide a nuanced understanding of the complex interplay between family dynamics and children's educational experiences.

n The patterns of life (POL) present a unique challenge for computational modeling because systems must produce both meaningful regularities throughout a large population and also believable behaviors at the level of each individual. We describe how computational POL modeling integrates diverse artificial intelligence research areas and provides interesting challenges in multiple fields. SPRING 2014 11 tary and law-enforcement models could support observational and small-unit interaction training, intrusion detection, emergency planning, or community relations. Computational POL models will also benefit academic researchers by giving them new tools to generate and validate theories about complex sociocultural patterns. Finally, POL presents an interesting computational modeling challenge for research in many AI fields because of its complex, multilevel interaction. POL modeling differs from standard agent-based modeling in that not only individual behaviors, but also their collective emergent patterns, are targets of study. At the same time, the behavior of any single individual is potentially important. As a specific example, the virtual observation platform (VOP) is an immersive simulation designed to train military personnel to interpret indicators before a critical incident, such as a terrorist attack, occurs (Schatz et al. 2012). Pre-event indicators are often ambiguous variations in a typical pattern: a car parked in an odd spot, a sparse crowd in a normally busy public square. Trainees practice identifying and reporting regularities of individual behavior, small group interactions, and population gestalt as they watch a simulation play out in real time. They should see subtle variations in interactions between simulated characters and interpret the meaning underlying any differences. To support these needs, the system requires a POL model. --- Challenge: Scalable Models of Patterns of Life Creating computational models of POL, however, is a significant scientific and technical challenge. To meet it, researchers must achieve simultaneous scalability along three key dimensions: population size, individual fidelity, and automatic behavior specification. In the following text, we outline the POL scalability challenges and argue that AI offers methods and tools that have been used successfully in solving problems with features similar to POL modeling. --- Population Size Generating the behavior of many individuals in real time (or faster) remains a technical hurdle for POL. Even small villages contain hundreds of residents; cities have millions. In the VOP example, trainees might need to see hundreds of simulated characters populating a public marketplace in order to understand the normal range of behaviors and interactions in such an environment. At the same time, many more characters need to populate every surrounding business and city street that the trainees can observe. The large population is vital to providing the required fidelity in background activities and creating an appropriate context for identifying anomalies. In the current state of the art, researchers contem-plate scaling to millions of entities through parallelism (Aaby, Perumalla, and Seal 2010). However, narrow individual intelligences are required to model large populations today. For example, fluid dynamics efficiently models entity movement in large crowds (Hughes 2002) but is limited to modeling only physical movements and not the meetings, arguments, and interchanges that take place between friends and strangers. --- Individual Fidelity Scalable POL requires greater breadth in intelligence of individuals, including richness of inputs, behavior choices, and decision complexity in order to produce realistic behavior for individual entities. For example, the displayed behaviors that underlie patterns may need to be highly robust so that they can be carried out despite the interference of human users in the simulation. In cases where humans do not directly influence a simulation, intelligence is still required in order to respond to the many other agents that populate the environment. Unfortunately, efficient approaches like fluid dynamics models do not model individual intents and actions, and therefore do not provide the finegrained interactions necessary for many POL applications. Abstract models that completely subsume individual decisions in order to display group behaviors lack believability under fine observation of individuals, and if no goal or reason drives an agent, it is impossible to discern a correct meaning of its behaviors. Conversely, executing a fine-grained model of every individual, at all times, is likely to create unacceptable authoring and run-time computation requirements. As a consequence, a heterogeneous environment of intelligent entities is necessary in POL systems. This introduces additional run-time challenges: for example, blending relatively few highly intelligent agents with less intelligent entities so that distinctions between them are not obvious and dynamically switching individuals between simple and robust controllers, letting the entire population present large-scale patterns and modeling select entities with increased fidelity only when needed to ensure that vital interactions appear. We are taking this approach in investigating efficient POL representations that support planning and reacting for a small city of entities (Jones et al., 2014). Behavior Specification POL model synthesis includes authoring, generalization to diverse settings, and run-time adaptation. The complex interaction of components in generating a pattern of life creates tension between human specification (which is costly in time and labor), automated model creation from real-world data (which may be too tied to specific populations and biased by availability of limited data sources), and synthetic models (which may produce unrealistic POL). Researchers must determine which aspects can be automatically generated and how to ease human control over details that cannot be automated. Authoring POL content can draw from real-world data such as video sources, authoritative input from residents or anthropologists, or cultural artifacts like media. Current research in these fields will support improvements to POL, but important issues for computational modeling remain. Content generalization raises questions of identifying cultural universals, defining cultural differences, and creating relevant model overlays that efficiently capture the differences. Run-time adaptation of the patterns being displayed requires model representations that can influence many individual behaviors with fewer, more abstract directives. Without this abstraction capability, the patterns produced will be unacceptably dependent on individual decisions, making it difficult to identify core causal patterns. --- Artificial Intelligence Solutions Current population simulations often have limited application or research impact due to a lack of scalability along at least one of the scalability dimensions (figure 1). A city-sized traffic model for the VOP could be synthesized automatically from observed traffic patterns but would disallow a spontaneous street celebration due to the limited knowledge of individual entities. A high-fidelity model of the interpersonal interactions that occur with a few village elders during a military patrol in the VOP would not generalize to a town-sized population due to knowledge engineering costs. Modeling patterns of life that scale along all three dimensions requires new approaches New challenges in the fields of data mining and pattern recognition for POL will be to extract and interpret the more subtle variations of everyday life, to recognize gestalt patterns in addition to individual actions or events, and to incorporate commonsense reasoning and narrative understanding into diverse settings. In order for pattern-recognition approaches to identify and then simulate POL regularities and anomalies, researchers need to learn which features to consider despite all the breadth and subtleties of human interaction. Identifying these features and data sources to support them is a nontrivial task. We suggest it may be fruitful initially to study POL in constrained human domains that are limited in the number of possible observable behaviors and latent goals. Examples of problems with existing data sets might include movement patterns of ships, trucks, airplanes, or people within a specific geographic area or network. Studies targeting such domains could develop new metrics and processes for recognizing high-value inputs, outputs, and patterns for POL in general. This work will support POL if it can give insights into modeling new domains that encompass more numerous and varied observations and hidden processes, such as life in the VOP. --- Representational Abstraction A "missing link" in modeling POL is the lack of general, stable representations of population behavior. However, finding and exploiting computationally precise, useful representations at different levels of abstractions is a hallmark of AI, from the study of the processes of mind and structure of games in AI's infancy to recent advances in market abstractions and agency. POL researchers have defined representations, such as social networks and crowd models, which reflect AI's representational heritage. These results, while important, are comparable to Simon's (1996) individual watch parts. Progressing directly from these scattered elements to a useful and scalable POL has proven difficult. We recommend a shift to identifying higher-level abstractions (subsystem representations and rules to compose them) that encapsulate individual patterns and influences, control their interactions, and thus enable their assembly into the working watch of a scalable POL simulation. Hierarchical representations of crowds, groups, and individuals (for example, Musse and Thalmann 2001) suggest a path toward this goal, but significant extension will be required to include the many factors that influence patterns of life. --- Behavior Generation Computational models of human behavior (for example, Anderson and Lebiere [1998], Laird [2012]) and intelligent agents (for example, Wooldridge [2000]) have also been major thrusts in AI. Generative behavior models are needed in order to reify and explore new findings about POL. Researchers who develop generative POL models will contribute to validation and verification of work in the new field and provide important utility to applied users. In this area, crowd-integrated cognitive models (Pelechano et al. 2005) and agent-based systems that can plan ahead, reason, and react (Laird 2012) are relevant to generating complex behaviors that can both support and potentially control emergent patterns. Prior work in heterogeneous computational modeling of individuals (Lebiere et al. 2002, Wray et al. 2005) may offer initial points of exploration for heterogeneous behavior generation for POL. In conclusion, contributions from many fields of AI will be welcomed to meet key challenges and realize new opportunities by creating scalable models for patterns of life. --- AIIDE-14 is the definitive point of interaction between entertainment software developers interested in AI and academic and industrial AI researchers. The conference is targeted at both the research and commercial communities, promoting AI research and practice in the context of interactive digital entertainment systems with an emphasis on commercial computer and video games. AIIDE-14 will include invited speakers, research and practitioner presentations, playable experiences, project demonstrations, interactive poster sessions, and a doctoral consortium. The program also includes a workshop program, which will be held on the first two days of the conference, October 3-4. --- www.aiide.org

atterns of life (POL) are emergent properties of complex human social systems such as neighborhoods or even cities (Schatz et al. 2012). In such systems, observable regularities manifest from the interactions of individuals' behaviors and social norms. Simultaneously, these patterns of life impose structure on individual decisions. For example, a pattern of rush hour traffic arises from drivers' decisions to commute at a certain time. Knowledge of rush hour influences individuals' departure times. Modeling POL is not only an academic pursuit. Before the promulgation of germ theory, medical experts were able to explain a deadly cholera outbreak that decimated one London neighborhood when they reconstructed local patterns of life and related affected individuals to a particular public water pump (Snow 1855). In 2011, sociocultural experts were able to locate Osama bin Laden by recognizing ways his household deviated from the typical pattern of life in the surroundings, behaving much more secretively than his suburban neighbors (Preston 2012). Building on such social and cultural expertise, computational modeling of POL offers potential to continue extending POL's practical application and theoretical study. In industry, POL models might support decisions about marketing, logistics, network security, or building design. Mili-

INTRODUCTION Human papillomavirus (HPV) vaccination to prevent cervical cancer has been approved in many countries. The Department of Health in the UK introduced routine vaccination of 12-year-old girls in September 2008, together with a catch-up programme for older teenagers. The current vaccines are expected to protect against HPV 16 and HPV 18 which are responsible for 70 % of the cases of cervical cancer [1], but high coverage is required for maximum impact [2]. In England, inequalities in immunization uptake are persistent [3]. Previous research has shown that single parenthood, residence in ethnic or disadvantaged wards, high birth order or family size as well as maternal smoking, were associated with lower uptake of childhood vaccination [4][5][6]. Poorer children, or those in households with low uptake rates are at increased risk of developing vaccine-preventable diseases [7], including cervical cancer [8]. Persistent ethnic inequalities in health, extending between generations, have been reported in the UK [9]. Irrespective of socio-economic status, negative attitudes to vaccination against a sexually transmitted infection, which may be differentially distributed between and within ethnic minority groups, could reduce HPV vaccine acceptance [10]. In 2007-2008 we undertook a feasibility study offering bivalent HPV vaccination (Cervarix 1 ; GlaxoSmithKline, Belgium) to all year-8 schoolgirls (aged 12 or 13 years) in two primary-care trust (PCT) areas in Greater Manchester, UK [11,12]. In this school-based programme, uptake was 71 % at the first dose with 68 % receiving the full three-dose course [13]. In this paper we describe associations between HPV vaccine uptake and deprivation, ethnicity and other childhood immunizations. To our knowledge, no previous research has examined the relationship between social deprivation and adolescent vaccination coverage. --- METHODS This study was approved by the North Manchester National Health Service Research Ethics Committee. This analysis is based on the total population of girls (aged 12-13 years) invited for vaccination in two PCTs. The method for delivering the vaccine has been previously described [11]. Briefly, letters of invitation were sent by the PCTs to the parents of all female pupils in the relevant age group, along with information leaflets. Information evenings were also run for parents and pupils in each school. The vaccine was delivered in school, with catch-up sessions for those absent or late consenting. At least one reminder was sent to non-responders. Lower layer Super Output Areas (SOAs) (Office for National Statistics, Fareham, UK) and corresponding Index of Deprivation 2007 (ID) [14] were obtained from the UK National Statistics Postcode Directory using Geoconvert (http://geoconvert.mimas.ac.uk). Indices of deprivation range nationally from 0 . 4 to 86 in England, with higher ID values representing more deprived areas. Missing postcodes (2 . 6 %) were singly imputed using a hotdeck procedure, drawing from the records of pupils in the same school and with the same vaccination status. Ethnicity, based on UK census classifications, was obtained from ethnic monitoring forms distributed with the vaccination invitation and were returned by 62 % of those invited (79 % of vaccinated and 19 % of unvaccinated). Missing data were multiply imputed using data from the Local Education Authorities' (LEA) census, which provides aggregated ethnic composition for year-8 girls in each school. A total of 100 imputed ethnicity datasets were created as follows : the LEA data were used to infer the numbers of each ethnic group that were missing, and then these ethnic designations were randomly allocated among the missing girls. This constrained the ethnicity of the sample to be consistent with the known ethnic composition. The independent schools not included in the LEA dataset were assumed to have an ethnic composition proportional to the observed data, but there were far fewer missing data in these schools. To assess the relationship between HPV and childhood vaccination status, we used anonymized data from the child health systems of the two PCTs and selected girls who were born between 1 September 1994 and 31 August 1995 and thus eligible for HPV vaccination. Due to population movements, data were incomplete for a proportion of children who were born outside the PCT boundaries, and these girls' records were excluded. As the child health dataset was anonymized, it could not be linked to the HPV vaccination database. However, HPV vaccination was independently recorded in the child health systems allowing direct comparison of uptake between HPV and childhood vaccinations. HPV vaccination uptake was defined as having received at least one dose of the vaccine. Vaccine refusal was defined either as (i) the return of a negative consent form (active refusal) or (ii) non-return of a consent form (non-response). Ethnicity was grouped into four broad categories for analysis. We used logistic regression to assess the associations between HPV vaccine uptake and deprivation or ethnic group. Where ethnicity data were imputed, standard multiple imputation methods were used to derive parameter estimates from the analyses of each realization, along with their associated standard errors, 95 % confidence interval and statistical significance. Associations between HPV vaccination and childhood vaccinations are summarized by an odds ratio with a Fisher's exact test for inference. All computations were performed using the R language and statistical environment [15]. --- RESULTS There were 2817 girls invited for HPV vaccination, 91 % of whom were classified as White, with 5 % Asian, 1% Black, 3% Mixed and 1 % from other ethnic groups. The median ID score was 18 . 1 (range 2 . 3-77 . 3). HPV vaccine uptake was highest in the least deprived SOAs (Fig. 1) with a significant association between poorer uptake and deprivation (Table 1). Those who had actively refused HPV vaccination were more likely to be in the lower ID quintiles whereas nonresponse was higher in the more deprived areas, with both these relationships showing statistical significance. Non-White girls were less likely to be vaccinated than White girls (P=0 . 013) (Table 1), but there was insufficient data to demonstrate significant associations for specific ethnic groups. Active refusal was less common in most non-White groups, but this also did not reach statistical significance. Non-response was higher in all ethnic minority groups, and particularly in the Asian population (P=0 . 009). The relationships with ID score remained significant after adjustment for ethnicity, and the relationships with ethic minority status similarly remained after adjustment for ID score (Table 2). Childhood vaccination records were available for 2415 girls. Uptake for all childhood vaccinations was high (Table 3) and well above 95 % for the infant vaccines. The lowest uptake was 87 % for the preschool MMR booster. Girls who been vaccinated against HPV were significantly more likely to have received a previous MMR immunization, but no link to other vaccinations was demonstrated. --- DISCUSSION HPV vaccine uptake was significantly lower in more deprived areas (as defined by the SOA) and in ethnic minority girls. The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were, however, more likely to come from less deprived areas. Girls who did not receive HPV vaccination were less likely to have received all their childhood MMR vaccination doses. This probably reflects similar socio-economic and attitudinal processes driving the vaccine decision in both instances. --- Strength and weaknesses of the study The data presented here arise from a feasibility study ahead of the national vaccination programme. It is conceivable that the associations with deprivation will differ in the context of a well-publicized national programme. Ethnicity was not routinely recorded in the child health systems by the two participating PCTs. Although we asked parents to state their ethnicity, there was still a high proportion of missing data, resulting in reliance on imputation techniques. In particular ethnicity was not available for the non-responders. This reduced the precision of the estimates of the effects of ethnicity, almost certainly underestimating any effect. The ethnicity effects are also imprecise due to the relatively small numbers of minorities in the study population, and should be interpreted with caution. As the national vaccination programme is rolled out it will be important to record ethnicity on child health systems. At PCT level missing data may remain a problem as some parents are reluctant to disclose ethnicity, but regional or national data would provide a larger dataset and allow ethnicity to be categorized more meaningfully [16]. A novelty of this study was the ability to distinguish active and passive refusers as well as vaccine acceptors. This allowed us to detect qualitative differences between consent categories. --- Comparison with other studies Cervical screening rates are lower in deprived populations [17]. In a prospective study of factors associated with MMR uptake, children who dropped out between two follow-up visits were more likely to be from an ethnic minority or a disadvantaged household [17], confirming these as socio-demographic indicators of non-engagement. MMR has declined more in parents living in relatively affluent areas [4] and is lower in well educated parents [18], suggesting, perhaps, that some active refusers have safety concerns about vaccinations and are prepared to question health recommendations [19]. It is reported that children who remain unimmunized with primary vaccines are more likely not to receive MMR [5]. Our results suggest that this extends to adolescent HPV vaccination. Ethnic minority groups were less likely to receive the vaccine, but it is not possible to reliably determine from this data whether this is an effect of deprivation or relates to issues specific to particular cultural or ethnic groups. Several studies demonstrated higher coverage for childhood vaccinations in Asian populations than in Black Caribbean and White populations [20][21][22]. No such associations were seen in this study, but there was very limited power to detect such effects. Higher coverage in Asian populations has been attributed to non-use of English media and to the influence of grandparents and health professionals [21]. Similarly, although earlier studies found a lower reported cervical screening uptake rate in South Asian women, a study that adjusted for area and general practice greatly reduced this discrepancy [23]. Stronger social networks in areas of high South Asian concentration or higher deprivation in White women were possible explanations. Similar differences within and between population groups would be expected for HPV vaccination, Hence, interventions to increase uptake would need to be finely tuned to local area characteristics. More work is also needed to determine specific cultural or religious barriers to HPV vaccination in parents who do not respond to the invitation. --- CONCLUSION This analysis provides some evidence that different approaches may be needed to maximize HPV vaccine uptake in actively refusing and non-responding parents, including ethnic-specific approaches for nonresponders. Extra efforts might be made to follow-up girls whose parents do not respond to an HPV vaccine invitation, and if they agree to HPV vaccination, to also check their vaccine records with a view to offering missing childhood vaccinations. Data on ethnicity should be routinely recorded in child health systems to allow monitoring.

We investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007-2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0 . 001) and in ethnic minority girls (P=0 . 013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0 . 001). Non-responding parents were from more deprived (P<0 . 001) and ethnic minority (P=0 . 001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.

Introduction Few studies regarding Parkinson's disease (PD) have been performed in Sub-Saharan Africa, [1][2][3][4] and no studies have evaluated community knowledge and attitudes to PD in our setting. Reportedly, there is a low prevalence of PD within black African populations compared to European and North American populations. This might be reflecting a difference in the susceptibility in this population or lack of information in this population [4][5][6]. Alternatively, prevalence studies might be limited due to underreporting of PD and PD symptoms among individuals who fear societal stigma related to having PD. Studies have described PD stigma and its impact on the social activities of the sufferers. Subjects living in rural areas were more stigmatized than urban dwellers in these studies [7,8]. Despite advancements in treatment, Parkinson's Disease diagnosis, and care of Parkinson's disease patients' , lack of adequate knowledge and associated beliefs and attitudes among the community dwellers might have an important role in limiting access to proper treatment and care. Understanding community knowledge and beliefs in a rural and urban setting in central Uganda could help to inform care approaches that reduce stigma and promote care seeking. We therefore set out the main objective of this study, to assess knowledge and attitudes towards PD in a Ugandan community sample. --- Methods and Materials 2.1. Study Site. The study was conducted within urban and rural Mukono, with Mukono town council as urban and Kojja subcounty as rural. --- Study Design. This was a cross-sectional study conducted within an ongoing population survey of 3000 participants on prevalence and incidence of neurological diseases in Mukono district. This study was part of a larger US National Institute of Heath-Funded Medical Education Partnership Initiative (MEPI) neurological disorder survey, where we assessed community knowledge and attitudes on Parkinson's disease among some of the study participants. --- Patient Recruitment. Face to face interviews were conducted between August and November 2014. Multistage stratified sampling technique was used as described below. At the subcounty level, urban Mukono Town Council was randomly selected and Kojja subcounty (rural) in Mukono district. Mapping of the selected urban and rural areas was based on the Uganda population and Housing Census where 11,373 and 13930 households were identified in Mukono TC and Ntenjeru, respectively. The sampling frame was all households in these areas. Systematic sampling was used to select households in each village to total 2000 in the urban area and 2200 in the rural area that would participate in the large population survey. One adult, randomly selected from each household, was approached and consented and participated in the study. The selected households were visited by the research team. The randomly selected participant was informed about the research and invited to participate in the survey. --- Procedures. A request for a written informed consent was sought from all potential participants. Consenting participants were taken through a pretested screening questionnaire and those having symptoms suggesting neurological diseases were asked to come for follow-up check at a local health facility the following morning from where they were further evaluated by a team of neurologists. Blood pressure and anthropometric measurements were taken for each participant. Out of the 1500 participants in the urban area and 1500 in the rural area, systematic sampling was used to select 177 and 200 participants from the urban and rural areas, respectively, to be interviewed on selected aspects of PD knowledge and attitudes. The study was conducted from August 2014 to December 2014. The inclusion criteria included usual resident who is present in the sampled household on the night before the survey, being aged 18 years or older (adult), and willingness to provide informed consent. We excluded those who were physically unable to undergo interview. One adult, randomly selected from each household, was approached and consented and participated in the study. Consenting participants were taken through a pretested screening questionnaire. To address potential sources of bias, a standardized questionnaire was used with a wide range of responses for the study participants which were read to the participants. The interviewers were trained using standardized protocols for data collection to minimize interobserver variability during data gathering and entering data. --- Sample Size Determination. The sample size was calculated using the following formula: {𝑛 = 𝑍 2 𝛼 (𝑝𝑞)/𝑑 2 } where 𝑝 is prevalence of hypertension, 𝑞 is complement of the prevalence, margin of error is error which is 𝑑, and alpha is significance level. Setting significance at 0.05 and error margin at 5%, adjusted sample requirement for an assumed 10% level of nonresponse (nr = 10%) = 𝑁 * . Based on a previous study in Mukono [9] where hypertension prevalence was 27% and 𝑁 * = 336, we recruited 370 participants. --- Ethical Considerations. Ethical approval for the study was obtained from Makerere University College of Health Sciences' School of Medicine review board and ethics committee reference number 2013-145 and Uganda National Council of Science and Technology reference number HS1551. Written informed consent was obtained before enrolling the participants into the study. --- 2.7. Questionnaire. The questions were divided into two parts covering PD aetiology and PD symptomatology. The PD-focused questionnaire consisted of 9 questions with various options that were read out to the participants. The questions that were asked included one question on body part affected in PD, one question on the cause of PD, four questions on symptomatology of PD, one question on beliefs in PD, one question on attitude on work in PD, and one question on mode of transmission in PD. Data --- Results As illustrated in Table 1, 377 adults were enrolled with 177 (47%) from the urban settings. Sixty-eight percent (260/377) were women with a median age (IQR) of 34 (26-48) years. --- Knowledge on Parkinson's Disease. As illustrated in --- Associations between Participants' Response and Demographics. Correct belief regarding the brain being the main body part involved was significantly higher among respondents aged less than 35 years and urban residency with 𝑝 = 0.04 and 0.021, respectively. Urban residents significantly reported that the body becomes stiff or stiffness and tremor were part of the symptoms of PD compared to their rural counterparts with 𝑝 < 0.001 and 𝑝 = 0.003, respectively. There were no associated differences in responses to main symptoms of PD, associations with depression and insanity, and whether PD was contagious (Tables 3(a) and 3(b)). Parkinson's Disease --- Discussion This first report on community knowledge and attitudes towards PD in Uganda suggests that while most individuals recognize typical symptoms of PD, the awareness of causes of PD remains limited. Minority have beliefs about PD that may worsen stigma and social isolation. Without accurate understanding of the basic etiology of PD and the comprehensive scope of its impact in our settings, community responses to this neurodegenerative disease often are influenced by misconceptions based on myths and false assumptions. For example, it is believed in some communities that PD is associated with touching the mother-in-law. From this study, it is evident that PD awareness is low in central Uganda. Half of the study respondents were not knowledgeable regarding the body part involved in PD. The majority of respondents were, however, able to identify tremors as a major symptom in PD. This is different from a study conducted in Tanzania, where majority of the study participants were not aware of the symptoms and appropriate treatment for PD [2]. This might be due to population differences or effects of previous efforts by various health educational groups which have increased health awareness especially addressing issues related to misconceptions regarding PD. However, in this study rural dwellers were more likely to have incorrect knowledge about PD. Most people do not consider themselves likely to be susceptible to PD [10]. A key finding from this survey was that 17% of participants believed that PD was contagious while 28% believed that PD is a form of insanity. It might be expected that these attitudes contribute to stigma associated with PD. This is similar to earlier work which reported that half of the respondents saw stigma attached to this disease [10]. These stigmatizing misconceptions make it likely that individuals with PD might conceal their symptoms and delay care seeking, making their situation even more challenging [11]. Designing awareness campaigns for increasing knowledge and changing attitudes within communities would help in increasing social support for PD sufferers in our settings. This study emphasizes the need for adequate education and imparting accurate knowledge to communities. In an earlier study, participants with stigma were more likely to have negative attitudes to people with PD. Stigma leads to discrimination which may be associated with depression and poorer adjustment among those with the stigmatized condition. We did not find any significant differences between rural and urban communities regarding stigma. However, some studies have reported that stigma was higher in rural areas than urban areas [10]. Nearly half of survey respondents did not feel that those with PD could work for a living. The physical, psychological, economic, and social suffering caused by PD makes individuals dependent on their families for support [12,13]. Since PD seems to be stigmatized in the community, it is possible that some individuals might make efforts to conceal their PD from others, at least in the early stages when it is less noticeable. Perhaps, at least part of the reason why PD is so widely believed to be disabling by the community is that PD that is recognized tends to be later-stage illness. --- Conclusion PD, at least in its more severe form, is readily recognized by the community in Uganda; however, knowledge about what causes PD is limited and stigmatizing misconceptions are unfortunately relatively common. Awareness and education programs on PD have an important role in improving accurate understanding of illness and in reducing stigma. This may ultimately affect care seeking and health outcomes among those with PD. Further studies are needed to understand how knowledge and attitudes may influence care seeking and access for individuals with PD in Sub-Saharan Africa. --- Strengths and Limitations We realize that our study had a number of limitations including cross-sectional design, relatively small sample size, and reliance on standardized and closed-ended assessments. Our study could have benefited from longitudinal ethnographic data exploring further the experiences and meaning of PD to the general life of sufferers and their care providers within the community context. However, the studied population is representative of the general population, including the rural and urban settings in Uganda, and findings provide a reasonable stepping stone for further research. --- Conflict of Interests The authors declare that they have no conflict of interests. --- Authors' Contribution Mark Kaddumukasa, Edward Ddumba, and Martin N. Kaddumukasa collected data during the survey; Levi Mugenyi and Elly Katabira performed data analyses; Martha Sajatovic and Elly Katabira designed the study; Levi Mugenyi, Mark Kaddumukasa, and Edward Ddumba wrote the paper. Martha Sajatovic and Elly Katabira revised the paper for important intellectual content. All authors discussed the results and commented on the paper. All authors read and approved the final paper. Submit your manuscripts at http://www.hindawi.com --- Stem Cells International Hindawi

Background. Parkinson's disease (PD) negatively affects the quality of life. There is limited information on PD published from Africa. Lack of adequate knowledge poses a barrier in the provision of appropriate treatment and care for individuals with PD. Methods. A cross-sectional survey was conducted in urban and rural Mukono district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants, interviewed on selected aspects of PD knowledge and attitudes. Results. Of the 377 participants, 47% were from urban settings and 68% (260/377) were women with a median age (IQR) of 34 (26-48) years. Half of the study respondents did not know the body part involved in or apparent cause of PD. Nearly 1/3 of individuals believed that PD is a form of insanity and 17% believed that PD is contagious. Rural dwellers were more likely to have incorrect knowledge regarding selected aspects of PD. Conclusions. Understanding the cause of PD is very limited in our setting. Some beliefs about PD aetiology may potentially worsen stigma and social isolation. This study highlights the need for increasing PD awareness in our settings. Public health approaches that improve knowledge are urgently needed to promote care access and community response to Parkinson's disease.

INTRODUCTION The concept of understanding social capital, political culture, and the interaction between democracy and civil society is widely researched in both Western and Eastern scientific literature. American scientist T. Skochpol, in his arguments on the role of citizens and organizations in the formation of democracy, considers associations uniting citizens as a source of public pressure rather than a generator of social trust [1]. According to the American researcher, the democratic political system is the result of conflicts between different social groups and authorities and society [2]. Existing social and political disagreements force citizens to unite in order to influence the government to protect their interests [3]. The elites, in turn, mobilize citizens united towards a common goal to exert political pressure. Civil society institutions and organizations institutionalize systems that influence power, empower marginalized groups to participate in political decision-making, and oppose unbridled government [4]. T. Skochpol and his colleagues stated that civil associations are not considered separate organizations separated from the government only due to individual actions of citizens. According to them, the mass formation of political parties in the first half of the 20th century coincided with the development of civil unions. Government institutions and political parties have undoubtedly influenced the diversity, norms of behavior and strategies of civil society associations. Research shows that the process of electoral mobilization for national elections in the United States encourages citizens to join the activities of voluntary associations [5]. Civil society organizations help to activate their members to carry out political actions and rights protection activities in certain conditions [6]. The result of such activities is the registration of membership and the growth of organizations that include a wide range of citizens. The institution of equal and free elections has become an important factor in structuring conflicts and disagreements in society. In the 1950s and 1960s, elites shifted their emphasis on cooperation in favor of professional and human rights organizations focused on social service. As a result, the demand for large-scale volunteerism has decreased, which has led to a decrease in the level of public participation in civic associations. In our opinion, T. Skochpol's interpretation provides an opportunity to explain qualitative changes of civil society based on the preferences of the political elite. According to the logic of T.Skochpol, disputes give rise to citizens' activity, and their activity causes the creation of institutions, and institutions structure these disputes, ensure equal rights and protection of interests. Preferably, elites are mobilized through social groups or grassroots political parties and professional unions, or small lobbying and rights organizations.. Nancy Bermeo explains in her book that since the 1970s, civil society has been viewed as a positive component of democratic governance. The development of the concepts of interest groups, class associations and popular organizations showed their ambiguous role [7]. Juan Lins, a scholar of political regime change, considers the relationship between the ruling elite and citizen organizations to be problematic, as a highly active civil society often leads to the instability of democratic governance [8]. First of all, the connection of political parties with labor movements, trade unions and religious organizations does not help the stable functioning of institutions, because the existing social conflicts acquire a political dimension. Political regime researchers such as Martin Lipset and Giovanni Sartori have also emphasized the role of political parties as important institutions that enable citizens to interact with the state to support democracy. The ability of civil society to structure social conflicts is of great importance, because an institutionalized, politically mobilized, divided society poses a threat to democracy [9]. Some studies show that the participation of citizens in public (non-profit) organizations does not affect the quality of political institutions, and in many cases it can be the opposite. Sherry Berman believes that political institutionalization determines at the national level whether public participation is used in civil (democratic) or noncivil practices [10]. Strong political institutions have the ability to eliminate and structure existing contradictions in society [11], they direct citizens to achieve long-term, not short-term, goals. Political stability and transparent rules of the game (rule of law and security of private property) guide citizens to perform tasks within the framework of the existing system. Such a lack of stability leads to civil society becoming an alternative to politics for citizens who are not satisfied with the current situation. A number of researchers agree that the results of citizen activism depend on the state's ability to respond to public demands and the nature of the political community [12]. The theory of non-corporatism, which illuminates the interaction between interest groups and the state, has shown that the role of the state is one of the main ones in solving social conflicts, creating spaces for dialogues, and in the development of certain communities. In particular, the experience of the Scandinavian countries shows that the leading role of the state in resolving disputes between employers (business associations) and trade unions, taking into account the opinions of these two leading interest groups in the formation of political direction and reaching an agreement, helps to achieve stability in the development of society. will give. Philipp Schmitter defines the system of mutual action and representation of interests as a special ideal-typical agreement that makes decisions and provides communication between associatively organized interest groups of civil society and authorities [13]. Here, the concept of "civil society" is given a much wider definition, it is all associations in society, which are not part of the state economy, and thus include themselves in business systems and civil organizations. F. Schmitter prefers to describe non-corporatism as a system of interaction of interests. Because he doubts the ability of official associations to express the demands of their members, because he believes that this may not be a task of great importance for them [14]. Based on this interpretation, some researchers extend it to the system of political participation, in which citizens delegate their rights to the leaders of organized and centralized groups [15]. From this point of view, non-corporatist systems are representative bodies that use forms that substitute for the protection of their interests by political parties and parliament. Sometimes they associate the emergence of non-corporatist systems of mutual activity with the inability of political institutions (political parties and parliaments) to resolve social conflicts in society. Therefore, the government should always rely on the "most reliable" ways to reach an agreement [16]. One such way is used to create non-corporatist spaces. F. Schmitter connects the systematic involvement of interest groups in the decision-making process at the national level with the development of capitalist society [17]. Consideration of the advantages of socio-economic interest groups in cross-activity as an object of research has left its mark on the methodology and basic principles of the theory of corporatism. The researcher's interests include taxation and socio-economic policy in which the state shows interest. In addition, the agents of mutual action (activity) are often large business systems and trade unions, which have significant resources and can influence the state apparatus. Therefore, it is necessary to take into account the unique characteristics of non-profit organizations that can behave like interest groups, unite citizens towards a common goal, and influence the existing political path using certain methods. Scholars acknowledge that nonprofit groups have been seriously neglected in non-corporatist analyzes [18]. Annette Semmer in her scientific works points out that this concept can be very useful in some countries to illuminate the special interaction between society and the state. In the case of Germany, large associations of non-profit organizations and citizens are integrated into the process of making and implementing political decisions, and we can see the importance of using this theory. --- CONCLUSION: It should be said that non-corporatism explains a special type of interaction between interest groups and the state, and shows that it has the ability to resolve and stabilize existing social conflicts. In the framework of such interactions, the state plays a decisive role in the formation of political direction, in which it limits the influence of interest groups only to recognized and significant associations. In certain circumstances, when it is impossible to reach an agreement without the intervention of the state, it allows taking into account the interests of the latter. Thus, negative-porativism shows that the leading and regulatory role of the state is necessary for some communities in order to form a political agenda that takes into account the interests and interests of the main interest groups in society.

Abstracts: This article examines the efforts of citizen associations to further develop democracy and strengthen civil society. It has been analyzed by scientific studies that associations that unite citizens can be generators of social trust or vice versa

BRAIN HEALTH COMMUNITY REGISTRY: DEVELOPMENT OF A MODEL FOR CONNECTING PARTICIPANTS TO COMMUNITY-BASED SUPPORTS Laura Block 1 , Meghan Haas 1 , Lilli Kay 1 , Clark Benson 2 , and Andrea Gilmore-Bykovskyi 1 , 1. University of Madison,Wisconsin,United States,2. University of Wisconsin School of Medici,Madison,Wisconsin,United States Growing evidence demonstrates social and economic factors (e.g. socioeconomic status, level of education) contribute to risk for Alzheimer's disease and related dementia (ADRD). These factors also serve as barriers to research participation, contributing to systematic under-inclusion in ADRD research. The Participant and Relationship-Oriented Research Engagement (PRORE) Model outlines mechanisms through which socioeconomic determinants and reciprocal relationships may shape research participation; however, scalable protocols that address these mechanisms are lacking. Our objective was to develop and pilot the feasibility and acceptability of a research-based resource-matching protocol. The Brain Health Community Registry (BHCR) recruits adults ages 40 and above with and without changes in memory, and caregivers of individuals experiencing memory changes. BHCR connects participants with research opportunities and conducts a needs assessment to match individuals with community-based services and supports. Of 168 participants enrolled in BHCR, 33 (20%) report changes in memory, 93 (55%) do not, and 42 (25%) are caregivers. More than half (n=91, 58%) requested resource matching. Resource matching took 1.8 hours per participant (range 0.5-4.5 hours). Challenges included navigating rural counties with limited resources and effective follow-up; strategies included an interdisciplinary approach, offering multiple modes of contact, and a strengths and relation-based approach. Participants who responded to follow-up at two and six weeks (45% of total), and at annual review (100%, N=6) described resource-matching as instrumental for successful connection to supports, general knowledge/preparation, or on behalf of a friend or family member. Future work must ascertain whether needs assessment and resource matching change study participant perceptions of research. expenditure, and mortality. We assessed the contribution of coexisting conditions to mortality among Hispanic, non-Hispanic (NH) White, and NH Black older adults in the United States to measure their burden. We used nationallyrepresentative data from the Health and Retirement Study (HRS) from 1998-2016 (n=11,532). This analysis estimates the absolute additive contributions of seven somatic and two mental/neurodegenerative conditions using a longitudinal average attributable fraction derived from a surveyweighted multivariable discrete survival model adjusted for sociodemographic characteristics (sex, education, net worth, body-mass index, coupled, insured, and any of six ADLs lasting three or more months "because of physical, mental, emotional, or memory problems"). Conditions accounted for over 60% of mortality in each racial/ethnic group (64.0%, 62.2%, and 70.5% in Hispanic, NH White, and NH Black adults, respectively). Although we found that cardiovascular diseases (heart disease and hypertension) were the greatest contributor to morality in each racial/ethnic group, the impact of other conditions varied by race/ethnicity. Leading contributors to mortality were diabetes (12.0%) and dementia (7.2%) for Hispanic participants; cancer (13.0%) and lung disease (10.7%) for NH White participants; and diabetes (11.5%), lung disease (7.4%), and dementia (7.3%) in NH Black participants. This study provides insights into racial and ethnic differences in the contribution of chronic somatic and neurodegenerative conditions to mortality and may help target efforts for specific preventative care services to populations most impacted by them. Abstract citation ID: igad104.2469 --- EDUCATION AS A MEDIATOR OF GENDER DIFFERENCES IN COGNITION IN OLDER ADULTS Judith Rijnhart 1 , Matthew Valente 1 , Almar Kok 2 , and Martijn Huisman 2 , 1. University of South Florida, Tampa, Florida, United States, 2. Amsterdam University Medical Center, Amsterdam, Noord-Holland, Netherlands Although dementia is more prevalent in women than in men, studies on the socio-cultural mechanisms that cause and sustain gender differences in dementia remain scarce. Historic gender differences in education may explain why older women are at higher risk of dementia nowadays. This study aimed to investigate education as a mediator of gender differences in cognitive function, as measured with the Mini-Mental State Examination (MMSE). We used data from the Longitudinal Aging Study Amsterdam. The analytical sample consisted of 2,909 older adults aged 55-85, of whom 1,601 were women and 1,506 were men. We used causal mediation analysis to estimate total, indirect, and direct effects of gender on MMSE. Effect estimates were adjusted for confounding by age, parental education, and childhood adversity. The total effect was -0.60 (95% CI: -0.90; -0.32), indicating that women on average had a 0.60 lower MMSE score than men. The indirect effect was -0.84 (95% CI: -1.11; -0.59), indicating that women on average had a 0.84 lower MMSE score compared to men, because women completed fewer years of education. The direct effect was 0.24 (95% CI: 0.04; 0.44), indicating that if women had the same number of education years as men, their MMSE score would on average be 0.24 points higher than the average MMSE score in men. These findings indicate that education is an important mediator of gender differences in cognitive function. Future studies are needed to explore whether gender differences in cognitive function decrease as gender equality in education increases. Abstract citation ID: igad104.2470 --- HOW THE PATIENT-CENTERED MEDICAL HOME MODEL IMPACTS OLDER ADULTS' ACCESS TO HEALTH CARE IN RURAL GEORGIA Elisa Childs, University of Iowa, Iowa City, Iowa, United States Rural Americans face several healthcare access barriers, including limited providers and driving further distances to receive care. Georgia healthcare access is especially problematic given its high rurality, hospital closure rate, number of medically underserved areas, and older adult population. The government promotes the Patient-Centered Medical Home (PCMH) model to improve healthcare access. This study supports a better understanding of older Georgian's access to care by exploring PCMH's ability to improve healthcare access. Older adults were surveyed using a modified version of the Healthcare Quality Survey (N=746). Analyses included univariate, bivariate (t-test, ANOVA, chi-square, and a crosstabulation), and multivariate (multiple linear regression). Healthcare access was statistically significantly different depending on care source type, with significant associations between PCMH users and income, age, urban/rural status, and health status. Access was also statistically significantly different based on annual household income, educational attainment, age, and health status. Further, a significant relationship was found between access and age, income, and health status. PCMH users were primarily Caucasian and most often had an advanced degree and income of $60,000 or more. PCMH users most often reported living in Three Rivers, Atlanta Region, Northeast Georgia, and the Georgia Mountains. Finally, urban and rural residents with a regular care source reported "always" receiving needed care more often than PCMH users and those with no care source. The National Committee for Quality Assurance and other accreditation agencies should target low-income rural areas with high older adult populations when implementing the PCMH model to increase older adults' healthcare access. Abstract citation ID: igad104.2471 --- MALE BREAST CANCER IN OLDER ADULTS BELONGING TO THE LOWER-INCOME GROUP Esha Chakravarty, Calcutta Metropolitan Institute of Gerontology, Mitcham, England, United Kingdom Male breast cancer is a rare type of cancer constituting around 1% of male malignancies. Cases of 21 elderly (aged>60) patients diagnosed with breast cancer were studied with respect to age of onset, treatment choices, access to care, ability to perform activities of daily living (ADL) from CMIG, resource centre on ageing in east India. All 21 patients belonged to lower income group in society and the study was conducted over a 5 year period of 2018-2022. Primary symptom leading to diagnosis was self-detection of lump and the median time of diagnosis from onset of symptoms was 6 months. Twenty of the 21 patients were diagnosed with Stage III or Stage IV breast cancer and 1 patient was diagnosed with Stage I cancer. The average age of diagnosis of the patients was found to be 69 years. The main method of treatment was surgery for patient diagnosed in Stage I and

age, race, education, diabetes, cardiovascular disease, hypertension, and depression), Veterans tended to be less likely to have high food security (OR: 0.82 (95% CI: 0.66, 1.02), p=0.07). Further, non-Hispanic Veterans (OR: 0.72 (95% CI: 0.55, 0.95), p=0.02) and Veterans completing some college (OR: 0.71 (95% CI: 0.50, 0.99), p< 0.05), were significantly less likely to experience high food security compared to non-Veterans. Conclusion: This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socioeconomic determinates of food security status in Veterans.

Issue: The emergence of SARS-CoV-2 brought with it an urgent need to generate accurate and real-time surveillance data. The Irish Blood Transfusion Service (IBTS), along with many blood establishments worldwide undertook SARS-CoV-2 serosurveillance studies using residual blood donor serum. This response highlighted the role that blood donors can play in informing public health policy. --- Description: In September 2020 the IBTS undertook a SARS-CoV-2 seroprevalence study using blood donor specimens to track the 'first-wave' of the COVID-19 pandemic in Ireland. We utilised our operational capacity for sample collection and screening to quickly generate seroprevalence data. In 2021, the newly established National Serosurveillance Program (NSP) in Ireland invited the IBTS to collaborate on a SARS-CoV-2 serosurveillance study in blood donors which has continued into 2023. --- Results: This response has led to an enhanced relationship between the IBTS and public health in Ireland and has highlighted a possible future role for the IBTS in providing 'real-time' seroprevalence data to policy-makers. This data can be used to inform decision-making in relation to infection prevention and control strategies including vaccination policy. --- Lessons: This practice highlights the role that blood establishments can play in informing public health policy and indicates that this role could be expanded in the future in the cases of both emerging infections and vaccine preventable diseases. Blood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to infections on a national level and with the opportunity for longitudinal sampling of returning donors. --- Key messages: The relationship between blood establishments and public health should be further explored in the future to support infectious disease surveillance programmes. Blood donor studies can provide vital baseline data of healthy populations. Abstract citation ID: ckad160.1254 A conceptual framework for early life determinants of future multimorbidity --- Sebastian Stannard S Stannard 1 , A Berrington 2 , S Paranjothy 3 , R Owen 4 , SDS Fraser 1 , RB Hoyle 5 , S Batchelor 6 , J Welch 7 , NA Alwan 1,8,9 --- Background: Social, biological and environmental factors in early life, defined as the period from preconception until age 18, play a role in shaping the risk of Multiple Long-Term Condition Multimorbidity (MLTC-M). There is a need for conceptual framing of these factors to inform and shape future research on aetiology and for modelling prevention scenarios of MLTC-M. We developed a conceptual framework to characterise early life determinants of future MLTC-M risk. --- Methods: The conceptualisation of determinant domains was shaped by reviewing existing research evidence and policy, and coproduced with public contributors living in the UK via two workshops, one with 8 contributors age 18-30 regardless of MLTC-M status, and one with 12 contributors age 40-65 who all self-reported MLTC-M. Results: Domains included: 1.Prenatal, antenatal, neonatal and birth; 2.Adverse childhood experiences; 3.Child health, check-ups and screening; 4.Developmental attributes; 5.Child education and health literacy; 6.Demographics; 7. Parent health and health behaviours; 8.Socioeconomics; 9.Parental family factors; 10.Neighbourhood, physical environment and health care systems; 11.Health behaviours and diet; 12.Religion, spirituality and culture. Some domains identified by the public contributors, such as religion, health screening, check-ups, and diet, were not well represented within the research evidence or policy documents. --- Conclusions: This co-produced conceptualisation can inform research to investigate the early life characteristics of population groups at risk of future MLTC-M, as well as policy directions towards prevention of early-onset MLTC-M. Additionally, it can shape the direction of further data collection, particularly with respect to the understudied domains identified by our public contributors. --- Key messages: We developed a conceptual framework to characterise early life determinants of multimorbidity. This conceptualisation can inform future research and policy directions towards prevention of multimorbidity. --- Results: During the 2011-2016 study period, 34,700 Belgian inhabitants aged 65 or older died from an NDD (N = 1,883,182). We observed significantly higher mortality in the lowest educational-and income groups. Education had the strongest association in women, with 1.29 (CI 1.21-1.38) times the MRR in the lowest educated group compared to the highest. In men, income showed the strongest association with 1.11 (CI 1.04-1.18) times the MRR in the lowest income group compared to the highest. The biggest disparities were found in dementia mortality, generally negative association with SEP. For income, we observed a strong negative association on parkinsonism mortality, while we found a reversed pattern with education. --- Conclusions: Our study provides evidence supporting the existence of socioeconomic disparities in mortality due to neurodegeneration. We found a strong negative association between SEP and NDD mortality, which varies between men and women and between several NDDs. --- Key messages: NDDs are rapidly becoming a major public health issue worldwide. Mortality from these diseases vary between different social groups, differentiated interventions are needed in order to reduce inequalities. Abstract citation ID: ckad160.1256 Prevalence of overweight among Tunisian adolescents: Trend analysis 1996-2016 --- Mariem Zribi M Zribi 1,2,4 , N Zoghlami 1,6 , J Elati 3,4,6 , P Traissac The results showed a significant effect of time on overweight prevalence (p < 10-3), as well as a significant effect of sex group (p < 10-3). The model estimated that the prevalence of overweight increased by 1.29%

Inequalities in LE by income are widening again in Finland due to stagnation in the lowest income quintile. Contrary to the prior decades the increasing disparities are not attributable to smoking and alcohol-related deaths but occur in the majority of causes of death.After nearly a decade of narrowing mortality inequalities we observed an increasing gap in life expectancy by income mainly due to stagnation in the lowest income quintile. Contrary to the prior decades the increasing disparities and stagnation of the lowest income quintile are not explained by smoking and alcohol-related deaths but occur in majority of causes of death.

introduced visualization and interaction approaches with various types of data appliable to different domains, ranging from communications, diagnostics, decision support, education, and gaming. Papers [4,6] investigated research aspects of the cinematographic field. In particular, the former addresses the problem of designing a visualization approach suitable for viewing and browsing a large collection of movies, while the latter proposes a system for the production of web-based interactive fictions. Biomedical data have been analyzed and visualized by Frasca & Tortora [5] to identify correlations between the medical reports of Parkinson's patients. To correlate the information of each patient's medical report, Information Retrieval and Machine Learning techniques have been adopted, including the Latent Semantic Analysis, Text2Vec, and Doc2Vec techniques. The authors proposed to visualize the correlations among medical reports with an interactive chart by using the D3 framework. Educational research aspects have been addressed in [10,11] in Mathematics and Engineering education, respectively. To motivate children in learning the multiplication tables Rebotto et al. [10] proposed an Augmented Reality gamification approach based on two games, one turn-based fighting and other throwing-objects games. Computational fluid dynamics simulations is largely adopted in engineering education, broad engineering and business. Solmaz and Gerven [11] presented a system for generating dedicated workflows for computational fluid dynamics simulations in any kind of AR/VR environment. In [7,9] the coupling of Artificial Intelligence with visualization and interaction has been investigated for enhancing decision support. Situated visualization in AR modality has been proposed in [7] to obtain more effective and efficient decision-making. Data representations are displayed near the data referent, providing the user with contextual, relevant, and appropriate information. Nazemi et al. concentrated their attention on strategic decision making which can be enhanced through awareness of emerging trends and may improve the firm's competitiveness and market position. Their work introduces a novel interaction design by investigating the main ideas from technology and innovation management and detection. Architecture and product design support has been addressed in [2], where an interactive visualization system supporting team members in the understanding how to assemble a product is proposed. The problem of a multiuser visualization of data on a mobile device has been addressed by Miranda et al. [8]. They presented a hybrid proposal of an augmented reality prototype to interacting with cards through the mobile device to support the process of creating data visualization. An AR environment enables multiple users to interact simultaneously. Specific visualizations problems have been investigated in [1,3]. Chen and CUI addressed the problem of feature points missing and surface holes after 3D reconstruction, while the problem of visualizing data in high-dimensional space by exploiting machine learning dimensionality reduction techniques has been studied by Behera et al. [1]. --- Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Information Visualization is the field of study concerned with the development of methods for transforming abstract, complex data into visual representations in order to make that data more easily communicable and understandable. Technological advances enable information visualization in many areas, such as Visual Analytics, social media, geo-sociology, health, business, security and more. Interactivity and visualization increase the engagement with users, as they place them at the core of processes of access, dialogue, and relation with data providing visualization models for easy-to-use interactive systems. The use of interactive visualization in multimedia provides a powerful means for investigating, exploring, and imagining new communication modalities we will use in the near future. This special issue collected emerging contributions in the area of multimedia interaction and its applications for information visualization with different types of data. It includes a selection of the best papers presented at iV 2019, the 23rd International Conference on Information Visualizations. The conference took place in two different locations: 02-05 July 2019 in Paris (France) and 16-19 July 2019 in Adelaide, Australia. Participants included 70+ researchers from more than 23 countries. Eleven papers have been accepted for this special issue by considering the technical quality, the originality, and the innovation of the proposed ideas, solutions, and systems: the authors

SOCIAL ENGAGEMENT IN OLDER PEOPLE LIVING WITH HIV Atami De Main 1 , Marshall Glesby 1 , Carrie Johnston 1 , Mark Brennan-Ing 2 , and Eugenia Siegler 1 , 1. Weill Cornell Medicine,New York City,New York,United States,2. Hunter College,CUNY,New York City,New York,United States More than 50% of people with HIV (PWH) are at least 50 years old. PWH experience a high prevalence of multiple chronic conditions and fragile social structures. Although social engagement may be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence on older PWH's social engagement and associated factors in engaging with family, friends, and community. This study sought to examine social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study at the Weill Cornell Campus in New York City. We conducted factor and regression analyses to characterize social engagement activities and examine their relationships with AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors. PWH (n=349, age range=50-84) were less engaged in social (Mean=1.31; SD=0.71) and cultural-physical (e.g. attending cultural events) (Mean=1.55; SD=0.78) than media-based activities (Mean=3.09; SD=0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively. Having AIDS, experiencing increased HIVrelated stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p < .001). High SVI score and financial strain were negatively associated with engagement in culturalphysical activities (F(5, 317) = 2.61, p < .001). Increased depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p < .001). The findings provide foundations for future research to improve our understanding of social engagement in older PWH. Abstract citation ID: igad104.1997 Background: Social support and self-efficacy play a significant role in improving positive psychological well-being in marginalized older adults. However, to date, there are few studies on identifying the relationships during the COVID-19 pandemic. We examined the effect of social support and self-efficacy on hopefulness in marginalized low-income older adults during the COVID-19 pandemic. Methods: This study used baseline data from a clinical trial designed to increase COVID-19 testing in Essex County, NJ. The dataset --- THE ROLE OF SOCIAL SUPPORT AND SELF-EFFICACY ON HOPEFULNESS IN LOW-INCOME OLDER ADULTS AGED 50 AND OVER

study. We conducted telephone and face-to-face interviews (January -December 2021) with a nonprobability sample of adults aged 60+ in Puerto Rico (n= 213). Data collection included measures of objective and subjective physical and mental health. We used generalized linear regression analyses to explore main effects of salient demographic and health factors on loneliness. Missing data were treated with Multiple Imputation. Prevalence of loneliness (3-item TILS) was 36.3% . Widowhood (β=.832, SE=.38, p=.029), low household income (<$12,500; β=.691, SE=.23, p=.003), psychological distress (β=.141, SE=.03, p<.001) were positively associated with greater loneliness. Living alone (β=-.664, SE=.27, p=.015) and higher sense of community (β=-.067, SE=.01, p<.001) were negatively associated with loneliness. Pandemic specific challenges (e.g., someone close diagnosed or hospitalized with COVID-19) and other common predictors (e.g., age, female, self-rated health) were not significant. We consider that contextual (e.g., outmigration, under-resourced aging and healthcare infrastructure) and cultural factors (e.g., familism) may help shape predictors and their effects on loneliness. Mainland US and Puerto Rican researchers and practitioners should collaborate on examining loneliness narratives, their impact on health, and implementation of culturally appropriate and contextually feasible interventions in Puerto Rico.

INTRODUCTION The mechanism of combating moral threats is understood as a structurally interconnected system of organizational, legal, economic and other measures aimed at eliminating damage to the moral system and preventing its occurrence, usually carried out by internal security bodies. Its goals and objectives; objects of influence; threats and their sources; principles of efficient operation of the mechanism; areas of threats of occurrence of negative events; an algorithm for combating negative events in the generality of procedures and system elements; monitor adverse events and coordinate their response; adverse event risk criteria; may include structural elements such as resources, measures, and countermeasures. In addition, the application of the general scheme of the countermeasure mechanism in specific areas of practical activity in this regard involves adapting the implementation of its main activity to the nature of threats, the specific characteristics of their scope of existence, the specific characteristics of the objects of exposure, etc. --- LITERATURE REVIEW --- RESEARCH METHODOLOGY Summarizing the level of study of the problem of moral threats and their prevention and countermeasures in modern domestic and foreign literature, the topic of this article has been analyzed in a wide range of political sciences. To solve them, the research used the following methods, including: problematicchronological -the fight against threats, their prevention focuses on determining the origin of the emergence of certain forms and methods of security activities. Based on the comparative-historical method, it can be noted that the threats are becoming more complicated, and the difficulties in confronting them are increasing. The method of concrete-sociological research envisages the identification of threats directed against the interests of the individual, society and the state, the trends and changes related to them, and the logical method allows to determine the exact relationships between the existing events and processes. The combined use of these methods in the subject article made it possible to investigate the existing problem more accurately and in depth. The main elements included in the general scheme of the mechanism for combating moral threats of various directions can be described as follows. The main goal of combating such threats is, first of all, to increase the capabilities of the country's policy in the field of spirituality and to ensure a healthy spiritual environment by comprehensively ensuring the system of prevention, minimization, localization and elimination of these threats based on the current and prospective needs of ensuring the security of individuals, society and the state. The negative consequences of moral threats lead to the loss of state or political control, a significant deterioration in the safety of the lives of the population living in these areas for a single or long period of time, the destruction of infrastructure, irreversible negative changes (or destruction) of the country's administrative-territorial economy; --- ANALYSIS АND RESULTS --- International -collection of information about the used and promising information technologies of the antiinformation agencies in relation to the political sphere of the activity of the affected object; -Protecting the elements of the political structure of Uzbekistan, as well as the individual, group and public consciousness of its population from the use of information and political tools and methods of influence of the opposite party; -protecting the information infrastructure of Uzbekistan in general and the information infrastructure of the political system of Uzbekistan from the use of information and technical means and methods of influence of the opposite party; -Creating and developing a strategy for conducting counter-information operations in the information and political sphere under different conditions of the internal and external political situation; -development of the regulatory legal framework of information and political security, conducting special operations in the information sphere, including information-political spheres, the use of information weapons and methods of information warfare. Solving these tasks includes the formation of a list of subjects of informational and political threats at the initial stage. The objects of the mechanism of countermeasures in question are moral threats, which offer an understanding of the potential (expressed or implied) of harming the interests of citizens, the state and postindustrial society as a whole in the moral sphere. They apply to society and its various structures, state and civil society institutions, as well as to all organizations and communities that operate at a certain level in the spiritual space. The main principles of the effective operation of the mechanism for combating moral threats are as follows: 1) the principle of effectiveness in determining the activity of the moral influence technology of this activity in taking effective countermeasures. The principle is based on foreseeing the possibilities of using various technologies of spiritual influence. An example of disregard for this principle is the unhindered access to social networks of prankster information about the number of victims of demonstrations in Karakalpakstan, which fueled public unrest in the city; 2) the principle of prevention of moral threats, its essence is information about threats and predictive justification of the use of this or that technology of manipulation, exposing manipulation actions to the public and taking timely measures to warn about possible consequences; 3) the principle of active resistance, which consists of a constant effort to identify false ideas, information in For this purpose, it is necessary to develop descriptors that reflect the essence of current and prospective spiritual processes, as well as nationally specific options of information distributed in the spiritual space; 5) the struggle of information and ideologies in the spiritual space, the principle of unifying the efforts of state bodies, institutions of civil society and the internal security systems of the direct participants of the spiritual process implies coordinated actions based on the clear delimitation of their powers. The main sphere of moral threats covers actions in the spiritual system, the spiritual life of society, activities and aspirations within the framework of direct influence on the development of the state and society. Currently, this field has been significantly expanded due to the opportunities to create and reproduce information such as the spiritual wealth of humanity, human qualities, and their practical implementation in the real and virtual world. The main features of the global network, which allows to consider the Internet as a place of manipulation of the spiritual world of people, virtual space as an independent tool of spiritual-ideological struggle of various socio-political, ideological subjects, are the decentralized structure; In this, there is no official censorship, freedom to distribute and receive information; high data transfer rate; the ability to influence a certain narrow profile audience; absence of territorial and temporal restrictions; the low cost of communication is very convenient. The above advantages of the virtual space allow the forces spreading moral threats to actively use the global network to solve them by influencing the social consciousness of people through manipulation, propaganda, counter-propaganda, disinformation, ideas, values, behavior patterns, etc. "...the fact that in the virtual world an activity that is unavoidably punishable in real life can be carried out with ease, it corrupts a person. An example of this is the presence of countless pornographic sites on the network, the use of words that humiliate a person, openly insulting people, hiding the defects of products in advertising, posting harmful information for society (it is appropriate to point out that there are sites that provide information about the preparation, sale, and purchase of narcotics) can show". --- CONCLUSION In the process of historical development, the informational and psychological activity of state bodies and authorities has undergone significant changes, and now it has become a constant factor of politicsinformation conflict. In modern conditions, the information field remains an area of constant conflict between different political subjects at all levels of the organization of power. In the future, such a trend leading to the "informatization" of the armed forces and the "intellectualization" of conventional weapons may help to expand the control of power in the process of conquering information and information dominance, not through traditional armed struggle. The conducted studies confirm that both social progress and the development of each individual are --- https://theusajournals. com/index.php/ijlc --- accompanied by the development of the virtual information environment and are even determined in many ways, which, in turn, not only contributes to the formation of new national interests, but also creates new problems. Most of these problems are related to the desire of a number of different political entities to dominate the Internet information space. To achieve this goal, various political entities are developing the concept of network information warfare, as a result of which the normal operation of information and telecommunication systems on the Internet, the security of electronic and virtual information resources, as well as their unauthorized access to the Internet will be disrupted. "The Internet is not called a "spider's web" for nothing. In the spiritual-ideological struggle, Internet technologies expand the possibilities of the subjects of the struggle to influence the mass consciousness and technical resources of the opposing side, thereby helping to achieve wider goals and objectives of the ideological war. In addition, the existence of a large arsenal of attack and manipulation technologies used by various entities indicates that the share of the virtual information component in the spiritual sphere today has a steady growth trend, which indicates that Internet technologies are also deeply penetrating the spiritual sphere.

The article analyzes the classification based on the nature and manifestations of moral threats aimed at the national security and social stability of Uzbekistan in the Internet environment. Various approaches to threats, their scientific and official interpretations are also presented. At the moment, the nature, effects and mechanisms of prevention of external and internal moral threats to our country have been studied.

To write this book, Arar draws on his experiences as a high school principal, along with his insight from two decades of researching K-12 and higher education policies through the lens of equity and diversity and studying refugees in diverse settings. As an Associate Professor of Educational Leadership and Policy at Texas State University and an Associate Editor of the International Journal of Leadership in Education, Dr. Khalid Arar is well positioned to propose a model for how educational leaders can use CRL to welcome refugees into their school communities. Arar's academic research primarily examines how educational leaders consider equity and social justice while shaping policies and practices to meet newcomer students' educational needs. His research also emphasizes the essentiality of contextualizing practices through inclusive pedagogy and the involvement of school leaders in practice and policy formation. Arar incorporates this research into the book by emphasizing educators' roles in shaping the social perception about refugees, thereby speaking to the broader influence Arar believes that school leaders have in the dynamic nature of global refugee movements. Throughout its eight chapters, the book offers a global analysis of policy guidelines, obstacles, and coping strategies concerning refugee education, comprehensively framing a synthesized model for CRL. Chapters 1-2 define key terminology related to migrant populations, before turning to an examination of the policies that host states employ in response to the waves of incoming refugees. Arar notes the tension between nationalism and globalism as competing forces in policy approaches. He expressively highlights how government policies affect the social integration of refugees as well as educational institutions' abilities to welcome newcomer students. Arar also emphasizes the challenges countries face in developing educational policies due to the global lack of reliable, consistent, and accessible data on refugee students. He proposes the creation of Book Review: School Leadership for Refugees' Education: Social Justice Leadership for Immigrant, Migrants and Refugees an electronic information bank to better inform policy decisions related to the resources needed to achieve educational goals. Chapters 3-4 provide an in-depth account of political, financial, cultural, pedagogical, social, and psychological challenges that affect refugee students and school leaders, along with diverse coping strategies that educators use to address these issues. Arar draws from ten years (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) of scholastic literature to outline three themes that he argues could serve as theoretical pillars for refugee education praxis. These themes include a) The implementation of international and national policies for the absorption, resettlement and integration of children in host country schools; b) School-based psychological and social support; and c) Practices for academic leadership and instruction that directly address the needs of refugee students. In doing so, Arar highlights that even in cases where no formal barriers to educational access exist, the degree of actual inclusion varies greatly. Chapters 5-6 critically examine how CRL and Leadership for Social Justice (SJ) approaches, which have previously been implemented in racially and culturally diverse settings, are relevant for refugee contexts. SJ seeks to change systems, structures, and processes to abolish unequal starting points for marginalized students. CRL, which derives from culturally relevant pedagogy and culturally responsive teaching, allows students to achieve academic excellence without abandoning cultural integrity. Arar advocates for a synthesized model of CRL based on SJ and three established CRL frameworks: an ethnographic account of CRL (Khalifa, 2018); and a framework of CRL by Horsford et. al (2011) consisting of political context, pedagogic approaches, personal journeys, and professional commitment. Arar's holistic CRL model highlights four dimensions that apply to refugee education across these frameworks: personal awareness, inclusive pedagogy, policy mediation, and leader professionalism. The main premise of the model centers on school leaders' self-awareness, as well as their critical reflexivity on themselves and their school contexts. Arar aptly underscores a need for educators to adopt a CRL model even when government policies toward immigrants may be ineffective or hostile. He also stresses educators' roles in extending their pursuit of social justice into the wider community. This point feeds into the final two chapters, Chapters 7-8, which reemphasize the importance of a whole-school model when developing schools that operate as socially just environments. This holistic approach incorporates six interrelated areas that create a common vision for effective refugee education: building welcoming policies; strategies that ensure access to educational resources; hiring, development, and training of managers; collective responsibility of the school and community; teaching according to a curriculum; and teachers' professional development. The book leaves us with a vision for what could be while also broadening our contemplation of what should be, particularly how educational leaders can positively influence the wider societies within which they operate. This speaks to a consistent strength throughout the book, which is its poignant emphasis on the importance of contextualization, achieved through the authentic engagement of refugee communities in shaping school policy. Arar draws attention to this goal by infusing authentic narratives throughout that illuminate refugees' experiences, as well as by continually 115 Current Issues in Comparative Education Hough emphasizing the need for educators to better understand the context facing migrant youth. Another significant strength is the way in which the author guides readers toward understanding the necessity of a whole-school approach to creating an inclusive atmosphere, with holistic responses ranging from teacher training and the crafting of inclusive curricula to school and community partnerships. He does so while acknowledging that what is right for one situation might not be suitable for another, as the intricate dynamics of refugee movements create complex layers that make a single solution impossible. The author's argument would have been bolstered with further discussions about the wider effects on educational leaders of undertaking an advocacy-oriented approach. While school leaders are indeed well positioned to influence societal conversations, doing so may put educators and schools at greater risk, particularly in hostile environments, as they may come to be seen as politicized. Discussions of the potential risks involved with using social justice approaches would be beneficial, including strategies of how education leaders can mitigate harm to themselves and others when using such approaches in politically charged contexts. Adding examples of CRL implementation in a wider array of host-country contexts would also strengthen Arar's analysis. The book draws largely on the author's first-hand research in North America and Europe, with some concrete examples also drawn from his research conducted in the Middle East. Arar notes repeatedly, however, that a vast majority of refugee populations live in economically poor countries, whereas just 9% of the global refugee population live in the world's six richest countries (Arar, 2020). Though a guide for refugee education is still relevant for countries that host this 9%, additional research would be valuable to better understand how the proposed framework may apply in fragile environments. Presenting further cases of CRL implementation in conflict contexts and countries that have the largest influxes of refugees would complement the author's argument. Arar could also more concretely analyze differentiation in school leadership approaches between countries of first asylum and resettlement countries, as the goals and experiences of refugees in those varied contexts differ. Finally, as an extension to the concepts presented in this book, educational leaders would also benefit from information about the refugee teachers entering their school communities. Refugee teachers encounter their own challenges related to political, social, economic, and psychological barriers in education systems. Although they are certified to teach in their home countries and may be well positioned to contribute to a CRL vision, refugee teachers often encounter challenges, such as recognition of teaching certifications. Though the book speaks extensively about migrant students, it does not touch on the lived experiences and barriers to entry for migrant teachers, or their potential to be drawn into a CRL model. Including approaches for understanding and engaging teachers within migrant populations would make the book an even stronger resource for equipping educational leaders to holistically engage and support migrant populations in their school communities. In

and Refugees, Dr. Khalid Arar imparts a human-oriented and agency-driven lens to a dialogue that often revolves only around statistics. Arar's book provides educational leaders, policymakers, NGOs, and researchers with a clear resource for understanding the cultural and socio-political context regarding the movement and resettlement of refugees. The author incorporates both theory and data from empirical research he conducted in the Middle East, Europe, and North America, to illuminate the challenges and opportunities facing migrant populations. He speaks simultaneously to the responsibilities and prospects for educators and school systems in varying school contexts that absorb migrant populations. Arar presents a Culturally Relevant Leadership (CRL) model that aims to shape a holistic approach for welcoming migrant and refugee students into schools and societies.

INTRODUCTION A romantic relationship can experience abuse or aggressiveness, which is referred to as IPV. It can occur between both current and former spouses and dating partners. IPV vary in how often it happens and how severe it is. It can range from one episode of violence that could have lasting impact to chronic and severe episodes over multiple years. IPV is multidimensional; it could be physical, psychological, sexual and economical. 1 IPV cuts across all regions, culture and religion; it is however regarded in different light based on ethnocultural context of various society. While it is a punishable offense by the law in some parts of the world, it is somewhat accommodated in varying contexts in other parts of the world like the United Arab Emirates where men are permitted to 'discipline' their spouses without inflicting injuries on them. 2 There is a hybrid context in a country like Nigeria where a struggle exists between trado-cultural norms and the influence of western civilization. The prototype narrative of IPV is that which conceives the female as the victim and the male as the perpetrator. While this is common, it is not the only possible scenario. Men also are victims of IPV and in a country like Nigeria where tradition accustoms the Male as the stronger and fiercer gender: it is rather too surprising that men could be victims of IPV. There have been documented instances of loss of lives among male victims of IPV in Nigeria. One of such cases involves a 25-year-old housewife identified as F. A. who was arrested for allegedly killing her husband, G. A, with poison. According to police report, the deceased was the Chief Imam of the area, and the suspect was his second wife who allegedly served him food mixed with poison. When she was paraded at the police command, the suspect narrated that she killed her husband because she was tired of the marriage. And all her attempt to run to her parents to demand an end to the marriage yielded no positive response. She returned to her husband's house where she committed the act. They have been married since 2021. 3 Another instance was a middleaged housewife, identified as I.B, who ran away after allegedly setting her husband ablaze and killing him over allegation of extra-marital affair. The victim, B.B, had returned to Osogbo, Osun state from an international journey, to give his wife a nice treat on her birthday. The wife, discovered that he had cheated on her and even had a child outside their union and confronted him with the information. She allegedly sprinkled petrol in the bedroom while her husband was deeply asleep at night, locked the door and set the bedroom ablaze. The victim was hospitalized but died after some time. 4 A study conducted at a primary health centre in Port-Harcourt, Nigeria reported 5 male victims of domestic violence out of 70,400 male patients reviewed over 5 years and prevalence was very low. This was attributed to many reasons among which were: lack of routine screening for domestic violence; clinicians discomfort and misconception; the fact that psychological violence is not regarded as violence among the south-southern Nigerians involved in the study. The findings from this study suggested that IPV cuts across almost all social classes with different degrees of injury including scratches, bruises and scald. Additionally, men are least likely to go to the police or report in the hospital due to shame about disclosing family violence. Finally, this study was limited to the general outpatient department and excluded data from other department; inpatient wards or mental health settings which may have influence the reported low incidence. 5 Another study in Kano, Northern Nigeria among public employees to determine the life time prevalence and determinants of female-perpetrated IPV revealed that more than half of the participants experienced IPV inform of physical attacks, psychological aggression and sexual coercion. Few men in the survey reported to have experienced violence. The study also demonstrated that childhood experience of violence remained a significant predictor of female-perpetrated IPV after adjusting for confounders. 6 Furthermore a cross sectional survey was carried out in order to identify the factors linked to IPV at two tertiary health institutions in south-eastern Nigeria. More than two-third (70%) of the participants which were all men reported experiencing abuse in their family, with 8% of the male family members as the victim. There was a strong correlation between IPV and poorer socioeconomic status, alcohol usage, growing age gaps between couples and spouse unemployment. The male victims of domestic violence were linked to financial inequality favouring women, powerful in-laws, educated women and couples within the same age group. 7 This article therefore attempts to review the reported incidence of male victims of IPV in Nigeria and the peculiarities involved while providing recommendations moving forward. --- LITERATURE RESEARCH An in-depth review was conducted on relevant articles which were extracted from Google scholar and PubMed data bases using main keywords such as "men victim", intimate partner violence in Nigeria", "male victims" "and" "female perpetrators". 93 studies were identified, additional data were obtained from two Nigerian based Newspapers. There was no year limit for data obtained. To determine the final selection of articles for the review, a predefined set of inclusion criteria was applied. These criteria encompassed articles which focus was on male as victims, studies were in Nigeria and the requirement for articles to be in the English language. Ten articles were deemed relevant and articles which did not meet the inclusion criteria were excluded. --- DISCUSSION Physical, sexual, and emotional abuse are all possible forms of abuse that male IPV victims in Nigeria experience. Hitting, kicking, or using a weapon on the victim are all examples of physical abuse. Both sexual and emotional abuse can involve manipulation, humiliation, and controlling behaviour on the part of the abuser. Sexual abuse may also involve forced or unwelcome sexual activity. Male IPV victims frequently endure their suffering in silence because they are unsure of how to get assistance. IPV against men remains rarely reported in Nigeria. Male victims often do not receive the same respect, empathy, assistance and services given to their female counterparts hence the low reported incidence. Although there are similarities among the factors contributing to low incidence in different parts of the country, certain regions show peculiar features; for instance, in the south-south region of Nigeria, the low incidence was attributed to the fact that the people do not consider psychological violence as a form of violence-unlike the northern part that view violence as physical attacks, psychological aggression and sexual coercion-the lack of routine screening for domestic violence, clinicians discomfort and misconception are other factors in the regions. 8 In the south-eastern part of the country, factors like financial inequality favouring women, powerful in-laws, educated women and couples within the same age group were responsible for low incidence report. These findings are similar to other parts of the country. Additionally, the patriarchal nature of the Nigerian society has also contributed to this low incidence rate. However, men across different age group, educational level and social class continue to be victims of IPV. The major risk factor of female-perpetrated IPV in Nigeria remains childhood experience of violence. A girlchild exposed to domestic violence has a greater chance of becoming violent toward her partner or spouse in future. This agrees with the findings of Kolbe and Buttner who demonstrated that been abused or maltreated as a child has a greater chance of making one violent as an adult. 9 Other causes of female-perpetrated IPV include: poorer socioeconomic status, drug abuse (for example alcohol and other illicit drugs), growing age gaps between couples and spouse unemployment. While there is a paucity of Nigerian based data, it is important to note that the findings in Nigeria were comparable to data obtainable from other Sub-Saharan African Nations. A study in Cameroon and Sierra Leone looked at the frequency and correlates of IPV victimization among married or cohabiting men aged 15 to 59 using data from Demographic and Health Surveys (DHS) conducted in Cameroon and Sierra Leone during 2010. To emphasize the significance of avoiding extrapolating findings from one country to another or to the other as a whole, they selected to evaluate characteristics associated with IPV victimization independently in each country. In order to investigate the parameters connected to physical, psychological, and sexual IPV victimization, logistic regression analysis was utilized. In Cameroon, men reported psychological victimization at a rate of 26.5%, physical victimization at a rate of 24.4%, and sexual victimization at a rate of 2.3% in the year prior to the poll. In Sierra Leone, the comparable percentages of male casualties were 23.4%, 14.9%, and 2.7% respectively. 10 --- CONCLUSION Males are not only "villains" as they are often portrayed, they can also be and are often (though commonly unrecognized) victims of IPV even in a patriarchal country like Nigeria. There is therefore a need for renewed vigilance and action in protecting the interest of men in IPV in Nigeria and globally. --- Recommendations Several actions could be employed to improve the reported cases of IPV against male victims in Nigeria: raising public awareness, legal protection, increasing health care worker sensitivity, provision of support services, research and proper data collection among others. Addressing the issue of IPV against men in Nigeria requires raising public awareness. Many people are unaware that males can experience IPV and may have preconceived notions about male victims, which can leave these people without the assistance and services they need. To address this, the Nigerian government and Non-governmental organizations (NGOs) ought to start public awareness campaigns and programs to inform people about IPV against males and the negative impact it can have on people individually, families, and society as a whole. These can involve advertisements on television and radio, social media campaigns, and courses at colleges and universities. In addition, bringing attention to the issue can help men come forward and lessen the shame and stigma associated with being male victims of IPV. To comprehend the scope and characteristics of IPV against men in Nigeria, more research and data gathering are necessary. By using this information, relevant stakeholders can make sure that resources are distributed properly and build effective preventive and intervention strategy. Moreover, research can assist in identifying service gaps and areas that require additional support. In order to gather information on the frequency and characteristics of IPV against males in Nigeria, the Nigerian government should support research studies on this topic and collaborate with NGOs and other groups. --- Funding: No funding sources Conflict of interest: None declared Ethical approval: Not required

Globally, men have always been seen as perpetrators of aggression in romantic relationship which constitute intimate partner violence (IPV). In Nigeria, they are mostly considered as the villains due to the patriarchal nature of the society. However, there have been many cases of violence by intimate partners where men were the victims. Very few of such cases were reported either to the hospital or to the police due to many reasons ranging from sociocultural, ethnic, economic and religious values among others. In a patriarchal society like Nigeria, men experience various form of violence which could be physical, psychological, sexual and socioeconomic from intimate partners. Therefore, this article attempts to review the reported incidence of male victims of IPV in Nigeria and the peculiarities involved while providing recommendations. Some of the factors identified for the low incidence report includes; lack of routine screening for domestic violence in health facilities, the fact that psychological violence is not considered as violence in some Nigerian society, shame about disclosing family violence, poor socioeconomic status and many more. Additionally, a major predictor of female-perpetrated IPV was childhood exposure to violence. This paper recommends that several actions which would improve the report of IPV against men while ameliorating IPV in Nigeria may involve: raising public awareness, legal protection, increasing health care worker sensitivity, provision of support services, research and proper data collection among others.

Objective Many parents and pregnant women in the US use social media to access information and support related to parenting and children's health (1). Misinformation related to maternal and child health is prevalent on social media (2)(3)(4)(5) and may be harmful when people use this information to make health-related decisions for themselves and their families. Understanding social media use patterns can help public health professionals, health care systems, and researchers reach selected populations with evidence-based health information and health promotion programs (6,7). The Pew Research Center provided a snapshot of social media use among US adults in 2021 and documented higher rates of use among younger adults and differences by gender (8). However, the report did not describe social media use patterns at specific stages in the life course, nor among parents or women who may become pregnant, people whose social media use patterns may change (9). A 2014 Pew Research Center survey found that 74% of online parents in the US use Facebook and roughly one-quarter use Instagram, Pinterest, and Twitter, with higher use among women than among men (1). To provide more current estimates of use, we used data from the 2021 survey to describe social media use among US parents and US women of childbearing age. --- Methods We conducted a secondary analysis of data from the Pew Research Center's January 2021 Core Trends Survey (8). Telephone surveys were conducted in English or Spanish with adults (aged ≥18) from all 50 US states and Washington, DC, from January 25, 2021, through February 8, 2021 (8). The sample included a combination of landline and cellular telephone random-digit-dialed samples. Participants who provided a mailing address were sent $5. Additional details about the survey methods are available elsewhere (8). This secondary analysis did not require institutional review board approval. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Participants were provided a list of social media platforms and asked whether they ever used any of the individual platforms (yes vs no). Participants who reported using YouTube, Facebook, Instagram, Snapchat, and/or Twitter were asked how often they visit or use the platform (several times a day, about once a day, a few times a week, every few weeks, less often). Participants were asked whether they are the parent or guardian of any children younger than 18 years now living in their household; those who responded yes were considered parents (N = 351). Participants reported whether they described themselves as a man, a woman, or in some other way. Because more than 96% of US births are to women younger than 40 years (10), we considered women aged 18 to 39 years (n = 147) to be of childbearing age. We categorized age and education as in previous research (8). Pew Research Center classified participants as living in urban, suburban, or rural areas based on landline location or respondent-reported zip code for cellular telephone respondents. First, we described use of each social media platform by parents overall, and by demographic characteristics. Next, we described frequency of platform use among parents. Finally, we described use by women aged 18 to 39 years, overall and by parenting status and age. Analyses were weighted to be representative of US parents or US women aged 18 to 39 years (8). Analyses were conducted using SAS version 9.4 (SAS Institute, Inc). --- Results The most popular social media platforms among US parents were YouTube (88%; 95% CI, 84%-92%), Facebook (79%; 95% CI, 74%-84%), and Instagram (47%; 95% CI, 42%-53%) (Table 1). Mothers appeared more likely to use Facebook, Instagram, Pinterest, Snapchat, and TikTok while fathers appeared more likely to use Twitter and Reddit. Younger parents appeared more likely to use several platforms, especially Instagram, Snapchat, and Tik-Tok, but appeared less likely to use Pinterest. US parents with at most a high school education and those living in rural areas appeared less likely to use several platforms (Table 1). More than half of US parents who use YouTube, Facebook, Instagram, and Snapchat engage on these platforms daily (Figure). Among US parents who use Facebook, 83% (95% CI, 77%-89%) of mothers and 76% (95% CI, 68%-84%) of fathers engage on this platform daily. Among US parents who use Instagram, 50% (95% CI, 38%-62%) of mothers and 54% (95% CI, 41%-67%) of fathers engage daily. Respondents who did not provide an answer for frequency of platform use (YouTube, n = 2; Facebook, n = 1) are not shown. Response options for frequency of use were collapsed as daily (several times a day, about once a day), weekly (a few times a week), or less often (every few weeks, less often). Values are weighted % (95% CI). Source: Pew Research Center's January 2021 Core Trends Survey (8). Most US women aged 18 to 39 years used YouTube (92%; 95% CI, 87%-97%), Facebook (84%; 95% CI, 78%-90%), and Instagram (65%; 95% CI, 56%-73%) (Table 2). US mothers aged 18 to 39 years appeared more likely to use Facebook and less likely to use Snapchat, Twitter, TikTok, and Reddit than women aged 18 to 39 years who are not parents. Women aged 18 to 29 years appeared more likely to use Instagram, Snapchat, Twitter, and Tik-Tok (Table 2). Among US women 18 to 39 years who used the respective platform, 60% (95% CI, 51%-68%) used YouTube daily, 75% (95% CI, 67%-83%) used Facebook daily, and 68% (95% CI, 58%-70%) used Instagram daily. --- Discussion Most US parents use YouTube and Facebook, and nearly half use Instagram. We found social media use to be higher among US parents than US adults generally (8), likely due to greater use among younger adults. For example, while 69% of US adults use Facebook, 79% of US parents and 87% of US mothers use this platform. We saw similar trends among US adults generally in terms of use by gender, age, education, and rurality of residence (8). We found that 80% of US parents who use Facebook engage daily compared with 70% of US adults generally (8). Conversely, 51% of US parents who use Instagram engage daily compared with 59% of US adults (8). We found similar differences by gender among US parents as a report that used data from 2014; use of Instagram and Pinterest has increased over the past 7 years, while use of Facebook and Twitter among US parents was similar (1). A strength of this study was the use of sampling weights to generate prevalence estimates for US parents and US women aged 18 to 39 years. However, our study also has limitations. Due to the PREVENTING CHRONIC DISEASE small sample size, we were unable to examine social media use among gender minorities (n = 2) or by race and ethnicity (n = 29 parents identified as non-Hispanic Black, n = 12 as non-Hispanic Asian, and n = 18 as non-Hispanic multiracial or other race). Because only 23 parents in the sample were aged 18 to 29 years, estimates for this group should be interpreted with caution. Because this survey did not ask about the ages of respondents' children, we cannot describe social media use among parents of younger children (eg, infants, preschoolers) versus older children (eg, teenagers). Researchers, public health professionals, and health care systems seeking to provide evidence-based health information, combat health misinformation, or deliver behavioral interventions for parents or pregnant women can use information about the social media habits of these target populations when designing their programming and outreach. Platform choice should also be guided by the availability of platforms' features and functionality (11) and preferences of the target population (12). Most US parents and women of childbearing age use YouTube, Facebook, and Instagram, with most engaging daily. Although only one-quarter of US parents reported using TikTok, use is substantially higher among younger parents and women. Research on health-related topics on TikTok is emerging (5), and TikTok may be a novel platform for reaching younger parents. Tables Table 1. Use of Social Media Platforms Among US Parents, by Demographic Characteristics

What is already known on this topic? The Pew Research Center provided a snapshot of social media use among US adults in 2021. However, the report did not describe social media use patterns among parents or women of childbearing age.We used data from a 2021 Pew Research Center survey to describe use of commercial social media platforms by US parents and US women aged 18 to 39 years. Most US parents and women of childbearing age use You-Tube, Facebook, and Instagram, with most engaging daily. What are the implications for public health practice? Understanding social media use patterns can inform efforts to reach target populations with evidence-based health information and health promotion programs.

Introduction: The integration of technology and social welfare becomes a crucial focal point in an era characterized by swift technological advancements and a worldwide movement toward digitalization. This research paper explores the transformative potential of digital financial inclusion within the distinct socio-economic landscape of Karnataka, India. It focuses on the adoption of electronic payments within the framework of social welfare schemes. With the promise of increased accessibility, efficiency, and inclusivity, the introduction of electronic payment systems marks a turning point in the development of financial services. Karnataka, a well-known state in India, struggles to guarantee that people from a variety of backgrounds have fair access to social welfare benefits and financial services. The manual procedures and paper-based transactions associated with traditional welfare distribution methods have frequently been linked to inefficiencies, delays, and possible leakages. In light of this, the introduction of electronic payments into social welfare programs is a ground-breaking move that promises to close disparities, increase openness, and give recipients more power via digital financial inclusion. The acknowledgment of digital financial inclusion as a driver of wider socio-economic development serves as the foundation for this study's reasoning. Gaining insight into the adoption dynamics of electronic payments in the context of social welfare is crucial as Karnataka moves towards a digital economy. To illuminate the subtleties of this digital revolution in the particular context of social welfare programs, this study attempts to assess how electronic payments affect financial accessibility, inclusion, and overall welfare outcomes. --- Objectives of the study: 1. To review of existing literature on digital financial inclusion 2. To highlight the integration of electronic payments into social welfare schemes 3. To identify the challenges and opportunities of Digital Financial Inclusion in Karnataka Digital Financial Inclusion: By removing conventional barriers and ensuring that financial services are available to everyone, regardless of location or socioeconomic status, digital financial inclusion represents a revolutionary paradigm in the finance industry. Essentially, this idea uses digital technology to increase the accessibility of financial services, giving people who have previously been shut out of formal banking systems more power. Digital financial inclusion, in the age of smartphones, mobile connectivity, and sophisticated fintech solutions, is more than just a technological development; it is a potent catalyst for economic empowerment and participation. By embracing digital channels, people can now access banking, insurance, credit facilities, and payment systems, removing previous barriers to financial engagement. --- Social Welfare and Electronic Payments: Empowering Assistance in the Digital Age: The modern world of support and assistance is being redefined by the combination of electronic payments and social welfare programs. Traditional welfare benefit distribution techniques frequently struggled with inefficiency and transparency. With the introduction of electronic payments, a revolutionary strategy is introduced, utilizing technology to improve accessibility, expedite procedures, and give recipients more power. Digital disbursement systems replace manual, paper-based transactions in social welfare with electronic payments. This not only speeds up benefit delivery but also reduces errors and guarantees that aid reaches its intended recipients more precisely. Meeting the needs of individuals reliant on social welfare is made possible by the efficiency gained through electronic payment mechanisms, which enable a more targeted and responsive approach. The adoption of electronic payments also encourages social welfare programmes to be more transparent. Digital transactions produce an unambiguous, traceable record, which lowers the risk of fraud and increases distribution process accountability. Benefit recipients are more trusting as a result of this transparency, which also gives policymakers useful information to improve and tailor welfare programmes. Even though switching to electronic payments for social welfare has many benefits, there are still issues that need to be resolved, like technological limitations and worries about digital literacy. Still, the way these initiatives are developing shows a dedication to using technology for social good and is a step in the right direction toward more effective, open, and transparent social welfare policies in the digital era. --- Challenges and Opportunities of Digital Financial Inclusion in Karnataka: The digital revolution in financial services presents a range of opportunities and challenges, especially when it comes to social welfare programmes. As the dynamic Indian state of Karnataka embraces the use of electronic payments in its social welfare programmes, a careful analysis of the situation is necessary. This investigation reveals a dynamic interaction between challenges and opportunities that will shape the region's path towards digital financial inclusion. --- Challenges 1. Technological Barriers: The widespread adoption of electronic payments is greatly hindered by the pervasive digital divide. Inequalities in the availability of technology, especially in remote regions, could make it more difficult for recipients to interact with digital financial services. --- Digital Literacy: The seamless adoption of electronic payments may be hampered by some population segments' lack of experience with digital technologies. It will take sufficient training and awareness campaigns to close this knowledge gap. --- Security Concerns: As financial transactions become more digital, there is a higher chance of fraud and cyber-attacks. Establishing strong cyber security protocols and providing assurances regarding the safety of electronic payments are essential for cultivating user trust. --- Infrastructure Limitations: The full potential of electronic payments might not be realized in areas with insufficient digital infrastructure, such as dependable internet connectivity and banking services. For widespread adoption, these infrastructure gaps must be filled. --- Opportunities: 1. Financial Inclusion: those who are unbanked and under banked populations can benefit greatly from the financial services that electronic payments offer. Digital financial tool adoption could lead to the development of a more inclusive financial ecosystem by giving previously underserved groups access to formal banking services. --- Increased Efficiency: The efficiency of welfare distribution is improved by the digitization of payment systems. Electronic payments streamline the welfare delivery process overall by lowering administrative costs, minimizing errors, and ensuring prompt, targeted benefit disbursement. --- Accountability and Transparency: Since digital transactions create a transparent trail, the likelihood of fraud and corruption is reduced. By making welfare programmes more accountable, the use of electronic payments inspires confidence in legislators and people equally. 4. Economic Empowerment: Electronic payments provide people the ability to actively engage in the formal financial system in addition to their transactional benefits. Giving recipients access to digital financial tools promotes financial literacy, empowering them to make wise financial decisions and possibly end the cycle of poverty. Policymakers, administrators, and stakeholders are key players in navigating the obstacles and leveraging the opportunities brought about by the adoption of electronic payments in Karnataka's social welfare schemes. A more inclusive, effective, and transparent financial ecosystem that improves beneficiaries' lives can be achieved through strategic initiatives that address technological barriers, improve digital literacy, and strengthen security measures. --- Impact on Financial Inclusion Access to Banking Services Electronic payments have a significant and transformative effect on people who were previously shut out of the financial system by enhancing their access to formal banking services. Numerous advantages result from this shift, which not only improve financial inclusion but also support the socioeconomic advancement of marginalized populations on a larger scale. --- Breaking Geographical Barriers: Electronic payments allow people in underserved or remote areas to access formal banking services, regardless of their location. People no longer need to be physically close to a bank branch in order to conduct transactions, receive wages, and access financial products thanks to digital platforms. --- Reducing Physical Barriers: Traditional banking services can be difficult for many people to access, particularly for those who are physically disabled or have limited mobility. The ability to make electronic payments via mobile apps, online banking, and other digital channels removes the need for physical location visits, increasing the accessibility of financial services for a wider group of individuals. --- Minimizing Documentation Requirements: Individuals with restricted access to official records or identification may find it difficult to navigate the intricate documentation procedures associated with traditional banking. People without a lot of paperwork find it easier to participate in the formal financial system when they use electronic payments, especially in digital wallet or mobile banking formats. --- Enhancing Financial Literacy: A certain amount of financial literacy is required in order to use electronic payments. People who interact with digital transactions frequently gain a greater understanding of basic financial concepts. Their enhanced understanding of financial matters enables them to investigate alternative financial offerings, make well-informed choices, and recognise the value of savings. --- Facilitating Micro transactions: Micro transactions are a good fit for electronic payment systems because they enable people to conduct small-scale financial transactions that would have been difficult or costly with traditional banking. This is especially helpful for people with lower incomes because it makes it easier for them to invest, save, or engage in previously difficult economic activities. --- Building Credit Histories: Having the ability to establish credit history is frequently correlated with having access to official banking services. When credit reporting systems are linked with electronic payments, people can use their transaction history to prove their creditworthiness. This consequently provides access to a greater range of financial goods, including credit cards and loans. --- Promoting Economic Inclusion: Participation in the formal financial system affects economic inclusion in more ways than one. People can access government subsidies, electronically receive their wages, and use cash for a number of other traditional financial transactions. This promotes economic development by lowering the reliance on unofficial financial channels. --- Conclusion: As Karnataka charts its course towards a more inclusive and digitally-driven social welfare landscape, the lessons learned from this evaluation will reverberate beyond state borders. The convergence of technology and social welfare not only augments the efficiency of benefit distribution but also lays the foundation for a more resilient and equitable financial ecosystem. The evaluation of electronic payments in Karnataka's social welfare schemes offers a glimpse into the transformative power of technology in fostering financial inclusion. The ongoing commitment to addressing challenges and seizing opportunities paves the way for a future where the benefits of digital financial inclusion are realized by every stratum of society, ensuring a more prosperous and inclusive Karnataka for generations to come.

This research paper examines the transformative impact of digital financial inclusion through the adoption of electronic payments within the social welfare schemes of Karnataka, India. Against the backdrop of a rapidly evolving digital landscape, the study aims to evaluate the implications of this technological shift on financial accessibility, transparency, and overall welfare outcomes. Through a combination of qualitative insights, the research seeks to uncover patterns, challenges, and opportunities associated with the integration of electronic payments, contributing valuable perspectives to the discourse on digital financial inclusion in the context of social welfare.

INTRODUCTION Language is much more than verbal expression of thoughts and desires of each person. Learning a language is not just about getting knowledge of phonetics, grammatical structures, or vocabulary but it has more to do with the culture underlining that language since successful use of language requires two factors: the correctness and appropriateness (Brown,1994). Additionally, Linh (2021) supports that language users must be aware of sociocultural rules of use beside language codes to create effective communication. Knowing each one's culture is essential in using the language. Language is the expression and communication of emotions or ideas between human beings by means of speech and hearing, the sounds spoken of heard being systematized and confirmed by usage among a given people over a period of time (Webster Comprehensive Dictionary,1992). Furthermore, an understanding of language as ‗open, dynamic, energetic, constantly evolving and personal' (Shohamy, 2007:5) encompasses the rich complexities of communication. Learning another language entails becoming part of another culture to fully comprehend the additional language acquired. On the other hand, culture refers to the cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings, hierarchies, religion, notions of time, roles, spatial relations, concepts of the universe, and materials objects and possessions acquired by a group of people in the course of generations through individual and group striving (Hofstede,1997). Culture refers to the sum total of the attainment and activities of any specific period, race, or people, including their implements, handicrafts, agriculture, economics, music, art, religious beliefs, traditions, language, and story (Webster Comprehensive Dictionary, 1992). This includes how people live in a community where he belongs. The world is rapidly changing with access to the Internet and such tools as YouTube videos or blogging, to name but two areas that allow for instant entry into the ways of different cultures. Indeed, with the presence of technology learning of another language and adaption of one's culture would be easier. --- METHODOLOGY The respondents of the study were the 188 students, 118 grade 12 and 70 1 st year college of education major in English students at the college of Education and Social Sciences of Mindanao State University at Naawan, Naawan Misamis Oriental, Philippines. This study used a qualitative research design. A structured survey questionnaire composed of 6 questions was used and distributed accordingly. Students were expected to ponder their response as these survey questions are open ended with no right or wrong answer. Responses were treated with the utmost confidentiality. Completed surveys were analyzed as to commonalities or differences in responses. Letters of request to the students as participants and parents' consent form were also considered in this study. This study used percentage to present the responses of the students. --- RESULTS AND DISCUSSION --- You can learn a language, but can you learn culture? Figure 1 shows that almost all of the students (96%) responded that like language, culture can be learned. This is due to the interconnectedness of language and culture. Students believe that when people learn another or a foreign language, they also subconsciously learn the culture attached to that language. Few (4%) of them responded that they do not believe that culture can be learned. This is because culture is innate of them, and it comes naturally. Even if others would want to learn our culture, they still do not completely learn it like the others do. Language is an integral part of culture and human culture cannot exist without it (Vega et al. 2009). This means that language is important to culture. --- Yes No  culture is attached/connected to language  when we learn new language, we also learn culture  both can be learned at the same time  language is the country's identity and includes culture  can be learned but it takes more time  can learn culture through researching it  through observation, study, and communication  it comes out naturally from us  learning the language and culture can take time  can be adopted slowly into our lives  can be learned but needs practice  determined to learn it  as long as we are willing (willingness to learn)  speaking a language shows their culture  open-minded  language is the country's identity and includes culture  we are capable of learning anything  if you put an effort to it  language imprints the culture --- How long do you think it takes to learn a language? Figure 2 shows that the majority of the students (52%) responded that it takes a short time to learn a language, which is specified between few weeks to five years. This learning is not formal and does not mean mastery, which includes all nuances like phonetics, phonology, and others. It means that if the learners can be understood, they already learned the language. Some of them (26%) believe that learning a language takes a long time while others (16%) said that it depends on one's willingness and motivation. Still few (6%) believe that learning a language takes a lifetime. The relationship between second language acquisition and practice is tied to a learner's awareness of the culture that gives rise to that language (Lessard-Clouston, 1992). This means that constant used of language and awareness of culture can be of great help in learning another language. --- How long do you think it takes to learn culture? Figure 3 shows the distribution of the students' perception on how long it takes to learn another culture. Fifty percent (50%) believe that learning other's culture takes a short time, specified between few weeks to five years. Students believe that because culture is a concrete practice, it is easier to learn than language, especially when the learner is immersed in the new practices. Some of them (29%) believe that learning a culture takes a long time. This is because of the richness of the culture that it will take a while to learn them. Some others (13%) said that it depends on one's willingness and motivation to learn the culture because even if learners are within another community, if they refuse to learn the culture, they will not easily adapt to it. Few (8%) believe that learning a language takes a lifetime since aside from the abundance of cultural practices and traditions of others, culture is constantly evolving, making our education of our culture and other cultures a lifetime learning. Culture influences thought patterns, feelings, actions and interactions constituting basic communication behavior (Neuliep 2011). Indeed, culture can be easily adapted because of its nature of influences to human beings. --- Is culture being lost using technology and the internet? Figure 4 shows the percentage distribution of the students' response if they believe that culture is being lost because of technology and the internet. This is a bit divisive but many of them (58%) believe that, indeed, too much use of technology can be a reason for people, especially the millennial, to forget and lose interest in their culture and adapt some from other countries. Those who did not agree (42%) believe that even if we use technology and learn others' cultures, we also retain our own. It indicates that specifically using the social network Face book will considerably increase motivation in the process of learning (Mills, 2009). This means that culture will be lost when students engage in technology because of new learnings. Indeed, internet as a medium of communication fulfilled this forecast by connecting people in distant locations and by intensifying relations.  It is just a way to share culture.  Enrich, upgrade, and modernize culture.  Even when using technology, we still use our own culture.  internet preserves culture  Nothing can destroy culture because it is permanent.  loyal to their culture 6. Could there be one global culture in the future? Figure 5 shows the responses of the students as to whether there could be one global culture in the future. Many of them (59%) affirmed the possibility of having one global culture while still many of them (41%) also believe otherwise. Those who agreed stated that the movement of the world today is cantered on inclusivity and unity. This, partnered with the presence of technology, is what will drive unification of cultures. This is also possible when people try to find a common ground like finding a universal language. When we have one language, it is possible to have one global culture as well. Those who disagreed stressed that unity is hard to achieve and the differences between each one of us is too big of a gap to create one global culture. People are also loyal to their cultural values and will not be easily influenced and dictated to agree on having one culture. But theory states that a more successful student is one who has more engagement, and the higher the engagement, the more the learning (Astin,1984). This means that student engagement can increase his/her capability to accept one global culture in the future. Montgomery and Reid-Thomas (1994) defined culture as the whole way of life consisting of all social practices that connect people in that society and differentiate them from others. These things can shape people's behaviors based on their beliefs, values, and norms about way of life and become distinct characteristics of that society because of technology. --- CONCLUSION AND RECOMMENDATION This study concluded that language and culture can be learned but there's a possibility that culture can be lost and have one global culture due to technology. It is recommended that this study should be conducted in other schools with varied students.

the sounds spoken of heard among a given people over a period of time. Culture refers to the attainment and activities of any specific period, race, or people, including their implements, handicrafts, agriculture, economics, music, art, religious beliefs, traditions, language, and story. This study sought to assess the students' perspective towards language and culture on a multicultural basis. It aimed to determine the perception of students towards language and culture on a multicultural basis. The study used the qualitative research design. The respondents of this study were the 188 grade 12 and 1 st year college of education major in English students at the college of Education and

ADVANCED-COMFORT: TESTING A CARE PLANNING INTERVENTION FOR NURSING HOME RESIDENTS WITH ADVANCED DEMENTIA Ruth Palan Lopez 1 , Andrea Wei 2 , Jenna Locke 2 , and Evan Plys 3 , 1. MGH Institute of Health Professions,Sharon,Massachusetts,United States,2. MGH Institute of Health Professions,Boston,Massachusetts,United States,3. Massachusetts General Hospital/ Harvard Medical School,Boston,Massachusetts,United States Many nursing home (NH) residents with advanced dementia receive burdensome interventions rather than interventions that promote comfort or quality of life. The purpose of this study was to test the usability of a novel intervention called ADVANCED-Comfort that aims to enhance the provision of personalized, comfort focused care for residents with advanced dementia. The intervention consisted of structured care plan meetings between the NH team and proxies of residents with dementia (e.g., family members). Using the ADVANCED-Comfort workbook, proxies and staff created individualized care plans addressing 6 domains adapted from the Age Friendly Health System Framework (what Matters; Meaningful activities; Mealtime; Mobility; Medications and treatments; and Make comfortable). We evaluated the intervention using surveys, observation, and exit interviews. We found the intervention to be highly usable (acceptable, appropriate, and feasible) and exit interviews identified several promising outcomes. Both families and staff reported that the intervention improved communication and trust. Families reported that they had a newfound trust in staff to provide consistent quality care. Staff reported that the intervention helped them build better relationships with families and allowed families to articulate what they prefer rather than waiting until "something goes wrong." Staff also reported that the intervention improved their excitement to go to work and enhanced their sense of teamwork. Finally, both staff and proxies reported exciting implications for residents such as a reduction in antipsychotic medication, decrease in distressed behaviors, weight stabilization, and initiation of hospice. Based on these preliminary findings, additional testing of the ADVANCED-Comfort intervention is warranted.

themes emerged from this procedure: (1) The dimensions of forgiving: The victim as subject. Movement towards forgiveness occurs along three dimensions: painful memories with negative emotions, commitment to social obligations and life circumstances. (2) Being forgiven: Between lost forgiveness and hope. This theme related to the boundaries between the roles of being a victim and a victimizer simultaneously and describes the hope and willingness of survivors to be forgiven by closely related persons. (3) Self-forgiveness and the aging self. Forgiving self can be conceptualized from total renunciation due to exhaustion from lifetime abuse to full recognition of self-accepting forgiveness resulting from decision-making based on strength. While recognizing the salutary effects of forgiveness, we cannot disregard that this is not a universally desirable process. The dimension of forgiveness needs to be included in the study of abuse throughout the old person's life-course to better understand its complexity Such view should substitute the either/or approach based on the dichotomy of "forgiveness" or "unforgiveness".

Presenting author Mohammed Kamal-Deen Fuseini Dnshitobu, Agnes Abah --- Presented at TDWG 2023 --- Conflicts of interest The authors have declared that no competing interests exist.

Biodiversity is the variety of life on Earth, and it is essential for our planet's health and wellbeing. Language is also a powerful medium for documenting and preserving cultural heritage, including knowledge about biodiversity. However, many indigenous and underrepresented languages are at risk of disappearing, taking with them valuable information about local ecosystems. Also, many species are at risk of extinction, and much of our knowledge about biodiversity is in underrepresented languages. (Cardoso et al. 2019). This can make it challenging to document and protect biodiversity, as well as to share this knowledge with others. Crowdsourcing is a way to collect information from a large number of people, and it can be a valuable tool for documenting biodiversity in underrepresented languages. By crowdsourcing, leveraging the iNaturalist platform, and volunteer contributors in the open movement including the Dagbani* and Igbo* Wikimedian communities, we can reach people who have knowledge about local biodiversity, but who may not have been able to share this knowledge before. For instance, the Dagbani and Igbo Wikimedia contributors did not have enough content on biodiversity data until they received education about the need. This can help us to fill in the gaps in our knowledge about biodiversity, and to protect species that are at risk of extinction. ‡ § |

INTRODUCTION At the present time, education is very important and useful in life where we will learn various aspects of this life (Shidiq & Raharjo, 2018;Salsabila et al., 2021). Education as a noun is a process of changing the attitude and behavior of a person or group to mature humans in teaching or training (Setiawan & Nuraisah, 2018). As stipulated in the national education system law No. 20 of 2003 concerning the goals of national education, namely conscious and planned efforts to create a learning atmosphere and learning process so that students can actively develop their potential to have religious spiritual strength, self-control, personality, intelligence, noble character, and the skills needed by themselves and community (Kurniawan, 2015;Lukman, 2016). In coastal communities are a group of people living in coastal areas whose sources of economic life depend on the utilization of marine and coastal resources. Most of the people work in the marine resource utilization sector such as fishing, tie cultivation, and sea transportation (Ariwidodo, 2016;Syatori, 2014). Coastal communities in Indonesia have the same problems, namely inadequate socio-economic life and low levels of education (Anisa & Waloyo, 2021;Masrohatin & Khodijah, 2019). This low education for children on the coast needs to be discussed, because education will play an essential role in the sustainability of life and will affect the improvement of their standard of living later (Haderani, 2018). Therefore this problem needs to be studied to find any description of the issues related to children's education on the coast. The results of this study can be used as information for the community to find solutions to existing problems. The discussion related to the problems of children's education on the coast is very interesting to study because it is directly related to every individual human being. According to the Big Indonesian Dictionary, problematic is a term used to indicate a problem that must be solved. From several expert opinions, it can be concluded that the problem is something that requires solving (Novita et al., 2018;Nurfitriyanti, 2016). Problems are defined as something that hinders the achievement of a goal (Guswanti & Satria, 2021). Meanwhile, educational problems can be interpreted as problems that occur in the process of moral, social and economic maturation which is carried out with certain patterns of behavior to create human beings who are moral and responsible for the survival of society (Sunarso, 2020). Research on the problems of children's education on the coast has previously been studied by previous researchers such as research conducted by (Anisa & Waloyo, 2021). The fundamental difference between this research and previous research lies in the location of the research and the things discussed in this study. --- METHODS This research uses a qualitative method with an approach to ethnography. Sources of data were taken from eight informants with in-depth interviews selected using the technique of purposive sampling, while the selected informants met four criteria, namely, informants understand well the problem under study, are still active in the field being studied, have time to provide information to researchers and provide information according to the facts that occur in the field (Rahawarin et al., 2020;Ramli et al., 2017).To meet the criteria as informants, all informants consisted of two parents, one local community member, and five children aged 7-12 years. To strengthen the data from the interviews, the researchers also made direct observations. After the interviews were completed, all informants were taken, a transcript of the interview data was carried out and then the themes were taken in accordance with the objectives and needs of the research data. According to (Castleberry & Nolen, 2018;Clarke & Braun, 2018;Herzog et al., 2019) thematic analysis is an analytical technique that can be used by researchers in analyzing the results of interviews so that they can be seen clearly and easily understood by readers. The entire process of thematic analysis above was carried out using the Miles and Huberman technique. In Miles and Huberman's technique that is collecting data, after the data is collected then do data analysis, then data reduction and conclude the research. --- RESULT AND DISCUSSION Based on the results of interviews with eight informants, the researchers found five problems in children's education on the coast. In order to see more clearly the results of this study can be seen in figure 1 as follows: --- Fig 1. Description of the problems of the children's education on the coast In the following, the researcher will describe the research results that have been obtained from the results of the interviews that have been carried out. There are five findings from the interview results, namely inadequate economic status, the desire of children to follow in the career footsteps of parents, low interest in learning in children, environmental factors and friends, and lack of motivation from parents to go to school. First, is inadequate economic conditions. According to the informant, one of the problems in children's education on the coast is caused by inadequate economic conditions, as it is known that in general the people on the coast have a livelihood as fishermen, and are certainly very dependent on the weather if the weather is good then the fishermen can go to the sea to find fish but vice versa if the weather is not good then they cannot go to the sea to look for fish. This theme was stated by informants as excerpts from the below: ...in this coastal area it is certain that the economic situation is one of the problems in children's education, the unstable economic situation is the reason for children dropping out of school. Because the majority of people work as fishermen, which will depend on the weather.. --- . (I-1) ... low economy is one of the factors in the low education of children in this coastal area... (I-2&3). Second, is the desire of children to follow in the career footsteps of their parents. According to the informant, the desire of children to follow in the career footsteps of their parents is also a problem in children's education. In this coastal area, after school, many children of fishermen come home and help their parents go to sea to find fish. Because he often went to sea to help his parents, the desire arose to continue working as a fisherman as well. This theme was stated by informant as excerpts from the below: …sometimes after school, these children don't repeat their lessons, but there are also those who go to the sea with their parents to catch fish, then when they feel good about getting money from what they catch, they decide to just work to follow their parents … (I-1). Third, is low interest in learning in children according to the informant the low interest in learning in children is also a problem in children's education in coastal areas, most children in coastal areas do not have the self-awareness to go to school and study, they have a feeling of laziness to go to school and do not there is a desire to learn when they come home from school. This theme was stated by informants 1-4 as excerpts from the below: …I'm lazy to go to school is, sometimes because I wake up late, so I'm lazy to go to school, Problems of Children's Education on the Coast not to mention that there will be assignments from school, and I'm lazy to make them. Parents also don't mind it, if at home they can play… (I 1-4). Fourth, is the lack of motivation from parents, from the research the researchers conducted this theme was not used so much as an excuse for the problems of education on the coast. But in the opinion of researchers, motivation from parents can also influence it. This theme was stated by the informant 1 & 4 as excerpts from below: … I see a lot of parents of children on this coast are lacking in motivating their children in the world of education, the parents of children seem not to be indifferent to their children. When the child comes home from school, the parents don't ask how their child is studying at school and no one tells the child to repeat the lesson again at home, for example, it's like the child is up to the child, and what about the parents too, and even though basically the motivation is from parents are very important for a child's education…(I-1) …when I don't go to school, my parents don't tell me to go to school, my parents just ask why I don't go without giving the motivation to go to school…(I-4). Fifth, is environmental factors and friends, according to the informant as we know the environment and friends participate in being a problem in education, because the environmental conditions on the coast, where most of the previous education was low, have also had an effect until now, plus the environment on the coast has facilities also inadequate. Likewise with the influence of his friends, because most friends who are seen are lazy to go to school and study, so he is also affected by that. This theme was stated by informant 1 as excerpts from below: … yes, what you see is that this environment has a great influence on children, especially the family. Sometimes this child sees the low education of the people around him, he is also less interested in going to school. So if in their environment there are many children who want to go to school, and have high enthusiasm for school, maybe they will also be affected by that, especially if you have friends who study hard maybe they will be able to follow along diligently to study… (I-1). The five findings obtained by the author will be discussed based on theory, expert opinion, and the results of previous research that discusses these problems in more or less the same context and problems. First, the inadequate economic conditions. The economy is one of the most influential factors for a child's education, because if the family's economy is unstable, it will be difficult for children to get proper education (Wulandari & Hakim, 2020). Second, the desire of children to follow in the career footsteps of their parents. A child who at first just wanted to help his parents, but because it happened too often, a desire arose to follow his parents' work as fishermen, instead of continuing his education to a higher level (Anisa & Waloyo, 2021). Third, the low interest in learning in children. The feeling of laziness that appears in a child makes them not want to go to school, they also prefer to play after school rather than repeat learning material they have learned at school (Warif, 2019). Fourth, the lack of motivation from parents. Motivation ieencouragement that arises from within a person to do or think with a certain purpose, either consciously or unconsciously. Therefore encouragement from parents is very influential in raising children's enthusiasm to study (Azis & Amiruddin, 2020). Fifth, the environmental factors and friends. As we know, factors from the environment and friends will greatly affect a child. When he sees friends in his environment not going to school anymore, the greater his desire to follow his other friends not to go to school (Safitri et al., 2019). --- CONCLUSION This research has succeeded in uncovering five problems of children's education on the coast. The five results of this study are inadequate economic conditions, the desire of children to follow in the career footsteps of their parents, low interest in learning in children, lack of motivation from parents to go to school, and environmental factors and friends. Education is very important for every human being because with education we can create and shape Indonesian human qualities that are superior and have strong competitiveness. With the disclosure of the problems above, at least the results of this study can be used as a basis and reference for future researchers.

Education is one of the main keys to creating and forming Indonesian human qualities that are superior and have strong competitiveness. In Indonesia, children's education on the coast generally has the same problems, namely low levels of education and inadequate socio-economic life. Thus this study aims to analyze what are the problems of children's education on the coast. This research uses a qualitative method with an approach to ethnography. The research data was taken from eight informants consisting of children, parents, and the surrounding community. To strengthen the interview data the authors also made direct observations of children in coastal areas. Interview and observation data were analyzed using Analysis Interactive Model Milles & Hubberman. The results of this study are that there are five problems that hinder children's education on the coast, namely inadequate economic conditions, children's desire to follow their parents' career path, low interest in learning in children, lack of motivation from parents to go to school and environmental factors and friends. The results of this study can be used as information for the community to find solutions to existing problems.

Introduction Subak is a traditionally developed social organization according to customary law that has unique differences from other organizations (Sanica et al., 2018). Subak as a non-profit social organization has characteristics that include; 1) Subak is an organization of farmers managing irrigation water that has a board and organizational rules (awig-awig) both written and unwritten, 2) has a shared water source in the form of a dam (empelan), 3) has a rice field area, 4) there is autonomy both internally and externally, and 5) has one or more temples related to subdivision (Darmada et al., 2018). To finance its activities, Subak obtains funds from internal and external funds. Internal funds obtained by Subak Sembung come from pengaot dues, dedosan (fines) collection, as well as personal funds from the subak krama. Meanwhile, external funds obtained come from Special Financial Assistance (BKK) from the government routinely every year. Organization is basically used as a place or container where people gather, work together rationally and systematically, planned, organized, guided and controlled, in utilizing resources (money, materials, machines, methods, environment), infrastructure, data, and so on which are used efficiently and effectively to achieve organizational goals (Ambarwati, 2019). In management accounting, the accountability aspect in realizing good governance is very important. Governance is a performance management system that aims to increase business productivity, the elements of governance consist of: accountability, responsibility, independence, transparency, and fairness. Transparency and accountability in the management of an organization are part of the application of good governance principles (Putra & Muliati, 2020). Transparency and accountability have emerged as a way to overcome development failures (Dananjaya & Basuki, 2019). Public accountability is the obligation of the trustee (agent) to provide accountability, present, report, and disclose all activities and activities that are his responsibility to the trustee (principal) who has the authority to request this accountability (Widnyani et al., 2015). The implementation of this accountability is an obligation for all organizations, whether profit-oriented organizations, private, religious, governmental or other non-profit or non-profit organizations. Accountability is the main principle in realizing good governance, including in natural resource management, especially in mitigating negative social and environmental impacts (Sanica et al., 2018). In the financial accountability of non-profit entities, it is not only about reporting on the budget used, but also on one's accountability to other parties for the mandate given. Accountability in the spiritual realm leads to a call of conscience based on the principles of honesty, empathy, and love. This motivation realizes the responsibility of each party not only to the profit and loss interests related to the business world, but also to the Creator (Sanica, 2019). This is what distinguishes conventional accountability practices and accountability based on religion. The practice of accountability is a key principle in realizing good governance, including in natural resource management (Sanica et al., 2018). The role of religion, customs, and culture in Bali is in accordance with the Tri Hita Karana culture which is the main guideline for the subak krama in carrying out all its activities. In its financial accountability, non-profit entities, especially subak organizations, not only report on the budget used, but also on how accountability to God Almighty, to fellow subak krama and also the universe. Based on this, there are practices of financial accountability in subak organizations that are able to bring Subak Sembung into a success to maintain its existence as a wetland (rice field) when there is a decrease funds in subak management. --- Methods This research is a type of qualitative research using the interpretive paradigm, especially ethnomethodology studies. This research uses the ethnomethodology method to explore the social life of subak organizations that integrate religious social culture as well as guidelines for the Tri Hita Karana cultural philosophy that has taken root in Balinese society which focuses on aspects of financial accountability to answer research questions. This research uses an ethnomethodological approach that aims to discuss social practices in the organizational life of Subak Sembung in Peguyangan Village. Where the focus in this study is on aspects of accountability in the management of Subak organizations. The use of this ethnomethodological approach is motivated by the success achieved by Subak Sembung in maintaining its existence until now. The emphasis on the accountability aspects that will be discussed using this ethnomethodological approach will highlight the accountability of the management of the subak organization on the horizontal side (towards humans and the natural environment) and also on the vertical side (towards God Almighty). In the ethnomethodology approach, there are unique characteristics in the analysis method, namely conversation analysis research. Conversation analysis aims to study the ways that are taken for granted that make up a conversation (Ritzer & Goodman, 2011) cited in (Winarti & Sadewo, 2016). Conversation analysis discusses the relationship between language in conversation rather than the relationship between speaker and listener. Conversation is the most complete form of interaction and consists of socially organized communication procedures. The ethnomethodological research process can be briefly observed in the following flow original (inter) action, recording (audio/video), record, transcription, transcript (action), understanding, procedural analysis, analytical argument (Have, 2004). Based on this flow, conversation analysis data collection can be collected from observed daily actions (original action), and through interactions that occur in daily life (original interaction). Data analysis is carried out to understand the practice of financial accountability in Subak Sembung based on the information obtained. In qualitative research, data analysis is inductive, namely analysis based on the data obtained, developed into a conclusion. In this study, information analysis will be emphasized based on the ethnomethodological approach. Validation and validity of data in qualitative research can be done using the triangulation method. --- Result and Discussion The practice of accountability carried out in Subak Sembung is full of awareness of spiritual responsibility. Based on the concept of Tri Hita Karana which guides all activities: Maintaining a harmonious relationship with God Almighty (Parhyangan) in the concept of Tri Hita Karana, manifested in carrying out routine ceremonies in Subak including: mendak toya tradition, nyuyuk ceremony, ngiseh, nelu bulanin tradition, ngotonin ceremony, nangluk merana, mecaru, piodalan in Subak Temple. Maintaining harmonious relationships with fellow krama (Pawongan) in the concept of Tri Hita Karana, reflected by the existence of honesty that embodies the emergence of trust (trust) which is realized in the activities: gotong royong, subak paruman, munduk paruman, nuduk dedosan activities, assistance from krama, and reporting BKK funds to the Culture Office to maintain relationships with external parties. The source of funds used to finance baga Pawongan at the subak level comes from the allocation of BKK funds and at the munduk level comes from pengaot and dudukan dedosan fees that have been collected. Maintaining a harmonious relationship with the surrounding nature (Palemahan) in the concept of Tri Hita Karana, realized by carrying out activities related to environmental sustainability, such as: mendak toya tradition, nyuyuk ceremony, ngiseh, nelu bulanin tradition, ngotonin ceremony, nangluk merana, mecaru, piodalan in Subak Temple, and gotong royong. In the practice of accountability, Subak Sembung activities are based on high moral awareness. In accordance with the five dimensions of accountability. Transparency, which is the openness of information that is realized in the activities carried out, such as: paruman subak and paruman munduk. Liability, which is the responsibility to the organization manifested in the discipline of the subak krama to carry out activities that have become subak policies, such as: mendak toya tradition, nyuyuk ceremony, ngiseh, nelu bulanin tradition, ngotonin ceremony, nangluk merana, mecaru, piodalan in Subak Temple, and discipline in fulfilling applicable sanctions such as dedosan. Control, refers to the situation where the organization performs tepa tapa which is its main command. This is realized in activities such as: gotong royong and dedosan sanctions. Responsibility, the existence of applicable rules is realized in activities such as: the existence of an accountability report submitted in the paruman (meeting) subak and munduk. Responsiveness, referring to meeting the substantive needs of the organization, is manifested in activities such as: nyuyuk ceremony, ngiseh, nelu bulanin tradition, ngotonin ceremony, nangluk merana, and mecaru. Based on the principles of honesty, empathy, and love that arise from one's self accompanied by a sense of belonging in accordance with the concept of Tat Twam Asi more deeply presents how to treat the contents of the universe as part of oneself as a creature of God who must be accounted for. Krama subak shows a service that is not concerned with personal interests, but rather gives priority to meeting the needs of the organization, this is in accordance with the stewardship function. This research proves that the five dimensions of accountability according to (Koppel, 2005) are able to explain the accountability practices carried out in Subak Sembung. It has also been proven that Subak has never reneged on its promise as an organization that carries the teachings of Tri Hita Karana, because the concept of Tri Hita Karana has been practiced in every activity carried out by Subak. --- Conclusion In realizing the success of an organization, it is necessary to practice accountability in it. According to Koppel (2005), an organization is said to be accountable if it meets the five elements of accountability, including transparency, liability, control, responsibility, and responsiveness. It is importance of understanding and implementing accountability practices that are constructed by maintaining traditions, customs and culture and instilling high moral values. With the consistency of the event actors who prioritize the practice of honesty and discipline in preparing and reporting organizational finances, it reflects the serious work of the event actors. So that the outcomes obtained show evidence that as prajuru subak can be trusted as managers of religious organizations in front of the subak krama who are always aware of submission to divine power. This can support the implementation of stakeholders in improving organizational performance to realize and maintain the success of the organization in maintaining its existence. Indonesia is rich in noble values formed from existing religious values, so this can be used as a solid basic capital in carrying out the profession in the organization. Stakeholders can identify areas that need to be improved to maintain the sustainability of the organization as can be seen in the suggestions section of this study. In the future, these dimensions of accountability can be used as a foothold for an organization in managing various activities carried out starting from inputs, processes, outputs, and results, as well as how the environment responds to these results. An organization's sensitivity to the dimensions of accountability will help them to improve their performance concretely in the future, so that they can be accountable for their work. --- Compliance with ethical standards --- Disclosure of conflict of interest No conflict of interest to be disclosed.

This study aims to reveal and understand in depth about how the practice of accountability of subak financial management in Subak Sembung Denpasar. Subak is a traditionally developed social organization according to customary law that has unique differences from other organizations. Subak has a special culture regarding irrigation and rice farming activities based on Tri Hita Karana as its philosophy. Interpretive is the paradigm in this research with an ethnomethodological approach according to Harold Garfinkel. Data in this context is based on what is revealed by informants, then enriched with the results of observation and exploration of other sources through documentation. Analysis of the data findings reveals that the constructed accountability practice is an accountability practice that upholds the moral values of honesty, discipline, trust, and a sense of belonging guided by the teachings of Tri Hita Karana to form five dimensions of accountability. Bhakti to God Almighty which is always practiced and becomes the main thing in all its activities can deliver Subak Sembung to remain in existence.

Introduction With COVID-19 infection all set to become a household example of the modern times akin to plague, there is no better timing to disperse the thoughts and takes of this situation, especially for a health care professional who is experiencing it firsthand. On January 30, 2020, WHO declared the COVID-19 infection as a global pandemic [1]. As a dental professional and also as a citizen under lockdown, both have shaped my thoughts on dual horizons. The hope that modern medical science can conquer almost anything gets clouded over by the emotions that we face as a citizen. What is more frustrating is difficult to fathom; the desperation to overcome this plague or handling the sanctions on our freedom. Further twisting this disarray is the fact that educational sector has been affected in unprecedented way. Undoubtedly the pandemics impose devastating consequences on communities and exhibits long-term rippling effects in the economy and the health care system as well [2]. Never in the history of mankind, have we faced a global public health issue of this magnitude with its effect felt across a spectrum of activities encompassing economic, travel, governance and education [3]. Nevertheless, as our hope to binge in social intermingling does not seem to fade, we all have to work towards one common goal, to contain the virus and restoring the normalcy for the sake of a vivacious neighborhood. The aim of this paper is to discuss and understand the current situation of a health care professional in a foreign land. In addition, the role of the Saudi governance to combat this vicious infection has also been given a thought to. --- COVID-19 in the Kingdom of Saudi Arabia (KSA) Remaining undaunted by the economic challenges, most of the major economies have dived into the uncharted seas of the lockdowns, curfews and limitations of the movement of the population. KSA is the largest country in the Middle East, occupying approximately four-fifths of the Arabian Peninsula in km [2,4], It has >32 million population of which approximately 63% are Saudis, while the remaining consists of working-age immigrants, originating mainly from India, Pakistan, Bangladesh and the Philippines [5]. Holiest place for one of the major religions -Islam, Saudi Arabia has experienced changes at various levels of society and its effect is well felt by each stratum who are undergoing these times of tests. KSA is also battered by the presence of the COVID-19 with about 223,327 positive cases as on June 9, 2020, which comprises of 60,131 active cases and 161,096 recovered ones [6]. Life has come to a standstill in once a vibrant society and people are feeling the brunt of this deadly virus. With COVID-19 infection in one hand, this country is still battling with another viral infection known as MERS-CoV. Initially named as coronavirus or nCoV, it was first reported in 2012 after genome sequencing of a virus isolated from sputum samples from a person who fell ill in a 2012 outbreak. The patient had reported flu-like respiratory illness. By July 2015, MERS-CoV spread over 21 countries, including Saudi Arabia [7]. After several years of MERS-CoV circulation, intensive efforts by the Saudi Ministry of Health (MOH) has led to drastic improvement in infection control practices in health-care facilities nationwide. Most health-care workforce have a very high index of suspicion for MERS-CoV. Still the standardized and approved point of care testing for MERS-CoV is lacking, and hence the health care professionals continue to face challenges with respect to rapid detection and proper isolation of patients with MERS-CoV [8]. These challenges will now be faced by the whole global health community dealing with COVID-19. The symptomatic patients should now be tested for both MERS-CoV and COVID-19 simultaneously. With the ongoing MERS-CoV circulation in animal reservoir (dromedary camels) in the Arabian Peninsula and the continuing zoonotic spillover with 70% of cases resulting from nosocomial transmission [9], the risk of emergence of COVID-19 within the same community would be overwhelming for the health care infrastructure. This is a true concern with already rapid international spread to 25 countries outside China, especially with the ability of COVID-19 to spread from a totally asymptomatic person [8]. --- An expatriate's view on Saudi government in combating COVID-19 Being an expatriate has been challenging at various fronts, but after several years of stay, this society has been a comfort cushion. This welcoming atmosphere has widened even more in the current situation of global crisis. It is not only commendable the way the Saudi governance has managed to restrain the spread of the virus, but also worth appreciating the way the daily life needs have been available to everyone without any much perturbation. Early lockdown with phased interventions at various levels and restricting the population movement depending upon density is a lustrous example of a bureaucracy which is socially responsible. Creating awareness amongst the community through recurring messages on mobile phones and innovative ideas to catch the attention of denizens has been quite effective tool initiated by Saudi MOH. Involvement is to such an extent that the ministers themselves have been circulating videos on hand washing techniques and their actions has been on the war front. Additionally, a continuous awareness to follow trustworthy sources and reliable guidance on social media and avoid myths and rumors is also being promoted. The geographic location with deserts as definite borders around settlements seems to have smothered the disease to a great extent. Social distancing has been one of the cruxes in limiting the spread of the disease, with at least 3 feet of distance between individuals. Secondly, isolation through home quarantines and lockdowns with the cessation of almost all working activities has proved to be of immense importance in curbing of the viral dispersion. It is a pleasure to see around that the authorities in kingdom have left no stone unturned to achieve these goals. Numerous health care professionals and students have volunteered to fight the pandemic by setting up awareness camps and helping the screening procedure for people who visit the supermarkets and likewise. Medical care of the affected people and quarantine facilities is as important as recovery and it is majorly attributed to the way the patient is handled. Kingdom has issued an order for free medical care and quarantine facilities which are world class. Rich with resources to handle the situation and plethora of personal protective equipment has complimented the care brilliantly. Nonetheless, the lessons learned by MERS-CoV circulations are well utilized by the Saudi government to keep the emerging pandemic and its severe outbreak under control. By promoting drastic impact measures they have managed to 'flatten the curve' of the COVID-19 infection. --- COVID-19 and dental education Perhaps one of the most affected dimensions of the society is inarguably the educational sector. Thousands of schools and colleges have faced the backlash of closure and students all over have suffered in an unforgiving manner. Dentistry as a whole is not only a challenging field, but also demanding at various levels which is well supported by the fact that it needs one of the most grueling practical works including a balance between medical knowledge and dental services. Needless to say, any branch or field which needs this much of physical presence of the wards within the campus has been severely crippled. It is a well-known fact that open communication among students, clinical teachers, and administrative staff enhances mutual trust and facilitates adequate cooperation [1]. But during the outbreak period, all kinds of aggregation of people should be avoided without hampering the learning process and this is exactly what the Saudi government did by initializing the distant learning through the smartboards to continue the learning process by the students. Online lectures, case studies, and problem-based learning tutorials are delivered by all the teaching faculties within the KSA. Existing smart devices and applications have already made it possible for students to listen to and review lectures whenever and wherever possible. These smart learning methods were made effective from the very early hours of COVID-19 outbreak within the Kingdom. Additionally, the students are continuously encouraged to engage themselves in self-learning, make full use of online resources, and learn about the latest academic developments. Other than this, continuous academic advising services are provided to those students who need any academic or psychological assistance. Even though the distant learning has proved to be vital in stabilizing the learning experience, still it needs to be to proven in the long terms and it can be gauged only when we assess the outcomes through student experiences. There has been no dearth on delivering lectures and imparting knowledge through presentations via the electronic media, but laboratory sessions and patient experience has literally handicapped the overall course experience. The pandemic has deeply affected the delivery of services by the various health care specialties especially the dental professionals since they are at high risk for nosocomial infection and can become potential carriers of the disease. These risks can be attributed to the unique nature of dental interventions, which include aerosol generation, handling of sharps, and proximity of the provider to the patient's oropharyngeal region [10]. Although the significant limitation of clinical activities in the dental colleges is affecting the learning experience of the students but as a health care providers, it is of utmost importance to protect our patients, staff, family members, and society, and we must focus on preventing future outbreaks. One of the perspectives of education which has definitely faced the repercussions of the lockdown has been examinations. It is one of the challenges which we need to explore as how to assess our students in this time of social distancing and curfews. There is still a long way to go for understanding this tool of education and its outcomes in an unprecedented way. --- Conclusion Every bird at the end of the day wants to return to its nest, wherein it finds the solace, unless a migrant one finds himself in a promised land. It is no wonder that almost third of population of Kingdom is an expat population who have over the years made this beautiful country as their home. And as we face lockdown and the COVID-19 illness has been giving a cold shoulder worldwide, there might be few places on earth which can be counted on your fingers to feel safe as the Kingdom. It is absolutely challenging to balance all the essential frontiers like social, physical and mental wellbeing of the residents, educational, health care and daily needs especially during the pandemic. Also, there has been no bigotry and discrimination in any form, in the delivery of various services by the Saudi government during this outbreak. Experiencing it first hand, it is needless to say, truly it is land o' the Leal and a wholesome place to be to face such a profane crisis. --- Conflict of interest None to report.

The World Health Organization (WHO) has declared novel coronavirus (COVID-19) infection a global pandemic due to the fast transmission of this disease worldwide. To prevent and slow the transmission of this contagious illness, the public health officials of many affected countries scrambled to introduce measures aimed at controlling its spread. As a result, unprecedented interventions/measures, including strict contact tracing, quarantine of entire towns/cities, closing of borders and travel restrictions, have been implemented by most of the affected countries including the Kingdom of Saudi Arabia. OBJECTIVE: The aim of this paper is to share health care professionals' perspectives who are experiencing COVID19 firsthand in a foreign land. In addition, the role of the Saudi governance to combat the current situation is also discussed. DISCUSSION: Personal and previous experiences as related to Middle East respiratory syndrome coronavirus (MERS-CoV) by the authors has been compared to the current situation and how it affected our thoughts and management. A review of the evidence-based literature was conducted to investigate the demographics of the region; and to understand the awareness of the various tools that are available and how they were utilized in the present situation of pandemic. CONCLUSION: Saudi Arabia has been challenged during the pandemic as are other countries.

Editorial on the Research Topic The impact of COVID-pandemic on children and adolescents with disabilities: education, development, and well-being of culturally and linguistically diverse families In a series of four studies, researchers delved into the multifaceted impacts of the COVID-19 pandemic on individuals with intellectual and developmental disabilities (IDD), children and young people with special educational needs (SEN), and families of children with neurodevelopmental conditions (NDCs). According to the National Institutes of Health, NDCs are types of disorder that influence how the brain functions and alters neurological development, causing difficulties in social, cognitive, and emotional function. The most common NDC is autism spectrum disorder (ASD). These studies, conducted by Salinas et al., Sankoh et al., Kouroupa et al., and Di Poi et al., collectively shed light on the disruptions in services, challenges in remote learning, learning experiences, and heightened anxiety within these communities. Salinas et al. focused on the IDD community in California, examining the influence of COVID-19 on services. Before lockdowns, racial/ethnic groups showed no significant differences in services. However, during the pandemic, respondents identifying as White reported a significantly higher mean number of services compared to people of color. Across all groups, age and diagnosis consistently predicted service access, receipt, and perceived support. This underscores the need for targeted interventions to address disparities in service provision among diverse populations within the IDD community. Sankoh et al. investigated parental experiences in using technology for remote learning for children and young people with SEN during the pandemic. The study highlighted the unprecedented burden placed on parents, particularly for children and young people with SEN, as schools transitioned to remote learning. Poor communication between parents and teachers, unmet desires for parental involvement in remote learning planning, and a failure to meet Individualized Education Programs (IEPs) during remote learning were identified challenges. The study emphasized the inadequacy of remote learning for special-needs students without appropriate educational assistance, emphasizing the need for improved communication channels and tailored support systems. Kouroupa et al. explored the experiences of families with children with neurodevelopmental conditions in the UK during home schooling. The study revealed that learning primarily occurred through school-provided worksheets in both home and hybrid learning settings. While families had access to the internet and devices, they lacked crucial resources such as special equipment, software, printers, and, notably, desks or tables for 11% of families. Additionally, satisfaction with school support was low in both home and hybrid learning settings, contrasting with higher satisfaction among families with children attending school daily. This highlights the importance of addressing resource gaps and improving support structures for families of children with neurodevelopmental conditions during remote learning. In a global survey conducted by Di Poi et al., the focus shifted to the increased anxiety within families of individuals with neurodevelopmental conditions during the early months of the pandemic. The study, involving over 10,000 families across 78 countries, revealed that parents reported heightened anxiety at the onset of the pandemic. Concerns related to the loss of institutional support and financial problems were major stressors for parents, while children's anxiety was primarily related to the fear of becoming bored. Notably, there was a bidirectional effect between overall parental anxiety and reported anxiety in individuals with NDCs, indicating emotional convergence among family members. The study also uncovered transdiagnostic findings that suggest potential avenues for future research on the psychological impact of the pandemic on individuals with IDD. Collectively, these studies underscore the intricate challenges faced by individuals with IDD, children and young people with SEN, and families of children with neurodevelopmental conditions during the COVID-19 pandemic. Disparities in service access, inadequacies in remote learning, resource gaps, and heightened anxiety emerged as prominent themes. Addressing these issues requires a comprehensive and tailored approach that considers the diverse needs of these communities, emphasizing the importance of targeted support, effective communication, and resource provision to ensure the wellbeing and educational success of individuals with intellectual and developmental disabilities. --- 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.

Rios K, Luelmo P and Ramos Torres S ( ) Editorial: The impact of COVID-pandemic on children and adolescents with disabilities: education, development, and well-being of culturally and linguistically diverse families.

Introduction According to what has been mentioned above, it is apparent that there are various differences between Chinese and Western table manners. In order to make them more coherent, before analyzing possible cultural factors, it is necessary to list concrete differences in terms of the listed points respectively. --- Tableware For one thing, the use of tableware has personnel characteristics both in China and western countries. In China, tableware is relatively simple and free. People usually use chopsticks, spoons and plates. Before beginning, it's polite to place chopsticks on the right side of plates. Compared with Chinese tableware, it's more complicated in western countries. They have a series of strict rules about tableware's position and usage. On dinner table, there are various kinds of knives, forks, cups, spoons and so on according to the usage. For example, tablespoons prepared for tasting soup are forbidden to eat cakes. Then, all of the tableware should be placed from outside to inside in accordance with the order of serving dishes. What's more, the number of tableware is supposed to be the same as the dishes' number. For another, the meaning of tableware display is different. At a Chinese banquet, if one is having a pause in the process of dining, he would lay his chopsticks aside on the plate; when he has finished his meal, he would vertically lay the chopsticks on the bowl. At a western banquet, crossing the knife and fork would mean that one is not fi-nished eating, just pausing for a break; when finishing eating, one would place his knife and fork together across the top of the plate, with the sharp edge of the blade facing in. --- Dining Atmosphere In western countries, the dining atmosphere is quiet and romantic. With the dim light and soothing music, people concentrate on delicious food on their own plates and seldom speak aloud. However, interaction is an integral part of Chinese dining culture. Chinese people prefer to chat and interact with each other while sharing delicious food because we believe that the lively atmosphere on the dinner table reflects the hospitality of guests and the warmth of the host family. If necessary, we would like to place tasty food on the elders' or leaders' plates to show their respect. Affected by this custom, it comes into being a special table etiquette called "drinking culture", which means people narrow down their social distance and make negotiations by toasting on the dinner table. --- Seating Arrangement The arrangement of the seat is an important form of using the spatial position to express each person's status and the relationship between people and land (Bian & Gao, 2004). In western countries, people like to choose a long table at a big party. Host and hostess sit at both ends and guests of honor sit beside them. In general, the more important the guests are, the closer they will sit to the host and hostess. In China, people are accustomed to sitting around a large round table. The best seat normally faces south or the door. Diners often spend a few minutes figuring out who should sit in the best seat. And only the host or the most respected one gets the honor to make the order. --- Causes Analysis Table manners are influenced by various complex factors, such as historical and geographical backgrounds, national characters and so on. In my opinion, thinking modes in different cultures is one of the most important factors. Therefore, in this paper, I demonstrate some reasons from the perspective of culture. --- Relationship of Man to Nature According to Kluckhohn and Strodtbeck's value orientation, there are three kinds of relations between man and nature: mastery, submissive and harmonious. This theory indicates the basic attitude toward nature in different countries. Tableware is an epitome of man-nature orientation. Deeply affected by Confucianism, Chinese people believe in the theory that man is an integral part of nature, so their attitude toward food is temperate. Traditional chopsticks are the most typical tableware embodying Chinese harmonious consciousness. There is no main or auxiliary part in the use of chopsticks. Only when the user operates two sticks together with five fingers properly can they taste delicious food (Yu & Ling, 2015). As Roland Barthes commented on chopsticks: "Food is no longer the prey of human violence, but a matter to be transported in harmony." (Liu Chenghua, 2002). However, most western countries are influenced by maritime civilization and commodity economy, so they have more courage to take adventures and conquer nature to make profits. That's the reason why they choose knives and forks as the common tableware to control the food. --- Collectivism and individualism In Hofstede's dimensions of cultural variability theory, he has mentioned that people in collectivist cultures are interdependent and think highly of group harmony. On the contrary, people in individualistic cultures concentrate more on independence and competition. Most western countries are immersed in individualism. It means that the boundary between people is very clear, so they do not like mutual interference. Besides, for people in western countries, eating is just a basic tool to sustain life and maintain health, like adding fuel into machines. They don't consider restaurants as the best place to integrate and communicate. When they are having dinner, they wouldn't share plates of food with each other and talk about private affairs. But it's an opposite way in China. China is a typical country influenced by collectivism. Since a young age, children have been taught to take care of others and cooperate with them. Harmony is one of the most typical characteristics of Chinese cooking culture. The purpose of dining together in China is to share, relax and accompany (Yi Zhongtian, 2009). Meanwhile, Chinese people's idea of privacy is weak. On dinner table, to show politeness and create a harmonious atmosphere, Chinese people prefer to ask some questions related to privacy, such as job and hobbies, even when they meet for the first time. --- Space speaks People's concept of space is affected by acquired factors. Therefore, in different cultures, people have different communication rules and values related to space. Edward T Hall demonstrates the importance of "space speaks" in his book "The silent language": "Spatial changes give a tone to communication, accent it, and at times even override the spoken word. The flow and shift of distance between people as they interact with each other is part and parcel of the communication process." The non-verbal meaning represented by spatial orientation is closely related to the cultural traditions and local customs of different nationalities (Zhang Dong, 2012). Seating arrangement mirrors spatial conception in different countries. During Chinese long history, no matter in which dynasty, the emperor always sat facing south when they enthroned and deliberated state affairs. South has become a symbol of honor. Hence, in big parties, the most important person often chooses the seat facing south in China. In ancient Western society, the seat of the most honored guest was on the right side of the host, because people used to hold a dagger with the right hand and stab the person sitting on the left. If the most distinguished guest is placed on the right side of the host, not only will the slayer be unable to kill, but the host will have the advantage of subduing him (Edward T. Hall, 1973). With the development of society, the ancient appearance of stabbing at dinner parties has become extinct. But the rule has been preserved. Today, in western countries, the honored sit on the right side of the host. --- Conclusion Table manner is actually a kind of historical and cultural sedimentation and extension. This paper has compared tableware, dining atmosphere and seating arrangement in China and western countries. Knowing the differences, people can understand foreigners' behaviors better. Facing these gaps, people should comprehend more and remember that every culture is equal and valuable. It's irrational to justify right or wrong with our own standard. Only by recognizing cultural differences between China and West and making an effective integration can we establish a social cultural etiquette system and achieve the goal of the ideal harmonious society. My research still has some limitations. On the one hand, the factors causing different table manners are multiple and comprehensive. In this paper, I just analyze the causes from the perspective of culture. On the other hand, the content of table manners is rich and I just choose three appropriate manners to illustrate. So, based on personal interest, I will do further research about cooking culture in China and western countries.

With the development of globalization, having dinner is not just for people's basic need, but also for social communication. Nowadays, decent etiquettes on dinner table are more and more essential. Against different cultural backgrounds, China and Western countries may have different table manners. With the influx of Western culture into China, Chinese traditional etiquette has been constantly impacted by Western culture. To diffuse Chinese traditional etiquette and effectively integrate it with Western etiquette is more conducive to the cross-cultural communication. Hence, based on Hofstede's dimensions of cultural variability theory, Kluckhohn's value orientation theory and Edward T. Hall's space theory, detailed discussion and comparison of differences between Chinese and Western table manners, including tableware, dining atmosphere and seat arrangement, are mainly talked about in this paper. It aims to analyze the cultural causes of these differences. It is essential to distinguish these differences and take an objective and respectful attitude to cooperate.

Introduction: Person centred care is vital to ensure we improve access to the right care, treatment and support for all people. Meaningful engagement with people with lived experience is essential in the design of this and can also have direct benefits for people as a consequence. The ALLIANCE coordinates a number of networks for people with lived experience This includes a heart disease network that has been established to directly influence the Scottish Government's Heart Disease Action Plan to ensure we can improve access to the right care, treatment, and support, and minimise preventable heart disease. This interactive workshop we will share insights we have gathered and the learning to date as well as the methods we have embedded to ensure structures are in place to allow people to share their experience, and turn these experiences into meaningful action through our direct link into policy. This session will be useful for all health and social care stakeholders as through this discussion we will explore the importance of ensuring lived experience is at the heart of planning and decision making Purpose: To share learning, insights and generate discussion on how we can amplify the perspectives and insights a of lived experience --- Outcomes: •Participants will feel more knowledgeable having reflected on the the session's learning through discussion and presentation and potential to translate this into actions. •Participants will build connections and relationships across countries based on a shared goal. •Participants are more likely to incorporate the voice of lived experience through their own practice. --- Session Plan: •Welcome and introduction the session highlighting the purpose asking participant's if they can commit to the purpose of the session. --- •Icebreaker -what/who inspires you most to do what you do? •Presentation by the ALLIANCE sharing the learning from our lived experience networking, focusing on the Heart Disease Networking as a case study. --- •Feedback, questions and reflections on what has been shared •Facilitated small group discussions on individual learning oWhen people with lived experience are active and equal partners, what does that look like? oHow do we incorporate the principles of person centre care into our own practice •Feedback from each group with key themes being captured live through flipchart At the end of the session we will capture the key themes to develop a summary report of the discussion that can be shared with all participants taking part in the conference and promoted via the ALLIANCE website, newsletter and bulletins.

Amplifying the perspectives and insights of Lived Experience -Learning from ALLIANCE lived experience networks.

INTERNATIONAL JOURNAL OF FILM AND MEDIA ARTS (2023) Vol. 8, Nº. 2 The film Parasite (Bong, 2019) has attracted global attention awarded four Oscars in 2020. Many viewers as well as film critics see the universal themes that the film addressed such as increasing economic stratification and class struggles as the points of global success (Liu, 2020;Dianlya, 2020;Anker, 2020). Yet, the film displayed ambivalent visual symbols and eccentric characters. In this regard, some critics see the film as conservative because it is not rebellious enough (Brody 2019;Kim 2020). However, Parasite features the transition of the social system and a new vision of social relations rather than addressing the mere criticism of inequality between the rich and the poor, and recurrent social relations in capitalism. Parasite addresses social changes reflected in the family system and presents an alternative social system and family type. The film presents irony of the nuclear family, which has played the ideological and psychological roles of supporting the modern social system (Todd 1989;Gittins 1993). Parasite visualizes paradox of modern family in a form of mystery by portraying ironic characters in the film such as "a ghost" living in a basement, hysteric bourgeoisie and a fraud family. Although these characters appear to be eccentric being disconnected from the class structure, they illustrate the struggles of people in the existing mode of production (Zaretsky, 1986: Cooper, 2017). Moonkwang and her husband, represents the downside of modern family which has been hidden and suppressed under the modern mode of production. expected by the people at the bottom when precarious and gig labors drastically increase (Comaroff & Comaroff, 2014;Ettlinger, 2007). South Korea is one of the countries that have the high number of precarious workers in the world (OECD, 2022). Currently, South Korea is ranked on the top in terms of the rate of precarious work, and the seventh in the rate of self-employment among over 100 OECD countries. 1 Growing number of precarious workers and the transition of employment in Korea was originated from Neo-liberal restructuring of its economy during the Asian crisis in 1997 which has affected Korean economy throughout until now. It is not only economy and employment but also family relations and psychology of individuals that are affected by Neo-liberal restructuring. High rates of unemployment and precarious employment have led to breaking up families and affecting individual psychology (Cho, 2009;Ham, 2002;Kapur & Wagner, 2011) 1884), which presented how family has been formed depending on class relations from the beginning of primitive society to capitalism. Even though the family has been developed as a small but effective unit of social reproduction for thousands of years, the nuclear family is unique in the sense that it appears to be distanced from the mode of production. In pre-modern society, family lives are mingled with working lives such as farming and manufacturing in the family unit. In the modern era, on the contrary, the nuclear family intends to segregate from the mode of production and perpetuates separation and boundaries. It is not only Marxists, but also right-wing structural functionalists such as Smelsen & Halfner (1978) and Hartman (1990) who also present the social necessity of creating a nuclear family disconnected from the local community of premodern society. Both left-and right-wing sociologists concur with the point that the nuclear family is formed by the need of flexible labor power to facilitate capitalist development. The nuclear family both becomes a basic social unit of capitalist reproduction and develops emotional bonds in the late modernization period of the nineteenth century to mitigate class struggles (Zarestky, 1983). During this period, the family became romanticized and sacred, and the ideology of family centrism and unbreakable family values was legitimized. The nuclear family has been formed by disconnecting from local communities and the material basis during the period of modernization and urbanization. The nuclear family has created a sublime image by ideologizing and romanticizing family relations in the process of modernization (Giddens 1992;Kim 2013). In this sense, the modern family is a salient example of what Zizek (1989) calls "the sublime object of ideology." Zizek (1970) explains how a fantasy of cultural products and media contributes to maintaining capitalism in the contemporary world and supporting ideology. (Maden, 2017;Hanike, 2019). Fantasies are created as a form of metaphysical and sublime horror such as ghosts and lunatics that threaten sacred places of middle-class families. Poor and marginal subjects are presented as horror in these films. The mode of production in the modern period established not only capitalist production system in the workplaces, but also affected identity of individuals and their personal lives (Cooper, 2017;Gandal, 2007). The family system is an integral part of the modern mode of production, and the nuclear family supports the reproduction of capitalism. Nuclear family is an important basis of forming modern subjectivity which is constituted by meta-narratives including religions, nation-state, and other ideological aspects (Lyotard, 1984;James, 1999). The ideal type of nuclear family is certainly an important part of the meta-narratives of modernity. The film also presents a naughty boy who sniffs around people. In spite of their alertness and sensibility, the daughter is sexually seduced by her private tutor, Kiwoo, who is a fake university student. The film suggests that she was also victimized by the former tutor (a friend of Kiwoo) who wanted to use her to step up to a higher social status. Additionally, the film shows that the son is instantly tamed by the fake art teacher (a sister of Kiwoo). Some critics point out that Parasite describes the brutal reality of poor people who are deprived of education and employment opportunities however talent and diligent they are (Liu 2020;Dargis 2020). The critics point out that clever and artistic children in Kim family could not enter in the good universities, and diligent parents are constantly jobless. However, the film describes Kijeong, the daughter of Kim, as having "good skill of handcraft" instead of artistic talent, Kiwoo, the son, as shrewd instead of intelligent. In fact, the film does not emphasize unfair opportunities for poor people, and the members of Kim family look far from victims of social inequality. Indeed, films have not always portrayed poor people as victims and rich people as exploiters. Even silent films described working class people as active agents instead of victims as illustrated Metropolis (Lang, 1927). It is often viewed "classploitation" that describes poor as victims and rich as vice in mainstream movies (Gandal, 2007;Farahbakhsh & Ebrahimi, 2021). The film the Triangle of Sadness (2022), for example, features the revolt against the triangle of class hierarchy and rebellion of the lower class. It is same to Bong's previous films that consistently describe rebellious underdogs and vigorous class struggles as shown in his films including Host, Mother and Okja (Schulze, 2018;Lee & Manicastri, 2018;Ugwu, 2020;Noh, 2020). These films feature rebellious underclass who fight against social inequality and end up restoring family Moreover, many middle-aged people who had hard time to find new jobs after layoffs during the economic crisis became self-employed and opened up small business. The number of opening small business is about 500,000 a year whereas the number of closing business is 40,000 every year (Kim 2015) During the economic crisis, however, IMF required the strict Additionally, IMF restructuring plan of Korean economy affected the social welfare system in Korea. It is often called privatization of Keynesianism (Crouch, 2011;Pierson, 1994;Peng, 2004), which means that welfare policies were re- demonstrate their different attitudes toward the existing social system. Moonkwang and her partner show nostalgia toward the past. It is often called 'Post-Fordist affect' that precarious workers wish to return back to the hey days when they had a job security and firm beliefs such as American dream and social mobility (Isin, 2004;Lambert, 2019). Moonkwang and her husband emulated the bourgeois lifestyle while having precarious psychology of nostalgia and grief. Kim family, on the contrary, do not show any wish for social mobility nor emulate any tastes of the high-class. Park and Moonkwang families are the two sides of the same coin of the nuclear family like a decalcomanie 7 . The Although Kitaek's murder is often interpreted as a rebellion by the underdog by many critics (Kiang, 2019;Dargis, 2020;Noh, 2020), the film does not show any emotion of Kitaek, outrage or humiliation, when he murders Park. Also, his behavior Parasite challenges the fantasy of nuclear family which is believed to be romantic and sacred realms. The film illustrates that it is intruded by the fraud family and uninvited residents in the basement who are suffering from brutal reality as precarious subjectivities.

widely on Asian media, cinema, media technology, and audience studies. She is the author of the book Social media and cultural politics of Korean pop culture in East Asia (Routledge 2023).

Introduction In the present days, Social Media is a recent innovation of digital advertising and marketing. We have witnessed the importance of social media quickly increase over the past ten years. The most recent data predict that there will be 4.89 billion social media users worldwide in 2023, up 6.5% from the previous year. Inevitably these people look up to influencers in social media to guide them with their decision making. Social media advertising has done extremely on large scale to expand business by affecting consumer's , impression of a company or product. Social media influencer marketing has long lasting effect on the public because of their trust and faith for the influencers. Organizations' are continuously engaged in recognizing influencers who could promote their products among the target customers. They choose popular and trust worthy influencer of that particular target customers on social media platforms. The paper focuses on influencer marketing and how it affects the buying decision of people of rural area. According to the findings credibility and popularity of influencer is significantly affect the buying decision of people. It is also focuses on potentials of influencer marketing. The study also recommends the brands to go for the future potentials of rural areas as a great market for influencer marketing. --- Need of the Study The growing popularity of Social media has attracted many people around the world to share their views, opinions, knowledge and expertise on digital platform; and also it is sure that no one can imagine a smooth life without social media. For anything people refer social media. Millions of people are following social media that gives birth to social media influencers. These influencers, views, experiences are being followed by the followers. They have a very strong impact on the followers. So using these trends, brands are approaching influencers to promote their products among the customers. If we would see the data of followers a major portion of followers are from rural areas. They spend most of their time in following their followers. Hence if their passion to follow social media will be studied and utilize to promote sale of particular brand .Hence there is need to study the benefits of social media influencer marketing. One of the most well-known trends in content marketing right now is influencer marketing. It is not brandnew and is well-liked by B2C businesses. The exciting potential of working with social media influencers as a part of their social media marketing strategy has only recently been recognized by B2B organizations. To maximize your business benefits of different types of influencers, collaborating with the right influencer is a must. However, since the number of influencers has continuously been rising, marketers have to decide from a lot of options. Below we tell you six main types of influencers, through which you can have a clear view of the influencer market, and hopefully, you can find the most suitable influencer types for your company. Nano-Influencers: These influencers are the smaller ones. The range of their following is 1K to 10K. Nano influencers may be fans of a particular brand or product and constantly promote and discuss brands on their networks. Ideal for small businesses with minimal resources because it maintains a tight relationship with its audience and answers almost all questions and comments. It makes it more likely that their followers would consider their recommendations to be sincere suggestions rather than paid endorsements. Nano influencers have engagement rates that are twice as high as other sorts. Micro-Influencers: They are such influencers with a 10K to 100K following growth potential. When compared to other influencer categories, those that specialize have a very high fan engagement rate. Audiences that are highly segmented will make it simple for your brand to tailor adverts for them are reasonably priced, authentic, and relevant to followers. Since many of them are also amenable to other forms of payment, such as freebies and shout-outs, there are additional chances for businesses without the resources to launch an influencer marketing campaign. Mega-Influencers: Mega-influencers, who have more than a million followers, are well known on social media because of their celebrity status. They produce a tonne of engagement on the social media channels where their audience is engaged. This is what makes them desirable to organisations looking to utilise influencer marketing, as well as what drives up their cost. The rate of engagement declines as an influencer's overall number of followers' increase, despite the fact that mega-influencers have a tremendous reach. The engagement rate for Instagram influencers with more than 10 million followers is only 1.6%. Macro-Influencers: With a slightly smaller audience size between 500,000 and 1 million followers, macroinfluencers may be celebrities, TV personalities, athletes, or thought leaders. Since they can leverage their reputation to gain followers on social media, brands can expect a high price tag-though not as hefty as mega-influencers. Brands still get a large reach with this type of influencer but may not get the engagement rate they want. This is due to the follower to engagement ratio mentioned earlier. --- Background of the Study Now a days it has been seen that social media influencers are occupying a very important place in the lives of common people. They are following them for the purpose of their entertainment, gaining some knowledge in their specific domain and sometimes to update the knowledge through the experience of their influencers. These trends have given birth to the influencer to market their products. They share their reviews to recommend the product. Sometimes buying through their id the buyers also get a good discount. It has also observed that followers in urban areas they are used to buy products through influencer marketing. But it has also been calculated that followers of rural areas are just followers but they don't aware of the influencer marketing. It also benefits. Therefore it has been realised to study the perception of rural area followers about influencer marketing. If this sector got focused then a huge data rise in digital marketing as well as it promotes small traders. --- Objectives of the Study  To find out the percentage of social media users in the rural areas.  To know the percentage of population buying through social media influencer marketing.  To know the factors affecting their buying habits.  To find out the benefits of buying through influencer marketing. For the purpose of the study the researcher has chosen primary data to conduct research. Also the research environment of the study is in a village named Singaila and the respondents are adults of the age group of 18 to 40. In total 100 samples have been connected from rural area, then it has been coded and analyzed through excel converted into frequency tables to comprehend the complex data into simplier one. The sample size is again divided into 50 male and 50 female of the age group between 18 and 40. --- Findings  80% of the respondents follow social media on regular basis.  75 % of the respondents like to watch YouTube and face book.  75% of respondents follow influencer and average following is 7  Study reveals that 80% of respondents follow micro and nano-influencer.  It is evident from the data that respondents mostly like to watch short videos call Facebook reels and family contents like daily vlogging.  Study shows that a very little percentage of people buying commodities of their use through social media.  The respondents following influencers have view that they buy any product because of the trustworthiness and credibility of their influencer.  Respondents have experience of getting discounts, some offers, and reasonable products are the benefits of buying. --- Conclusions From the above findings we can conclude that social media is very popular platform for the entertainment as well as updating knowledge. From the study we can say that majority of the people in rural area follow social media for the purpose of entertainment. But they have very little awareness of buying through social media to get better products of their choice as well as offers. Various brands approached mega and macro influencers to promote their products on the social media but due to their less engagement ratio with followers their products remains unordered by the people of rural areas. In order to counter a particular portion of population it is necessary to approach the popular influencer of that particular target group. Also it is important to customize the products and provide possible discounts and attractive offers to grab and retain the customers of rural areas.

Social media influences on marketing as a recent innovation of digital advertising. The most recent data predict that there will be 4.89 billion social media users worldwide in 2023, up 6.5% from the previous year. Social media advertising has done extremely on large scale to expand business by affecting consumers' impression of a company or product. Social media influencer marketing has long lasting effect on the public because of their trust and faith for the influencers. They choose popular and trust worthy influencer of that particular target customers on social media platforms. The paper focuses on influencer marketing and how it affects the buying decision of people of rural area. The study also recommends the brands to go for the future potentials of rural areas as a great market for influencer marketing.

SUBJECTIVE AGE MODERATES THE RELATIONSHIP BETWEEN GLOBAL COGNITION AND SUSCEPTIBILITY TO SCAMS Gali Weissberger 1 , Aaron Lim 2 , Laura Mosqueda 3 , Annie Nguyen 2 , Laura Fenton 2 , and Duke Han 2 , 1. Bar Ilan University, Ramat Gan, HaMerkaz, Israel, 2. University of Southern California, Los Angeles, California, United States, --- Keck School of Medicine of the University of Southern California, Los Angeles, California, United States Understanding factors that increase susceptibility to scams in old age is of critical importance. Cognitive functioning has been demonstrated to be an important factor in predicting financial exploitation and scam risk. There is also evidence that subjective age, or one's perceived age relative to chronological age, may be associated with financial exploitation risk. This study examined the interactive effect of subjective age on the relationship between global cognition and susceptibility to scams. Sixty-five participants underwent an assessment of global cognition (Mini-Mental State Examination; MMSE), reported their subjective age, and responded to a self-report questionnaire on scam susceptibility. A main effect of global cognition on scam susceptibility was found (b = -0.029, ß = -0.280, p = 0.028); there was no main effect of subjective age on scam susceptibility (p = 0.819). An interaction between cognition and subjective age was found, such that the negative association between cognition and scam susceptibility increased as subjective age increased (b = -0.185, ß = -0.311, p = 0.016). Examination of conditional effects demonstrated that the relationship between cognition and scam susceptibility was not significant amongst those with subjective ages below one standard deviation (SD) of the mean, but was significant for those whose subjective ages fell around or above the mean (within 1SD, b = -0.03, SE = 0.01, p = 0.03; +1SD, b = -0.06, SE = 0.02, p = 0.001). Findings suggest that individuals with older subjective ages may be particularly vulnerable to the negative effects of lower cognition on scam susceptibility. --- SESSION 4280 (SYMPOSIUM) Abstract citation ID: igad104.1626 --- THE IMPACT OF COVID-19 ON RESIDENTS AND FAMILY/FRIEND CAREGIVERS IN ASSISTED LIVING HOMES Chair: Matthias Hoben Co-Chair: Colleen Maxwell Discussant: Anna Beeber Healthcare reforms have neglected assisted living (AL) and nursing homes (NHs) for decades, setting them up for the excessive rates of death and suffering during COVID-19. Research before and during the pandemic has primarily focused on NHs, largely overlooking AL. AL is rapidly expanding, caring for people with similar vulnerabilities as those in NHs, yet is less regulated, offers fewer services, has lower staffing/skill mix levels and requires significant family/ friend involvement in care. This symposium presents a program of research (COVCARES, COVID-19 and the Care of Assisted living Residents), aiming to understand how the pandemic has impacted AL resident, family/friend, and facility outcomes, and how resident outcomes compare between NHs and AL. Our research started over a decade ago with the first population-based cohort study comparing AL and NHs in Canada. Our current research includes repeated surveys (10/2020-04/2021 and 07/2021-09/2021) with family/ friend caregivers and AL facilities, and population-based clinical and health administrative data (2017-2021) from AL and NH residents in Western Canada. Five presentations will report on the design/methods/goals of COVCARES (#1), the impact of the pandemic on family/friend involvement in AL resident care (#2), impacted of the pandemic on psychotropic drug prescriptions in AL (#3), and the association of AL home preparedness for and response to the pandemic on resident pain (#4) and loneliness (#5). Our discussant (Anna Beeber) will highlight similarities and differences between AL and NHs, similarities and differences in both settings between the US and Canada, and how policymakers can account for these differences. --- CAREGIVER INVOLVEMENT AND CONCERNS WITH RESIDENT CARE IN ASSISTED LIVING BEFORE AND DURING COVID-19 Matthias Hoben 1 , Hana Dampf 2 , David Hogan 3 , Kyle Corbett 2 , Kim McGrail 4 , Lauren Griffith 5 , Andrea Gruneir 2 , and Colleen Maxwell 6 , 1. York University, Toronto, Ontario, Canada, 2. University of Alberta, Edmonton, Alberta, Canada, 3. Univeresity of Calgary,Calgary,Alberta,Canada,4. University of British Columbia,Vancouver,British Columbia,Canada,5. McMaster University,Hamilton,Ontario,Canada,6. University of Waterloo,Waterloo,Ontario,Canada Family/friend caregivers are essential in promoting assisted living (AL) residents' health/well-being, but their involvement was restricted during the COVID-19 pandemic. Care needs in AL are similarly complex as in nursing homes, but fewer staffing resources and services are available. Caregiver involvement and concerns with care of AL residents before and during the COVID-19 pandemic is a critical knowledge gap. This prospective cohort study collected online surveys from caregivers to AL residents in Western Canada. Surveys assessed socio-demographics, ways of visiting or communicating with residents, involvement in care tasks, concerns with resident physical/mental health, perceived lack of resident access to care services, and whether caregivers felt well informed/involved with resident care. Our first survey assessed outcomes in the three months before and after pandemic wave 1 (03/2020), our second survey assessed outcomes in pandemic wave 2 (11/2020 -02/2021). Based on 386 responses, in-person visits dropped significantly in wave 1 (91.5% to 30.6%) and so did caregiver involvement in nearly all care tasks (e.g., toileting: 7.5% to 2.6%, social/ recreational activities: 73.6% to 25.7%). While these rates increased in wave 2, most did not return to pre-pandemic levels. Caregiver concerns increased in wave 1 (e.g., concerns about residents' depressed mood: from 21.3% to 50.3%) and stayed high in wave 2. Concerns were particularly high (e.g., >20% higher for depressed mood) among caregivers who did not feel well informed/involved with resident care. Continued caregiver involvement in resident care and communication with caregivers is key to mitigating caregiver concerns and supporting caregiver and resident well-being. Abstract citation ID: igad104.1629 --- ASSOCIATION OF ASSISTED LIVING HOMES PREPAREDNESS AND RESPONSES TO THE COVID-19 PANDEMIC WITH RESIDENT LONELINESS Rashmi Devkota 1 , Colleen Maxwell 2 , Hana Dampf 1 , Shovana Shrestha 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 Loneliness has been an ongoing problem among Assisted living (AL) residents and has worsened during the COVID-19 pandemic. Loneliness is associated with an increased risk

Each year, the number of informal caregivers in the United States continues to rise, in conjunction with the increasing aging population. Concurrently, the number of immigrants in the United States had progressively increased over the past few decades, leading to an intersection of three pivotal issues: caregiving, aging, and immigration. While there are several studies targeting caregiving in the United States, fewer studies have aimed to understand the experiences of caregivers of older immigrants. This study examined differences in time spent caregiving between caregivers of older immigrants compared to caregivers of older non-immigrants. Data were taken from Round 11 (2022) of the National Study of Caregiving, a nationally representative study of informal caregivers caring for an older adult with functional limitations. Chi-square tests were used to test bivariate associations, and a multivariate logistic regression model was run to determine the relationship between and older adult's immigration status and time spent caregiving by their caregiver. Results showed that caregivers of older immigrants were significantly more likely to report that they provided care every day, compared to caregivers of non-immigrants. These results point to potential cultural implications for immigrant families, who are generally less likely to use formal caregiving avenues such as nursing homes, and less likely to use additional services such as home health aides. Implications for researchers, policymakers, and practitioners are discussed.

Results and Discussion

Common problems experienced by partners are still found to be negative stereotypes of certain ethnicities and religions. Therefore, the solution that we offer in this service program is to carry out strengthening peace education through inter-ethnic relations. Implementation of Submission of material in the form of a group discussion forum (FGD) about the importance of peace education programs through inter-ethnic relations at the Children's Communication Forum. The purpose of this PKM is so that the younger generation is equipped with multicultural values in order to create an attitude of integration so that it is not easy to be carried away by SARA issues which are very vulnerable to occur in multicultural societies such as in Batulayang. This service has proven to be able to increase understanding of the importance of peace education for the younger generation in Batulayang village. The strengthening of Peace Education is carried out in order to prevent social problems in the form of negative stereotypes between good ethnic groups. This program also institutionalizes social values to citizens so that they have awareness of the risks of any social problems. This PKM also provides citizens with knowledge and skills so as to increase their social intelligence and to increase citizen participation in preventing and overcoming social problems which in the end citizens develop character and character to have responsibility in social life, namely not to riot, violence and brawls, conflicts with other ethnic groups, races and religions, intolerance and human rights violations.

Introduction Despite the evident benefits of modern technologies both on the personal as well as on the societal and economic level, technology solutions do not receive unequivocal acceptance by the potential end users. Since acceptance is directly linked to technology use, it is thus the essential characteristic of user experience. Technology acceptance is predetermined by several factors both at the individual as well as the societal level. Here, we will focus on the characteristics of the "elderly user" on the individual level without neglecting that the interaction of individual characteristics, the context of technology application, and the larger societal context may also play a significant role in explaining differences in individual use. Moreover, we will narrow the focus to the use of information and communications technology (ICT). --- The "Elderly ICT User" Despite the broad consensus that ICT in its various manifestations will bring benefits to elderly persons, there are at least three perseverant myths holding that elderly users show several limitations that can inhibit the use of these technologies [1]. The first myth concerns the level of interest and negative attitudes towards technology in elderly adults. Although there is evidence that older adults use information and electronic technology less often than other age groups, interest and willingness to acquire new ICT-related skills characterize the major part of older adults. A second myth concerns the learning capacity of elderly persons, assuming to be limited due to decline in cognitive performance. Here, there is evidence that the young-old (age 60 to 74) and the old-old (age 75 and above) can readily acquire computer skills, navigate Web sites and maintain these skills over time [2]. Evidently, the most important factor within this context is the availability of training and continuous support of the elderly novice user [3]. Finally, a third myth holds that negative attitudes and anxiety may impact computer task performance of older adults. Results of several intervention studies are in favor of the benefits of training programs, showing that experience and training diminish anxiety [4]. These general findings may give the impression that there is some kind of a prototypical elderly ICT user; however this would simplify the heterogeneity of attitudes, motivational states, and experiences which constitute individuals in old age. In a representative European sample, the following typology of elderly ICT users was derived: (1) the experienced front runners who benefit from a lifelong expertise of computer use, (2) the old age beginners who use the computer less often than once a week, ( 3) the technologically open-minded non-users that are keen on learning about technology or wish to improve computer skills, and (4) the digitally challenged non-users who are not interested in learning or improving computer skills [5]. Whereas this user typology mainly relies on the factors 'technology experience' and 'current technology use', we postulate that various other characteristics also promote or hinder the use of ICT at the individual level. Some of the factors that have proven to be important in this context will be described in the following. --- Inhibiting and Facilitating Factors of ICT Use -What We Know so Far Earlier research has identified important user characteristics from a psychological point of view [6]. We will extend this line of thinking in suggesting to combine these characteristics in order to elaborate differential user profiles. When it comes to explaining differences in ICT use, it is important to underline that differences can be interas well as intra-individual: There are differences between individuals and one person may also show different profiles across time. Table 1 lists a non-exhaustive overview of several domains and indicators that are associated with differential ICT use at the individual level and may explain both kinds of differences. The list starts with general demographic characteristics. Throughout the literature, high age, low educational attainment and low socio-economic status (SES), as well as being female are discussed as central features associated with low ICT use in old age. Although chronological age as a proxy of different functional and physical conditions may go along with a decrease in technology use, it is noteworthy that functional restrictions and age are not related to the interest in ICT. Moreover, cohort effects and the underlying different levels of expertise, knowledge and habits have more predictive validity for differences in ICT use than chronological age. Besides demographic characteristics, differences in physical and functional status represent a further and evident category. This domain comprises visual and hearing impairments with their direct impact on ICT use as well as more systemic characteristics such as morbidities and comorbidities. Linked to this, we would also like to underline the importance of performance issues such as motor function including the coordination of fine and gross motor skills as further pre-determinants of ICT use. The cognitive domain and here the process of information processing is listed as a further central complex that explains differential ICT use. Information processing describes the interplay between attention, perception, and memory and thus the encoding and retrieval of information. All these processes play a dominant role in lifelong ICT use as well as in old age; it is also well documented that the speed of information processing decreases with age, although there are considerable interindividual differences. Impairments in attention span, perception or memory lead to a decreased efficiency in information processing and might thus hinder both the acquisition and application of knowledge on ICT use. Thus, information processing might even be considered as prerequisite for ICT use. Motivational factors are essential for both the short-and long-term commitment to technology use. We would like to underline the importance of individual needs for a given technology application: Only if the application serves -or is perceived as serving -a personal need, the person will be motivated to use a specific device or application. This notion exceeds the user gratification approach, since it considers both explicit and implicit motives and the fact that various different personal goals may underlie the use of a given specific application. Of course, for motivational factors to influence ICT use, the user needs basic knowledge about the functions and handling of a technology device, given that many users state that (a) they do not know why they should use a given tool or (b) they do not know that a given tool may serve a specific need. Personality traits as stable interindividual differences in specific dimensions are illustrated by self-efficacy and control beliefs, which represent central dimensions of ICT use: Only if a person believes that he or she can handle technology applications or that these will have an effect on his or her life, the person will be motivated to use specific technologies. Another domain represents the individual's life story. Here, we subsume autobiographical memories linked to ICT use and technology experience as the result of a lifelong learning history of technology use. Lastly, the domain of social cognition comprises all ICT-related attitudes and beliefs, stereotypes, and the general openness to ICT use. All these personal characteristics have shown to explain differences in ICT use in older adults. --- Conclusion: The Need for a Differential Approach to ICT Use Taken together, these factors represent important predictors of ICT use on the individual level, though factors might be of differential importance, interact in complex ways, or even counterbalance one another. High age, low education, and low SES characterize conditions of low ICT use despite a good functional status. However, even with major physical impairments, a person with high self-efficacy and control beliefs feeding upon a lifelong technology experience may be a frequent user. Both examples underline the importance of fine-grained differential user profiles to explain interindividual differences in ICT use. In knowing about different user profiles, technology applications in different fields (e.g., virtual coaching) can be manufactured accordingly to maximize user acceptance.

Extending a literature review, the paper gives an overview of inhibiting and facilitating factors associated with the use of information and communications technology (ICT) of older adults. The paper takes the position that there is no prototypical "elderly user" but that there is a wide heterogeneity of personal characteristics such as cognitive and motivational states and experiences in old age. Dependent upon various characteristics of the elderly user as well as the context of application, development and implementation of ICT should follow the desideratum of a differential technology implementation taking an integrative approach by reconciling individual and social as well as socio-political approaches.

SOCIAL NETWORKS: BUILDING RESOURCES FOR DIVERSE AGING FAMILIES Chair: Kristine Ajrouch Discussant: Toni Antonucci Social networks provide tangible resources for older adults and their families. Yet, their formation and characteristics may vary across diverse aging contexts. Friedman and colleagues examine multiple dimensions of caregivers' networks using a nationally representative sample (N=2,176). Latent profile analysis identified three classes of caregiving networks: (1) Large, sparse networks with relatively few kin and only some people who assist with caregiving tasks for care recipients; (2) Moderately-sized, somewhat dense, kin-based networks; (3) Small, very dense family networks where caregiving is shared across network members, all of which uniquely influence caregiver well-being. Hu and colleagues evaluate measurement invariance of objective and subjective social isolation between US-born and foreignborn older adults using a regionally representative sample (N=611). Findings show indicators of social network structure and perceived relationship quality may be useful for examining social isolation among older immigrants. Ajrouch and colleagues show distinct dimensions of networks differentially influence older adult's cognitive function. Larger networks and higher proportion of family are positively related while higher contact frequency is negatively related to cognitive function. Using data from the Detroit-based Social Relations Study, Webster and Chin show the extent of similarity in health-related behaviors between older adults and their closest social network members. Analysis of 247 dyads illustrate associations between multiple social network factors (homophily, structure, and relationship quality) and similarity in these behaviors. Together, these papers advance theoretical and methodological approaches to the ways in which social networks serve as a resource across diverse aging contexts. Abstract citation ID: igad104.0493 Social networks provide tangible resources for older adults and their families. Yet, their formation and characteristics may vary across diverse aging contexts. Friedman and colleagues examine multiple dimensions of caregivers' networks using a nationally representative sample (N=2,176). Latent profile analysis identified three classes of caregiving networks: (1) Large, sparse networks with relatively few kin and only some people who assist with caregiving tasks for care recipients; (2) Moderately-sized, somewhat dense, kin-based networks; (3) Small, very dense family networks where caregiving is shared across network members, all of which uniquely influence caregiver well-being. Hu and colleagues evaluate measurement invariance of objective and subjective social isolation between US-born and foreignborn older adults using a regionally representative sample (N=611). Findings show indicators of social network structure and perceived relationship quality may be useful for examining social isolation among older immigrants. Ajrouch and colleagues show distinct dimensions of networks differentially influence older adult's cognitive function. Larger networks and higher proportion of family are positively related while higher contact frequency is negatively related to cognitive function. Using data from the Detroit-based Social Relations Study, Webster and Chin show the extent of similarity in health-related behaviors between older adults and their closest social network members. Analysis of 247 dyads illustrate associations between multiple social network Downloaded from https://academic.oup.com/innovateage/article/7/Supplement_1/150/7487847 by guest on 07 May 2024 --- SOCIAL NETWORKS AND COGNITIVE HEALTH IN RACIAL/ETHNIC CONTEXT

and career opportunities. Both traditional (e.g., nursing homes, senior centers) and non-traditional internship settings (e.g., research, teaching) are examined in regard to providing students with experiences that will enhance their knowledge, career development, and/or future academic goals. As both an undergraduate minor and a Master's level gerontology student, the presenter discusses their own non-traditional internship experiences that helped them to reach their goal of pursuing a doctoral degree in aging studies. Feedback gathered from other students in a variety of internship types is also presented. Finally, lessons learned, finding the right fit, and the overall value of internships and similar experiences is discussed from a student perspective.

Introduction Modern Family, a family sitcom that premiered on the American Broadcasting Company (ABC) in 2009, employs a mockumentary format in its filming and storytelling, as previously stated [1]. The show's humorous style serves to not only entertain audiences but also prompt them to consider family relationships. The characters' personality traits, behavior, and particularly their discourse patterns leave a lasting impact on viewers. The family dynamic of Claire Dunphy and Phil Dunphy is a prime example of a typical family, wherein conflicts often arise between parents and children, and disagreements or differences in viewpoints frequently occur among family members. These conflicts are characterized by distinct discourse patterns and expressions that reveal the nature of the relationships and psychological processes of the individuals involved. Utilizing Satir's Iceberg Theory as a framework and applying various language analysis methods, this paper seeks to interpret the parent-child relationship in this family. The paper aims to investigate how parents and children can establish or undermine their relationships during communication by analyzing the effects of the language family members use in their interactions. --- Overview of Satir's Iceberg Theory Virginia Satir is a well-known psychotherapist and a pioneer in exploring family therapy models [2]. According to Satir, an individual's relationship with their birth family is profoundly interconnected and profoundly impacts their entire life. Satir employs the iceberg analogy to explain this relationship, illustrating that while a massive iceberg's visible actions and reactions are apparent above the sea's surface, only one-eighth of it is visible, with the remaining seveneighths concealed beneath the water. The broader hidden ice represents the "internal" aspects we have long ignored. By uncovering the mystery of this glacier, we can unearth our desires, expectations, viewpoints, and emotions in life, enabling us to see our true selves. The Iceberg Theory offers significant guidance for parentchild relationships within families. As a couple, parents must learn to place themselves in a "relationship" and consider each other's perspectives. As children, they must learn to think from others' perspectives and avoid restricting others with their own beliefs. Parents and children must also learn to respect one another and communicate equally. The Iceberg Theory encourages us to understand and care more about our family members, encourage our children, and criticize them less. This paper utilizes the television show Modern Family as a case study to analyze the communication patterns and discourse analysis in parent-child relationships within the context of this sitcom. --- Case Analysis In contemporary society, the family unit is often subject to external influences, mainly through parental guidance. Pursuing a happy and harmonious life is a universal aspiration, with a peaceful and healthy family being a fundamental prerequisite for attaining this goal. The quality of an individual's family atmosphere during their formative years is crucial to their future outlook. A positive and optimistic disposition can be fostered through experiencing a supportive and nurturing family environment. However, children seldom experience their parents' childhood, and parents are often unable to fully comprehend their children's unique qualities or discern how best to provide them with love and support. In light of this, it is essential to recognize that a family plagued by contention, disparagement, violence, and indifference is not conducive to fostering positive personal growth. Such negative outcomes can often be traced back to the attitudes and behaviors exhibited by parents toward their children. --- Overview of the Family Background Claire exhibits a dominant and competitive personality, which can be attributed to her upbringing in a divorced family with a sickly older brother. Her challenging circumstances necessitated her to display strength and resilience. Her father's beliefs about parents' total dedication to their children also influenced her outlook on child-rearing. Claire has devoted herself to her family for over a decade as a housewife, viewing the relationship between parents and children as one of elder and junior with a necessary distance. Regarding her children's romantic relationships, Claire tends to be overbearing and even meddlesome, as evidenced by her efforts to break up her eldest daughter's relationship. Her focus on academic performance is high, making her a challenging parent in the eyes of many children [3]. In contrast, Phil is a popular parent among many children who values fun and experimentation over traditional approaches to parenting. He emphasizes teaching through enjoyment and fostering friendship with his children. Phil prioritizes his children's happiness, considering academic achievement a secondary external aspect. The three children raised in this family exhibit varied personalities. The eldest, Haley, is viewed as a rebel by her parents due to her disinterest in academics, which often causes conflicts with her mother. The youngest child, Luke, is treated with great care and affection, leading to him being spoiled and naive in his interactions with the outside world. Alex, the second eldest, is talented and intelligent, with a history of academic success and outstanding achievements. Still, her parents' inattention and indifference toward her have left her longing for their love and attention. Despite her efforts to attract their attention through exceptional performance, she is often met with indifference and is now indifferent to others. --- Analysis of the Conversation Conversation: (Background: The family is wearing Christmas sweaters and preparing to celebrate Christmas via video call when the mother, Claire, notices a burn hole on the couch and wants to know who the smoker is.) Claire: Real smokers, if you don't step forward, all three of you will be punished. Children: What? That's not fair. Phil: I can forgive you for smoking, but I can't forgive you for lying. No, I can't forgive you for smoking either. Does no one want to confess voluntarily? It's okay, do you know what will happen next? We'll cancel Christmas! Children: Dad, that's not fair [4]. This dialogue features Claire's assertion that if a child is unwilling to admit smoking, she and Phil will enact punishment, and all three children will face equal consequences. This approach by mother Claire represents a threat to the children's rights. Expressions such as "all three of you will be punished" may engender a tendency to evade responsibility in the children, leading to inconsistent responses. Throughout the conversation, the discourse between Phil and Claire is characterized by the imposition of control and the use of intimidation, infringing upon the rights of both parties and impeding the smooth exchange of ideas. As a result, a conflict arises in the conversation. --- Interpretation of the Parent-Child Relationship Based on Satir's Iceberg Theory Effective communication is vital in promoting mutual understanding and comprehension between parents and their children in the context of parent-child relationships. During this communication process, parents should aim to understand the psychological differences between themselves and their children, including differences in culture and personality traits. Additionally, parents should treat their children equally and respect and recognize and encourage specific behaviors and characteristics that their children possess. This approach creates the most favorable gift and educational environment that parents can provide to their children. To foster harmonious, stable, and long-lasting relationships, parents and children should approach each other with a positive and optimistic attitude toward the personality and lifestyle differences between them. Effective communication that appreciates, rather than denies or blames, the other person's perspectives and feelings should be practiced to fully understand what each individual wants to express from their innermost being. In addition to understanding the personality and lifestyle differences between each other, it is also essential for parents and children to learn how to express negative emotions arising from their psychological needs. Only when emotions are relatively stable can individuals reason and take the correct approach to dealing with one another. It is common to experience negative emotions such as unhappiness and irritation when faced with unpleasant or unfavorable situations. However, it is crucial to learn how to understand and express one's feelings appropriately to resolve and eliminate negative emotions in a timely manner. According to Satir's Iceberg Theory, everyone has aspects of themselves that are unknown and unwilling to be accepted. However, this does not mean these aspects are forever buried in our hearts and cannot be seen. Only through selfunderstanding and the ability to change those aspects of ourselves that we are unwilling, do not want, or cannot face can we gradually recognize those hidden parts of ourselves that are unwilling to be seen and accepted by others. This recognition allows us to transform these aspects into new strengths that can be used to solve problems and improve relationships with others. This approach enables individuals to face challenging situations and confusion with a new attitude and approach, ultimately leading to harmonious, stable, and long-lasting outcomes. --- Conclusion The concept of family education pertains to the education parents provide to their children throughout their growth and development. According to the renowned Chinese education specialist Xue Lixin, parents serve as children's first teachers, enabling them to comprehend the world and acquire knowledge. Family education is deemed critical for facilitating children's physical and psychological wellbeing [5]. This paper applies Satir's Iceberg Theory to analyze the conversations between a family depicted in the television series, Modern Family, and explores how parental communication impacts parent-child relationships. Furthermore, the paper suggests appropriate solutions to address the concerns raised. It is hoped that this paper will foster increased awareness and discourse surrounding these issues. As contemporary society continues to transform various aspects, such as social structure and ideological beliefs, conflict and discord among family members are becoming increasingly prevalent in this era of rapid development, diversity, and information exchange. In order to more effectively promote parent-child relationships and foster a harmonious and positive family environment, it is necessary to conduct an in-depth analysis of the unhealthy and disharmonious elements present in our surroundings while adopting novel perspectives to view them. Additionally, family education in both Eastern and Western societies should engage in mutual learning and complementarity to construct a family environment that is both harmonious and fulfilling [6].

This paper presents a case study of the Dunphys' in the American TV series Modern Family to examine the discourse between parents and children from the perspective of Satir's Iceberg Theory and to investigate the influence of discourse on parent-child relationships. The study argues that parents should cultivate the ability to position themselves within the "relationship" rather than the "change." In addition, the study emphasizes the importance of children's capacity to think from others' perspectives and avoid imposing their own perceived correct views on others.

Introduction With estimates of a quarter of the world population living with Mycobacterium tuberculosis and 10.6 million people diagnosed with active tuberculosis (TB) in 2021, disparities in diagnosis, access to care and management are still experienced worldwide [1]. Management is particularly difficult in high TB burden-low income countries due to logistic difficulties and economic limitations. Likewise, in low TB burden high income countries, some difficulties are met in reaching, testing and treating special populations, such as migrants, incarcerated people and people experiencing homelessness or sheltered housing conditions [2,3]. TB treatment and diagnosis are challenging also in transgender individuals due to difficulties both in screening and follow-up connected with social stigmatization [4]. In high income countries, many transgender individuals resettle from high burdenTB countries, resulting at higher risk of TB reactivation within two years from migration as well as with an higher probability of RR/MDR-TB compared to natives of the destination countries [5]. Data on epidemiology, management and treatment outcomes are extremely limited in transgender individuals, especially in low TB burden countries. --- Materials and Methods We Clinical and radiological criteria included signs, symptoms, and/or imaging findings consistent with active TB in any site or the clinician's decision to treat the patient with anti-TB regimens [6]. Microbiological criteria included positive microscopy for acid-fast bacilli (AFB) and/or culture, and detection of M. tuberculosis complex nucleic acid in a clinical specimen with GeneXpert® (after its clinical introduction in 2010) [6]. Miliary TB and cases involving both lungs and other sites were classified as pulmonary TB (PTB) due to lung involvement. For each patient, we collected the following data: gender, age, WHO Region of origin, more or less than 2-year stay in Italy, social background, legal status of regularity, first diagnosis or recurrence/re-treatment, PTB or extrapulmonary TB (EPTB) and site of EPTB, inpatient or outpatient management, pattern of M. tuberculosis resistance and treatment outcome. We reported whether the patients arrived in Italy two or less years prior to presentation as this is generally considered a cut-off for higher risk of TB reactivation [7]. Treatment outcomes were classified according to the WHO definitions [8]. The study received ethical approval n. 578-112,018 from the ethical committee of ASST Niguarda Ca′ Granda in Milan (Italy) and it was conducted in agreement with the Declaration of Helsinki (1964) and its later amendments. All data collected remained anonymous and it was not possible to link any patients to the collected data. Strengthening The Reporting of Observational Studies in Epidemiology (STROBE) recommendations were followed. The study received no internal or external fundings, nor did the investigators receive payments for the research. Overall treatment success rate was 72.7% (48/66 patients), with differences observed according to social conditions (Figure 2). Among patients with RR/MDR-TB, 4/5 (80%) successfully completed treatment. Full description of the study cohort is provided in Table 1. --- Results --- Sixty --- Discussion Our study describes one of the largest European cohorts of transgender individuals with TB, offering some insights. First, an overall increasing trend of new diagnosed cases of TB in transgender individuals was observed; however, since the beginning of SARS-CoV-2 pandemic, the number of new cases of TB per year significantly decreased, suggesting a possible gap in diagnosis and the need for effective efforts to recover the missed cases [9,10]. Second, most patients were from high TB burden countries and high resistance rates (12.1% of patients with isoniazid-resistant or MDR-TB) were detected. This underlines the extreme need for active surveillance reaching special populations also in terms of public health, as treatment success rates are much lower in patients with RR/MDR-and pre-XDR-TB, with less than half patients completing treatment [1]. In our cohort, all except one patient with MDR-TB successfully completed treatment, but overall treatment success rate was lower than the target set by the WHO in the End TB strategy. Third, economic conditions and social factors play a key role in TB management and significant disparities in treatment outcome were observed among different social condition groups, highlighting the need for an integrated medical and social approach in at risk populations. The main strength of our study is the description of a large cohort of transgender individuals diagnosed with TB and treated in a referral Italian center for TB over a long study period. Among limitations, due to the retrospective design of the study, some data were missing, and the study population, despite being one of the largest described, was too limited to make general assumptions. --- Conclusions A tailored patient-centered approach taking into account social and economic aspects, as well as health education actions aiming at stigma reduction, is crucial to optimize screening, management and follow-up and to obtain high retention in care in transgender individuals with TB.

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These initiatives grew out of the direct experience of caring for patients through the hearts of two third-year students and, later, of one faculty member. Both of these initiatives connected to the overall goal of the medical school to help students develop into professionals. This development is not straightforward and does not take place only through learning pathophysiology and differential diagnosis. The attitudes and behaviors that characterize the true professional are those born when hearts and minds are aligned and rooted in authenticity and humanity. The many activities and experiences that an individual student has during medical school contribute to his or her development as a professional. Those experiences that link to the inner life are especially powerful in developing the heart of a professional. For some physicians, their experiences with art or music or literature create the space and reflection to connect with their inner life. Poetry-both the reading and the writingis a powerful vehicle for exploring feelings and observations. This exploration leads directly to the inner life where a true professional is born. What began as serendipity is directly aligned with the core purpose of our school and with the ultimate goal of educating compassionate physicians who will contribute to the betterment of humanity.

Being in the privileged position of working with talented students, residents, faculty, and staff, I have encounters nearly every day of unexpected surprise. Such was the case several years ago when two of our students presented the idea of creating White Coat Pocket Poetry, a small book of poems for each third-year medical student. Students were encouraged to use the book in whatever way would be most meaningful to them-in reflecting privately on their experiences, in speaking with their families about their medical training, or in talking with their patients. Soon after White Coat Pocket Poetry was published, another moment of serendipity occurred. This time, the surprise came through an unsolicited e-mail from one of our faculty members offering to personally fund a poetry contest in our medical center. We soon put together a committee and opened the contest to all physicians, nurses, students, and staff. The Pritzker Poetry Contest was born in 2011, and the entries that followed touched our hearts and souls deeply. From my view in the dean's office, why should I support these initiatives? Obviously, I cannot support all of the good ideas that cross my desk. But these endeavors were different.

CURRENT GUIDANCE ON THE TREATMENT OF HYPERTENSION The current British National Institute for Health and Care Excellence guidelines [3] recommend that people who do not have Black African or Black Caribbean heritage are offered ACE inhibitors initially, in preference to calcium channel blockers or thiazide diuretics. In contrast, people who have Black African or Black Caribbean heritage are offered calcium channel blockers initially but not offered angiotensin-converting-enzyme (ACE) inhibitors. This is because all people with Black heritage are thought to be low renin responders so therefore less responsive to ACE inhibitors. However, ACE inhibitors may be offered later if calcium channel blockers are insufficient to maintain adequate blood pressure control. The inconsistency in this recommendation as well as many others was highlighted in a previous publication in this journal [4]. This correspondence was sent to the British NICE hypertension committee who considered the presented evidence but deferred guidance change (personal correspondence) until the next review, the date for this being uncertain at the current time. The British NICE guidelines are also notable in their contrast to US [5], South African [6] and International [7] hypertension guidance, as none of these include race as a determinant of treatment decisions. This perspective article summarises the evidence base for the guidance on the treatment of hypertension published by NICE and explains why the inclusion of race as a criterion for treatment is questionable and deserves to be reviewed as a matter of urgency. --- WHAT DO WE KNOW ABOUT BLOOD PRESSURE AND ETHNICITY? First, there is a minimal difference in blood pressure response to ACE inhibitors when comparing Black and White people. A 2013 meta-analysis using results from 13 trials found that there was 4.6 mmHg lower blood pressure response to ACE inhibitors for 2505 Black people compared to 10427 White people [8]. Twelve trials were based in the USA with the remaining trial based in the Netherlands. Whilst there was low risk of publication bias, we wonder whether this data could reliably apply to UK populations. None of the trials considered known confounders such as socioeconomic inequalities [9] or perceived discrimination [10]. A 2020 UK cohort study, using data from 2007 and 2017, found that 4010 Black people had 5.6 mmHg lower anti-hypertensive effect to ACE inhibitors and angiotensin receptor blockers (ARBs) compared to 150704 non-Black (including people with Asian heritage) at 12 weeks [11]. This effect persisted one year later without controlling for confounders. Despite this, the overlapping confidence intervals in changes in blood pressure indicates that Black people had a non-significant blood pressure lowering effect to ACE inhibitors and ARBs compared to non-Black people in the UK context. This is more representative of the UK population, compared to the 2013 meta-analysis [8] using populations from the USA and the Netherlands. Second, the inclusion of race within the hypertension guidelines assumes a distinct biological and genetic homogeneity amongst all Black and White people which contradicts contemporary thought [12]. The blood pressure lowering effect of ACE inhibitors is thought to be smaller in Black people as outlined above. Some report that this is due to inherent biological differences between Black and non-Black people such as a lower renin response [13]. Despite this, renin activity varies independently of blood pressure casting doubt on this theory [14,15]. Genetic differences between members of different races are much smaller than differences between members of the same race [16,17]. Furthermore, race is a social construct, not a biological one [12]. The classification of Black African or Caribbean lineage is self-ascribed and does not account for people with mixed heritage or people with distant Black ancestry such as grandparents or great-grandparents. People who describe themselves as white may very well have distant Black ancestry. Consequently, it becomes much more difficult for clinicians to base treatment decisions on race and who is judged to be black, especially given immigration from Asia and Africa to the UK over the last 70 years [18]. Third, the NICE UK hypertension guidelines are inconsistent, given that initial treatment is assigned on race, but subsequent second line management is not. If race is a criterion for treatment, why would it become irrelevant once initial treatment is ineffective?. Fourthly, there is no mention of race-based guidance for the use of ACE inhibitors in British NICE guidance such as in heart failure [19] or post-myocardial infarction [20] possibly as the cardioprotective rather than anti-hypertensive effect of prescribed medications is desired. A factor that we must highlight is the reported increased risk of ACE inhibitor angioedema within Black people that is described in the NICE guidance evidence reviews [21]. A 2006 systematic review [22] compared the risk of ACE-inhibitor angioedema between 55252 Black and 133964 non-Black patients. The data was from 4 US cohort and randomised control trials and 1 multinational trial using US, European, Israeli, Russian and Australian populations. The incidence of ACE-inhibitor angioedema for Black people was 0.43% compared to 0.18% for non-Black people. This would give an almost 3 times higher odds ratio of angioedema for Black people, but the absolute risk is small. A 2005 US trial [23] that was not included in the meta-analysis found a similar odds ratio but higher incidence of angioedema at 1.62% in 1237 Black people compared to 11397 non-Black people. This trial was cited as evidence to use ARBs over ACE inhibitors for Black people as part of recent international hypertension guidance [7]. Interestingly it is not clear how race is defined and whether that was defined by participants or researchers. Both the metaanalysis and trial contain predominantly US data which once again may have limited applicability to British guidelines let alone international guidance. In addition, ACE-inhibitor associated angioedema is apparently not relevant in the treatment of heart failure, reinforcing the view that race as a criterion is unjustified. Another consideration is cardiovascular outcomes which have been flagged from a recent meta-analysis [24] comparing the effect of ACE inhibitors or ARBs against other antihypertensives such as calcium channel blockers amongst Black people with hypertension with 4-to-6-year follow-up. The four US studies included in this analysis, involved 38,983 participants but since all studies did not involve all types of antihypertensives, it was not possible to include all study data in subgroup analysis. There were no significant differences in all-cause mortality or any cardiovascular outcome when comparing ACE inhibitors/ARBs to betablockers. However, ACE inhibitors/ARBs had 56 and 59% significantly higher risk of stroke compared to calcium channel blockers and diuretics respectively. For example, the absolute risk of stroke for Black people who were taking calcium channel blockers was 2.57% compared to 3.99% for those taking ACE inhibitors/ARBs. Once again, US data may not be applicable to the UK given differing regional and national socioeconomic inequalities [9] and perceived stress [25]. The meta-analysis concluded that the lack of measurement of blood pressure reduction in response to the analysed anti-hypertensives makes it hard to speculate on the cause of the higher stroke rate. Furthermore, not all the studies used multivariate regression models to adjust for known confounders such as socioeconomic inequalities. The meta-analysis compounds results for ACE inhibitors and ARBs making it hard to determine causation based on positive correlation between medication and stroke risk. --- CONCLUSION There is an urgent need to re-consider the inconsistencies in using ACE inhibitors to lower blood pressure for Black people and the rationale of assigning antihypertensives based on self-assigned race. Furthermore, there are inconsistencies in the inclusion of race in all guidelines and the reliance on US data without context for identifying short-term and long-term effects of ACE inhibitors such as angioedema or risk of stroke. There is a real concern that poorly defined self-assigned race without context, would encourage a historic perspective of racial pathology that lacks a robust scientific evidence-base to persist, and to allow persistence of existing health inequalities [26]. A more nuanced approach [27] that incorporates the fields of genetics, physiology, pharmacokinetics and social science would be more applicable to current scientific research approaches, as it would use mixed methods to integrate the complex intersection of race, ethnicity, society and medicine in the antihypertensive prescribing guidance, and indeed in all treatment guidelines in the future. --- AUTHOR CONTRIBUTIONS DPG, GNO and MR developed the initial idea. DPG drafted the initial manuscript which was critiqued and improved upon by GNO and MR. All authors have seen the final manuscript. --- COMPETING INTERESTS The authors declare no competing interests. --- ADDITIONAL INFORMATION Correspondence and requests for materials should be addressed to Dipesh P. Gopal. Reprints and permission information is available at http://www.nature.com/ reprints Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Last year saw the resurgence of the Black Lives Matter movement and a renewed global call for racial justice. The disproportionate impact of the covid-19 pandemic added further weight to a clear moral argument for equality within wider society. Against that background, in medicine too, long held biological assumptions about the influence of race in the diagnosis and management of illness are being evaluated, in light of expanding scientific knowledge. Traditionally medical research typically relies on the concept of finding a single clear truth or 'scientific' answer. In this way researchers are seen as objective observers who have an ability to control for research biases. This is the premise of quantative research and how race is currently seen as a proxy for understanding ethnic differences in health. However, research data and clinical guidance do not develop in a vacuum and are shaped by society and the politics of their time [1]. An alternative view to traditional medical research is that scientists are not exempt from the influence of bias, and it is impossible to correct for our biases in research. This is the premise of qualitative research. Self-ascribed race is used to provide insights into the rates of hypertension or blood pressure responses to medication without appreciating the context in which they occur. These opposing ideologies challenge the very core of using race, a poorly defined social construct, within medical research [2].

INTRODUCTION The development of tools that can help protect users, businesses and states online can also be used by those committing illegitimate activities. This can lead to a potential arms race with regards to attacking and defending online assets, with the advantage going to whomever has the most up to date tools. Social psychology research into humancomputer interaction aims to give cybersecurity specialists a better understanding of hacktivism and cybercrime through engagement with people involved in such groups and understanding of group processes. This paper puts forward the need to investigate such methods, focussing on interdisciplinary fusion and advises caution in accepting the negative stereotypes as fact. It is evident that there are a number of young people engaged in hacking and hacktivism groups who are clever, skilled and passionate about their causes. It is better to act with such individuals to explore ways of bringing about positive change, than to leave them to become criminalised. --- HACKERS, HACKTIVISTS AND MOTIVATION Definitions and categorisations of 'hacker' have been contentious and the use has evolved over the last couple of decades. In this paper 'hacker' will refer to someone who gains access to a "computer system, regardless of motivation or the extent of the damage caused," (Seebruck, 2015:38). By understanding the social and psychological influences and motivations on individuals and groups it may be possible to identify common factors or behaviours that precede a cyber-attack. Typologies for hackers have been created and updated throughout the history of the term (Chantler, 1996;Landreth, 1985;Seebruck, 2015;Taylor, 1999). Recent recommendations in hacker typologies have been made to include the increase in social and ideological motivations in hacking, incorporating those who are seen as 'hacktivists', also a contentious term but meaning a combination of 'hacker' and 'activist' (Krapp, 2005). This growth of social and ideological motivations have been attributed in part to the fact that a generation has been raised in a time of digital evolution and innovation (Seebruck, 2015), with increased user generated content and unrestrained communication increasing the confidence and perception of power individuals possess. (Seebruck, 2015). It has also been highlighted that there is a need for increased research on who is involved in hacking and their motivations. Greater understanding of the skills and motivations of cyber adversaries would "benefit a security industry that is over-dependent on technical solutions" (Glenny, 2011:269). The motivations of hackers have been redefined and updated (Seebruck, 2015:39) to include: It should be noted that all of these motivations are related to social identity and group processes; the authority of a group should not be underestimated. --- Group Processes and Collectives While looking at the online influences and motivations, the effects of group processes on the individual must be considered. Intergroup attribution research (Hewstone & Jaspars, 1982) can help explain the achievements of group actions by hacktivism and other cyber adversarial groups in terms of strengthening individual members' beliefs that they are highly skilled and influential. This can lead members to conclude that the success of opposing groups is attributable to external circumstances and luck. This may encourage the group to carry out additional actions against other organisations, especially if that group identity is reinforced by media reporting. It has been observed that early news reports about Anonymous generally exaggerated the intensity of cohesiveness between group members and organisational structure of the group (Olson, 2012), which has then been a factor in the group becoming more cohesive and organised. The cohesiveness of hacker groups was affected by the shock of the "Sabu-tage" when a high status member of Lulzsec was exposed as having been an informant for the FBI. His information led to the arrests of prominent group members. There have been significant changes to the group behaviours since (Coleman, 2015), with greater antipathy of 'leader-fags', suspicion of new or unknown members, and those who seem to be desiring attention. Hacker groups also experience indirect attacks, on group brand or reputation. It has been claimed by some Anonymous related Twitter accounts that multiple "ops" are false flag attacks, malicious efforts to undermine the successes and status of the hacktivist groups. By creating many different ops on social media, attackers of hacktivist groups weaken the power of numbers (which is a large part of Anonymous' success) and then use the failed ops as examples of how the hacktivist groups are declining and far less influential than they once were which would in turn affect their recruitment and membership. --- SOCIAL PSYCHOLOGY AS A TOOL Social psychological theories should be further examined to inform methods used to educate and communicate with these hacker communities and individuals. Cyberpsychology and social psychology both highlight the importance of not only what is said but how it is said as well (McMahon, 2016). Generalised trust is believed to make a person more willing to engage in collective efforts and cooperate with other people (Gunnarson, 2014). In the context of hacking, there is usually a paranoid and suspicious mindset, so how do these groups establish trust? The online disinhibition effect is the removal or reduction of the social and psychological restraints that individuals experience in everyday face to face interaction (Suler, 2004, Joinson, 2007). It could be argued that anonymity and online disinhibition can be positive, allowing the internet to be an open place where individuals can be honest on subjects that they may otherwise not wish to be identified with. This privacy combined with openness is what many involved in hacking and hacktivism claim to want to protect. Hacker groups have evolved on the internet, developing alternative ways to signal identity and status. These collectives subtly create the ingroup through methods based on knowledge (Bernstein et al, 2011). Online groups might be better understood as fluid collectives (Dobusch & Schoeneborn, 2015) rather than traditional groups. For example Anonymous use assertive speech to form identity, through established lines of communication that can be used by many individuals -it is the mode of communication that is significant not the speaker. They also use controversial control of group identity through methods such as doxing -showing that even anonymous group membership can be revoked (Dobusch & Schoeneborn, 2015). --- CONCLUSION There is currently a strong emphasis on teaching coding. By teaching individuals the skills that are essential in cyber hacking (regardless of intention), our research becomes all the more important. Not only do we need to teach coding but also about the risks and consequences of actions online. Global internet regulation is beyond our research, our focus is to help protect and educate users. By identifying groups and individuals at-risk of becoming involved in cyber-crime, campaigns on awareness and informed use can be targeted. The more that is known and shared about the functions and influences of these groups, the more prepared the next generation will be to make deliberate choices regarding HCI and online behaviour.

In cyber-security the weakest link is often seen as the human factor. This has led to discussions about the optimal methods in preventing cyber security breaches. This paper proposes that the fusion of cybersecurity and social psychology can inform and advance attempts to educate those on both sides of the law. Awareness and education will lead to more effective communication between parties and greater understanding of the risks and consequences for cyber attackers and defenders alike.

INTRODUCTION The phenomenon of underage marriage is often found in Indonesian society and is a serious problem because it gives rise to many controversies and problems. There are various reasons for these marriages, including changes in rules or regulations, family economic problems, low levels of education, societal views or stigma, and even in the last 3 years, many marriages of underage children have been carried out as a result of the COVID-19 pandemic (Firdusy, 2021). In view of the 1945 Constitution of the Republic of Indonesia, Article 28B passage (2), it is expressed that "each youngster has the option to endurance, development and improvement and the right to assurance from viciousness and segregation (Padmadewi & Artini, 2018)." This is made sense of exhaustively in (Abraham, 2023). One of these privileges is the option to acquire insurance, which is the obligation and commitment of guardians. Security that is the right of a kid and is the obligation of guardians incorporates security from underage marriage or early marriage as managed in Article 26 section (1) of Regulation Number 35 of 2014 (Fitriani, 2016). Sragen Regency, which is known as Bumi Sukowati, is also not free from the problem of high rates of underage child marriage. Based on information, up to the end of November 2022, 300 marriages of minors had occurred. Based on data obtained from Solopos.com on September 12, 2020, the number of marriages of underage children in 2019 was 151, in 2020 it was 349, and in 2021 it was 363. The high rate of marriage among underage children in Sragen Regency is due to changes in regulations in the field of marriage. Law Number 1 of 1974, which sets the minimum age limit for couples wishing to marry for women at 16 years and men at 19 years, by Law Number 16 of 2019 at home, is 19 years for both men and women (Khotimah, n.d.). The public's ignorance about changes in these regulations has an impact on the occurrence of marriages among underage children. Apart from that, promiscuity and conditions of poverty also trigger the marriage of underage children. The Sragen Regency Government has attempted to take preventive measures against the marriage of underage children through the formation of a task force for the prevention of child marriage, the launching of a declaration on the prevention of child marriage, outreach to community members through social media, and through media meetings during wedding celebrations carried out by government officials such as the village head or subdistrict head.It seems that strengthening the role of parents is very necessary in efforts to prevent the marriage of underage children. Parents' understanding of changes in regulations must also be improved, and parenting patterns that prioritize harmonious synergy between parents and children must also be pursued continuously. Community stigma that is contrary to efforts to prevent it should not be ignored. Efforts are needed to realize the various desires above. Through outreach carried out by educational institutions, it is very helpful to prevent the occurrence of marriages among underage children. --- METHODS Community service activities are carried out using a two-way lecture method followed by questions and answers. In lecture activities via two-way communication, the Community Service Team will present service material, which will then be followed by a question-and-answer session from community service participants (Mulyani et al., 2021). 1) Everyone has the privilege to frame a family and proceed their descendants through legitimate marriage. --- DISCUSSION 2) A legitimate marriage can occur with the unrestrained choice of the planned spouse and imminent wife worried, as per the arrangements of the guidelines regulation. 1) Marriage should be founded on the assent of both the imminent lady and husband to be. 2) To go into a marriage, an individual who has not arrived at the age of 21 (21) years should get consent from the two guardians. 3) In the occasion that one of the guardians has kicked the bucket or can't communicate his will, then the authorization alluded to in passage (2) of this article is adequate to be gotten from the parent who is as yet alive or from the parent who can communicate his will. 4) In the occasion that the two guardians have kicked the bucket or otherwiseable to communicate his will, then consent is gotten from the watchman, overseer or relative who is connected by blood in the straight line of drop for however long they are as yet alive and in a condition ready to communicate their will. --- 5) In the occasion that there is a distinction of assessment between the people referenced in sections ( 2), (3) and ( 4) of this article, or at least one of them doesn't offer a viewpoint, then, at that point, the court in the purview where the individual dwells will complete a marriage in line with that individual and may give consent after first hearing from individuals referenced in quite a while ( 2 2) In instance of a deviation from entry (1) of this article, you can demand guideline from the court or another power designated by the gatekeepers of both the male and female gatherings. 2) If guardians are missing, or their whereabouts are obscure, or for reasons unknown can't do their commitments and obligations, the commitments and obligations as expected in passage (1) can be moved to the family, which is completed as per the arrangements of legal guidelines. 1) The two guardians are obliged to really focus on and teach their kids as best as could be expected. --- 3) --- Arrangements with respect to parental commitments in --- 2) The parental commitments alluded to in passage (1) of this article apply until the kid weds or can remain solitary, which commitments keep on applying regardless of whether the marriage between the guardians separates. Consequently, guardians have a commitment to forestall youngster marriage to complete their obligations to really focus on and instruct their kids as best as could be expected. Marriage is a legal act that has legal ramifications for many aspects of a couple's lives. The event of a marriage bond isn't it simply has ramifications for common relations like freedoms and The commitments of a couple, joint property, the place of youngsters, the freedoms and commitments of guardians, yet in addition in regards to connections, customs of legacy, family relationship, family relationship and friendliness as well as in regards to conventional and strict services. 4 The enormous outcomes coming about because of marriage are the reason for figuring the reason why youngster marriage ought to be precluded. Marriage of minors is an infringement of insurance youngster. Kid insurance expects to guarantee that youngsters' privileges are satisfied can live, develop, create and take part ideally as per pride also, human pride, and get assurance from brutality and separation, for making quality, respectable and prosperous Indonesian kids. On Essentially, kid security is executed in view of the accompanying standards (Ibrahim, 2018): a. Not unfair. Regard and assurance the privileges of each and every kid inside the locale of Indonesia without segregation in any structure, paying little heed to race, skin tone, orientation, language, religion, political or different perspectives, public, ethnic or social beginning, resources, handicap, birth or other status of the kid or of the youngster's folks or legitimate watchmen. b. Putting kids with regards to their privileges to get by and create. The state guarantees however much as could reasonably be expected the endurance and advancement of kids. c. The child's best interests. In all activities including kids completed by government or confidential establishments, the wellbeing of the kid are the fundamental thought. d. Increment kids' chances to take part and offer viewpoints on all matters. --- As per Children are a group of people who must be protected because they have a special position. Children have a special position in the eyes of the law, which cannot be separated from several principles, which include (Sujana, 2015) : 1) The rule that kids can't battle for themselves, youngsters with every one of the limits joined to them are not yet ready to safeguard their own privileges. In this manner, guardians, society and the state should partake in safeguarding these freedoms; 2) The guideline of the kid's wellbeing, that the kid's general benefits should be seen as 'central significance' or primary need; 3) In accordance with the life cycle approach's guiding principle, it is necessary to recognize that child protection must begin early and be long-lasting; 4) Cross-sectoral rule, that the destiny of youngsters is exceptionally subject to different full scale and miniature elements, both straightforwardly and in a roundabout way. The provision and implementation of marriage age requirements for children is important in the context of child protection. Arif Gosita stated that the following are the foundations for child protection: a. Philosophical establishment: Pancasila is the establishment for exercises in family, society, the state, and the country. It is additionally the essential way of thinking for incorporating kid security. 1) Any individual who disregards the arrangements as planned in Article 76D will be rebuffed with detainment for at least 5 (five) years and a limit of 15 (fifteen) years and a greatest fine of IDR 5,000,000,000.00 (five billion rupiah). 2) The crook arrangements as planned in section (1) likewise apply to each individual who purposely commits misdirection, a progression of untruths, or convinces a youngster to have sex with him or someone else. Parents of children who are married may be subject to inclusion.to the provisions in these articles. Article 49 Law Number 1 of the Year1974 concerning marriage also regulates the revocation of parental authority towards children, namely as follows: 1) With a court decision in the case-matter, one or both parents may have their authority over one or more children revoked for a specified time at the request of the other parent, the child's immediate family, adult siblings, or an authorized official: 2) He significantly ignored his commitments towards his kid; 3) act gravely. Even though parents are deprived of their powers, they are still obliged to provide maintenance costs to the child. Thus, parental authority can be revoked if it is proven that it facilitates or even forces the marriage of underage children. Overall, strengthening the role of parents is not only an effective prevention strategy but also represents a sustainable and holistic approach to the issue of child marriage. Through the active involvement of parents, both in education and economic aspects, society can create an environment that supports children's growth and development in a healthier and safer way. Joint efforts from governments, non-governmental organizations and society are key to achieving the global goal of ending the practice of child marriage.

Preventing child marriage is a global issue that requires serious attention from various parties, including parents, as the main agents of change in the family environment. This research aims to discuss the important role of parents in preventing underage marriage and how strengthening their role can be the key to overcoming this problem. Several sub-districts in Sragen Regency, Indonesia, still have quite high numbers regarding the number of marriages of underage children. The marriage of underage children is a social and legal problem that has a negative impact on the lives of children who marry. Changes in regulations regarding the age limit for couples who want to get married, which are contained in Law Number 16 of 2019, are apparently unable to slow down the rate of marriage of underage children. Apart from that, it was found that strengthening the family economy can also play an important role in preventing the marriage of underage children. By increasing parents' access to jobs and economic resources, they can provide a more stable and supportive environment for their children. By increasing the role or obligations of parents towards children, it is hoped that they will be able to prevent child marriage.

INTRODUCTION The age of high school students is the age of adolescence which is an important target population in influencing public health globally. According to WHO data (2013), almost 50% of the world's population is under the age of 25, of which almost 85% of the adolescent population is in developing countries in the world. In Indonesia in 2010 the number of people aged 10-24 years is very large which is about 64 million or 27.6% of the population of Indonesia as much as 237.6 million people. ( Yessy, 2015) Adolescence is a transitional period in which individuals experience a transition from childhood to adulthood characterized by accelerated physical, mental, emotional and social development. In adolescence it is also a period of search for self-identity, their behavior tends to follow trends and is strongly influenced by association with peers. ( Rumini, 2004) Very rapid changes in its development cause adolescents to become unstable and easily influenced by moral and cultural values obtained from outside, both from the mass media and the surrounding environment. As a result, it is very susceptible to bad behavior such as smoking behavior. Smoking is a bad habit that occurs in society. Many studies prove that smoking increases the risk of various diseases, such as heart and vascular disorders, lung cancer, oral cavity cancer, laryngeal cancer, esophageal cancer, bronchitis, high blood pressure, impotence, as well as pregnancy disorders and defects in the fetus. (2,3,7,8) smoking can also lead to death. Based on the research results of the Ministry of Health's R & D agency in 2010 showed that deaths from diseases associated with tobacco occurred about 12.7% of all deaths in the same year. ( Kemkes RI., 2015) Currently, the adolescent group has become a vulnerable segment of society that needs special attention due to the fact that the prevalence of active smokers of young men aged 10-14 years was 3.7% in 2013 or menigkat 12 times compared to 1995 which is 0.3 %, while adolescents aged 15-19 years 37.3% in 2013. The age of starting smoking is getting younger, where children aged 5-9 years have started smoking and the highest increase in prevalence at the age of 5-9 years have started smoking and the highest increase in prevalence at the age of 15-19 years is 13.6 %, from 43.3% in 2010to 56.9% in 2013. (Global Youth Tobacco Survey, 2014) In the province of West Sumatra, based on the Basic Health Research Report (Riskesdas) in 2007 found that more than half of the male population aged 10 years and above are smokers every day at 52.4%, the highest percentage of first-time smoking in men is in the age group of 15-19 years of 40.9% and in women 22.7%. While in Padang, the highest percentage of smoking age is in the age group of 15-19 years, which is 46.3%. ( Depkes RI, 2007) Based on research conducted by Yessy s Sabri, et al. found that more than a quarter of students in three junior high schools in the city of Padang had smoked and all men, and tried to smoke at the age of less than 10 years, and almost a fifth had been addicted to smoking. ( Yessy S Sabri, 2015) Many factors cause teenagers to smoke. According to Komalasari and Helmi, smoking behavior is caused by factors within (internal) and environmental factors (external) such as family or parents, siblings and peers who smoke and cigarette advertising in the mass media. ( Santrock J. 2007) Environmental factors play a major role in influencing adolescents to smoke. Based on research conducted by Rachmat, Thaha & Syafar stated that there is a relationship between peer group interaction, family interaction, cigarette advertising, and attitudes with adolescent smoking behavior.( Muhammad M, 2013) peers are the dominant factor for influencing adolescent smoking and are an important source of teens 'first cigarette, cigarettes are used to improve boys' social status among their friends and increase self-confidence, more mature, and richer than their peers. In addition, the role of Parents strongly influences the smoking behavior of adolescents, it is seen that smoking parents are significantly associated with a higher risk of early smoking. The risk of early smoking of children with smoking parents increases according to the duration of their exposure to smoking parents. Cigarette advertising as a medium of cigarette promotion and various types of very potential to shape the attitude and behavior of smoking teenagers. Research in March 2007 on 278 students in a State Junior High School in Makassar showed 15.2% of teenagers smoke due to the influence of mass media and 92.4% of respondents often see cigarette ads. (Muhammad M, 2013). --- RESEARCH METHODS This study is a quantitative research with cross sectional study design conducted in May to October 2017, interviews were conducted on 220 male students from 5 (five) public high schools in Padang city selected based on multistage random sampling. Data collection was carried out using structured questionnaires that have been tested for validity and reliability. The dependent variable in this study is the smoking behavior of high school students, the independent variable is knowledge, access to rokk, pocket money, exposure to Mass media, Family Smoking behavior, and smoking behavior of peers. --- RESULTS AND DISCUSSION Univariate analysis is an analysis used to look at the frequency distribution of each research variable. ( Kleinbaum,, 2002). Based on Table 1 can be seen the characteristics of respondents, the results showed that 130 students from 220 respondents of high school students in Padang city, more than half (59.1%) behaved smoking. most (62.3%) high school students in the city of Padang have less knowledge about cigarettes, especially the dangers of smoking for health. It is easy to get cigarettes (75%) with enough pocket money to be able to buy cigarettes (59.1%). More than half of the students ' parents smoked (51.4%). Most of the students had friends who behaved smoking (60.5%), and more than half of the students were often exposed to mass media featuring cigarette ads (52.3%). The average age of first time smoking was 14.76 years with a mean Standard Error (SE) of 0.171. The youngest age a teenager has ever smoked is 7 years. 2. Shows independent variables related to smoking behavior of high school students. It is statistically proven that there is a relationship between the behavior of parents and peers to the smoking behavior of students. Students with smoking parents were 2.2 times more likely to smoke than students with non-smoking parents, while students with smoking peers were 10.3 times more likely to smoke than students with non-smoking peers. ( Kleinbaum,, 2011) the results of the analysis of the Global Youth Tobacco Survey (GYTS) increased the prevalence of active smoking of young men aged 10-14 years by 12 times, namely 0.3% in 1995 and increased to 3.7% in 2013. Similarly, the age group of 15-19 years there was an increase in the highest prevalence of 13.6 % in 2010 to 56.9% in 2013. The age of smoking is getting younger, where children aged 5-9 years have started smoking. (Global Youth Tobacco Survey, 2014) predispositions that affect a person's behavior, and it is expected that those with high knowledge will behave positively. In this study, knowledge about cigarettes is a predictor of smoking behavior in high school students in Padang city. Their knowledge is in the low category (62.3%), this is in line with research conducted by Indra S. that there are 89.5% of students have a low knowledge of the dangers of smoking. ( Indra, 2019) but contrary to the results of research conducted by Rahmadi A and Fallis, the proportion of siwa who smoked was greater in highknowledge students compared to low-knowledge students. ( Rahmadi, 2013) one way to improve students ' knowledge about cigarettes is by training anti-smoking upbringing patterns, menesukkan smoking Hazard material on the curriculum of teaching students in schools. Pocket money is a factor that can influence students to smoke, because a large pocket money allows students to be able to buy cigarettes. Student allowance is mostly below fifteen thousand rupiah (59.1%) and there is no significant relationship between allowance and smoking behavior of high school students in Padang city. The results of this study are not in line with the research Shaluhiyah Z that there is a relationship between pocket money with smoking practices respondents. ( Shaluhiyah, 2006) Parents play a role in shaping the attitude of children, parents are role models for the family, especially for their children, therefore parental behavior is an example for his children to be emulated and emulated. The results of the study found 51.4% of student parents behaved poorly (smoking) and statistically there is a significant relationship between parental behavior and smoking behavior in high school students in Padang city. This is contrary to the study conducted by Rachmat m, namely bivariate test showed no significant relationship between smoking families with smoking behavior of students. ( Rachmat, 2001) in line with a study conducted by Purnawanti in Bogor city, found 60% of Junior High School students have parents who smoke and the risk of smokers students with smoking parents 2.44 times greater than students with parents who do not smoke. ( Purnawanti, 2007) in adolescents, smoking parents were significantly associated with a higher risk of early smoking. The risk of early smoking of children with smoking parents increases according to the duration of their exposure to smoking parents. The behavior of parents encourages the behavior of imitating a child (teenager) towards parents. Parents become models of children's behavior, including smoking behavior. ( Rachmat, 2001) The influence of peer smoking behavior is very large, it is statistically proven that most students have friends with unfavorable behavior (smoking) and there is a significant relationship between peer smoking factors with smoking behavior in high school students in Padang with a risk of 10 times greater. This is in line with the research delivered by Soesyasmoro that peer factors also affect smoking behavior in school students or adolescents, ( Soesyasmoro, 2010) and in line with Indra s research which states that high school students with peers who smoke have the possibility to behave smoking up to 5 times greater than those who do not have friends sebanya who behave smoking.(8) similar to the research conducted by Rachmat, Taha & Syafar states that peers are the dominant factor for influencing adolescent smoking and are an important source of teens ' first cigarette, cigarettes are used to improve the social status of boys among their friends and increase self-confidence, more mature, and richer than their peers. (Muhammad Rachmat, 2007) The influence of peer groups on health-risk behavior in adolescents can occur through the mechanism of peer socialization, with the direction of influence coming from peer groups, meaning that when adolescents join peer groups then a teenager will be required to behave the same as the group, in accordance with the norms developed by the group (Hurlock, 2010) CONCLUSION Knowing that adolescents first smoke at age 7 and peer behavior are the most risk factors for starting smoking in adolescents, it needs to be a special concern for agencies that play a role and it is advisable to take preventive measures, such as health counseling as early as possible (starting in elementary or high school). Establishment of anti-smoking teenagers in every school that serves as cigarette activists. Government efforts need to cut the spread of cigarettes such as banning teenagers from buying cigarettes.

Youth is a phase of transition from children to adults, marked by the acceleration of physical, mental, emotional, and social development. They are still looking for self-identity, tend to follow trends, are still unstable, and are very easily influenced by peers, including the influence of smoking. This study aims to determine the influence of knowledge, pocket money, access to cigarettes, mass media, family, and peers to smoking behaviour among high school students in the city of Padang. The method of this study is a crosssectional survey by interviewing 220 male students in 5 (five) Public High Schools in Padang City who were selected by multistage random sampling. Data was collected using a structured questionnaire that had been tested for validity and reliability. Multiple logistic regression is used to determine the relationship. The study showed 59.1% of high school male students in Padang smoked. Most of them them have knowledge about smoking (62.3%) and are exposed to cigarette advertisements in the mass media (52.3%), have peers smokers (60.5%), and have families who smoke (51.4%) . Students who have peers smokers 10.1 times more likely to start smoking (OR 10.1,. Knowing that adolescents first smoke at the age of 7 years and peer behavior is the biggest risk factor for starting smoking in adolescents, precautionary measures are recommended, such as health counseling as early as possible (starting in primary or secondary school).

INTRODUCTION Metaverse was first coined by Neal Stephenson in a science fiction novel named Snow Crash in 1992 [12]. The word "metaverse" is a combination of the prefix "meta" (implying beyond) and the stem of the term "universe. " Stephenson described the metaverse as a parallel virtual world to the physical world in which users interact with each other and applications through avatars. Since then, the metaverse has been conceptualized in diverse ways [2][3][4]6] without a consistent definition. Besides being a popular subject of numerous science fiction novels and films (e.g., Ready Player One [11]), many technology companies have recently focused on the metaverse. On October 2021, Facebook announced Permission to make digital or hard copies of part or all of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for third-party components of this work must be honored. For all other uses, contact the owner/author(s). © 2022 Copyright held by the owner/author(s). Manuscript submitted to ACM its new corporate name: Meta, short for "metaverse" [7], bringing the metaverse to the forefront of discussion in social computing. Technology companies created many computer-mediated hybrid spaces which brought users different degrees of digital transformation, for example, AR applications (e.g., Pokemon Go by Niantic), 3D virtual-world games (e.g., Second Life by Linden Lab), VR experiences (e.g., Horizon by Facebook), etc. However, without involving "shared, open, and perpetual virtual worlds" [8], these applications could only be defined as "proto-metaverse" [6] rather than attaining full metaverse designations. A metaverse would be a collective platform of separate hybrid spaces with a consistent design language and a promising better user experience. Before achieving a metaverse, there still exists a mass of technological and computational challenges to be overcome [8], e.g., small objects detection, authentication in Blockchain, network congestion, and to name but a few. At the same time, social challenges would be more difficult barriers than technological and computational challenges [5]. Users' behaviors would be a key concern, as to how to protect users' privacy and safety, prevent cyber-bullying and users addiction, as well as keep user diversity and fairness in the metaverse are all substantially under-discussed [8]. In addition, moving users from existing hybrid spaces to an integrated metaverse platform would be a challenge. Unfortunately, there is currently a dearth of research on user aspects in the scope of the metaverse. Though there is no real-life metaverse application at this time, technology companies are trying to create a metaverse with different approaches: Facebook is promoting an immersive VR experience, while Niantic claims that the metaverse should enhance users' interaction with the real world rather than cut them out of it [9]; As a game company, Epic Games, will start with building connected social and entertainment experiences to players [1], while Microsoft Teams is trying to create a mix-reality based collaborative and shared holographic experiences for online offices [10]. Nevertheless, we believe that the metaverse is not owned by any technology company but owned by humans. And the essence of the metaverse is the interaction of humans and a computer-mediated virtual platform. Thus, worth discussing among HCI researchers how to build the metaverse in a proper direction. By discussing the topics above, designers and researchers can gain an increased understanding of the metaverse in domains considered pivotal in HCI: persuasive computing, virtual and augmented reality, and inclusive design. --- MOTIVATION As a revival topic in 2021, the metaverse showed its continuity in the long term. Different from the era when the term was first coined, the related technologies are developing to be mature in the foreseeable future [8]. The industry is getting ready to build a metaverse: Big technology companies worldwide (e.g., Niantic, Facebook, Tencent, Microsoft, etc.) set the metaverse as their future development strategy. The outcomes of this SIG and follow-on SIGs can enrich the number of research on metaverse and guide the development of the metaverse. Furthermore, this SIG and follow-on SIGs can contribute to subsequent conferences, for instance, user studies based on the metaverse. This SIG is essential mainly for two reasons. First, we have seen a rising number of discussions on metaverse in the industry recently, but without a consensus on the direction of development. In the literature, however, there is insufficient research on metaverse, which is a significant gap between the industry and academia. Also, as noted above, human factors and social aspects are pivotal topics in the metaverse but are far from being thoroughly discussed. Thus, the authoritative definition of the metaverse and the discussion on the future agenda are required in the HCI community. Second, the metaverse needs to be discussed in a diversified agora. As mentioned, the metaverse covers multiple domains in HCI (e.g., VR, AR, persuasive computing, etc) and requires a good understanding of the complicated social aspects surrounding these domains. We believe that discussion among researchers from different domains and cultural backgrounds can effectively improve and expand the understanding of the metaverse, as well as stimulate the discussion of multidisciplinary research opportunities. --- OBJECTIVES The overarching principle of this SIG is to build an international community for practitioners from different backgrounds to be exposed to existing discussions and challenges of the metaverse in an HCI context. These participants are further expected to explore multidisciplinary research and application opportunities. Our main objectives are as follows: First, to provide a platform for researchers and practitioners to engage with various definitions and directions of development of the metaverse. Second, to discuss three topics around the metaverse: opportunities, challenges, and future possibilities in an HCI context. Under the opportunities topic, we aim to raise discussions about the existing applications of the metaverse (proto-metaverses cases); and under the challenges' topic, we will stimulate discussions on barriers while creating the metaverse, making an emphasis on the social and human aspect in an HCI context; as well, we aim to solicit involvement from multiple disciplines on the discussion of future possibilities, including but not limited to the research opportunities for shaping the future of the metaverse. Third, to build a network for academics interested in the field for future multidisciplinary research on this agenda. --- SIG STRUCTURE --- Pre-SIG Activities We will make use of discord to build an online platform: 1) for attendees to introduce each other. 2) for organizers to collect basic information about the participants and understand their expertise. Then, we can better prepare materials that matter within the boundaries of the topics of SIG. --- The Main Event This SIG will be held online, accessible for attendees in different physical locations to join. The first part of the SIG will be a 10-minute opening from the session host, explaining the objectives and structure of the SIG, followed by voluntary self-introductions from attendees. In the next 10 minutes, organizers will present the various definitions and directions of the metaverse development, exposing the attendees to existing discussions of the SIG theme. Next, organizers will create three breakout meeting rooms for the topics: opportunities, challenges, and future possibilities in an HCI context. The discussion will last half an hour, and participants will choose one of three topic rooms to join and contribute to the discussion. Each topic room will have one organizer to observe and support the discussion. After the 30-minutes discussion, all participants will return to the main session room and present the primary outcomes, highlighting insights from their discussion (5 minutes each topic). In the end, organizers will raise a free discussion across topics around the metaverse and make conclusions for the SIG. Free discussion and conclusions --- Post SIG Activities After the SIG, we will: • Summarize the outcomes in a white paper and share it with all presented materials on our website. • Submit a research paper distilling research-specific content from the workshop in a journal or conference. • Invite the participants to collaborate on a special journal issue on the topic of the SIG in an HCI journal. We will also use this SIG as a touching point for the HCI community that is interested in the metaverse. Much of this work is interdisciplinary by nature and will require much translation, planning, and coordination. In order to facilitate those processes, we are currently planning to do the following: • Continue to grow our website with examples from the work of the participants and by continually adding resources (designs, etc.). • Continue our discussion and communication with the SIG participants through our discord server. • Use the insights gained from this SIG to inform the design of other activities (e.g. panel, Dagstuhl type seminar, etc.) at other venues and conferences to foster further collaboration, enlarge the community, and progress the topic of the metaverse. But this list is by no means exhaustive. Should new potential avenues of post-SIG activities manifest during the SIG, all efforts will be made to pursue those opportunities.

In recent years, the notion of the Metaverse has become the focus of a growing body of work in the industry. However, there is no consensus on the conceptualization in academia. To date, much of this attention has revolved around technological challenges. However, what is notably missing from these discussions is a consideration of the human factors and social aspects that are considered more critical challenges within HCI. The aims of this SIG are as follows: Firstly, to provide a platform for researchers and practitioners to engage with the various definitions and the ways in which the Metaverse is developing. Secondly, to discuss the opportunities, challenges, and future possibilities in the context of HCI. This will lay the foundations to build a network for academics interested in the field for future multidisciplinary research relating to the Metaverse. CCS Concepts: • Human-centered computing → Human computer interaction (HCI).

Introduction The quality of growth of a nation is determined by better health, education, wider and equal employment, a clean environment, self-esteem, and life security. Health is considered important by all the people and hence XI Five Year Plan strives for health as a right for all the citizens. It also aims to minimize disparities in health in all regions and communities by providing maximum health care. Health equity studies the difference in access to health care between populations. It causes social injustice and moreover, those countries with major health inequities lose the benefit of skills, ideas, and productive capacity of the population. Equity in health care is considered to be the main long-term principle of health policy in India which satisfies the needs of poor and underprivileged people. The Government of India has introduced a separate bill exclusively for recognizing the right to health care by addressing the societal impact of health. However, equity in the implementation of the health policy remains unanswered and it creates a challenge for the entire community. The current policy shift of the National Rural Health Mission (NRHM) is towards addressing health inequities, by improving the Information System, widening the participation of NGOs, more collaborations with the private sector, and a greater thrust by the public sector in providing social protection to the economically weaker sections. The equity of health parameters is best achieved with the assessment and direction of all states of India working towards the same. Hence, the study analyses the state-level disparities in health parameters on various dimensions. The rural-urban disparity in health has been a common challenge for all the states of India and hence the study attempts to assess the extent of rural-urban disparity relating to health care in Tamil Nadu 1-4 . --- Review of Literature Chakrabarty 5 found that the household incomes and the educational levels of the people strongly influenced their health condition. Bahuguna and de Haan 6 summarized the trends and changes in the Indian caste system, that had undergone major transformation, which had not influenced equality. Macinko et al., 7 identified that there exist large inequities in the health conditions of the vulnerable class and Tamil Nadu was not an exception. It was noticed that the conditions of ill health had affected different population subgroups in different ways and those people of lower economic background experienced poor health conditions. Subramanian et al., 8 illustrated the larger adult mortality rates in SC/ST as compared to the remaining population. Ravindran et al., 9 discussed the advantage of equity when measuring the nature of health differentials. There was sufficient evidence from all over the world that showed differences in health conditions among various social groups not just as the result of genetic endowments, but also due to changes in lifestyle. Nagaraja and Veerabhadrappa 10 examined the rural-urban disparities using the vital health indicators compiled from various sources and analysed the causes for the same. The study concluded that the less attention paid by the administrators and policymakers to the rural population was the major cause for the large rural-urban divide in the health parameters achieved during the study period. --- Objectives • To examine the basic vital statistics at the all-India level and Tamil Nadu in particular. • To analyse the extent of disparities in the health parameters between the rural and urban populations in Tamil Nadu. --- Methodology The study is related to the period 1992-93 to 2015-16, the --- Findings and Discussion --- Demographic Indicators of Tamil Nadu The population size, the growth rate of the population, the distribution of territory, gender composition, its variations, and the components of variations such as nativity, mortality, and social morbidity predict the demographic profile of a nation. In Tamil Nadu, 88 per cent of mothers have a postnatal check after their last birth and 74 per cent of mothers had a postnatal check within two days of the birth. Postnatal care is the most common following births; seventy-five per cent of births in public health facilities and 74 per cent of births in private health facilities are followed by a postnatal check for the mother within two days of birth, compared with 20 per cent at home. • The total Fertility Rate for Tamil Nadu is 1.6, which is also found to be lower than the all-India level of 2.3. From Table 1 and Figure 1, it is evident that Tamil Nadu has shown increased progress in improving the vital statistics of its population. Tamil Nadu has fairly progressed in the human development indicators over the last few decades owing to the active participation of the Government, NGOs, and public and private health institutions. --- Rural-Urban Disparities The macro perspective of health parameters in Tamil Nadu reports positive improvements. However, when looking at the inequities among groups and regions, it is found that there exist disparities in the health parameters in Tamil Nadu between the rural and urban areas as per the National Family Health Survey (NFHS) reports. Table 2 shows the disparities between rural and urban prevalent in the health indicators in Tamil Nadu. The primary objective of public policies must address health, inequities with health systems having a specific role in the achievement of equity in access to health care and health status in the country. The present study tries to find the extent of disparity in the health status of the rural/ urban population as compared to the total population by calculating the disparity index as follows: It is seen from Table 3 that the disparity value of the total fertility rate for urban areas has decreased from 95.16 to 90.58 between 1992-93 and 2015-16. The fertility rate for the rural areas has increased from 103.22 to 109.41 during the same period, which shows the fact that the population increase in rural areas has been higher than in Urban Tamil Nadu, owing to various demographic and societal factors. The Government with the support of Local-self-Government should ensure promoting programs to create awareness on the significance of reducing the fertility rate for the development of the economy. --- State Similarly, the disparity index of crude birth rate has decreased from 99 to 89 for Urban Tamil Nadu, whereas Rural Tamil Nadu has seen an increase from 100 to 110 from the NFHS I period to NFHS IV period. This again shows the need to ensure policies for rural Tamil Nadu to promote awareness of reducing population. The disparity index of infant mortality rate has been declining in the case of Urban Tamil Nadu from 90 during 1992-93 to 87 in 2015-16. Rural Tamil Nadu has seen an upsurge in the infant mortality rate from 105 to 223 during NFHS I and II periods, which is an indication of the inequality in the health progress of the rural areas. This trend should be taken as the base for policy measures to curb this large disparity growth in rural Tamil Nadu. The infant mortality rate has dropped during the third and fourth NFHS surveys but the comparative figures of Urban to Rural shows the disparity to be higher than urban Tamil Nadu, which should be tapped by the policymakers and the local self-government. With regard to the child mortality rate, unlike the other parameters, urban Tamil Nadu has recorded an increase in disparity in child mortality during the four surveys, from 18 during 1992-93 to 85 during 2015-16. This disparity in child mortality has to be further analyzed to find the cause of child mortality in urban Tamil Nadu and act to prevent the same. The lack of immunization programs and the prevalence of childhood-based infectious diseases have to be micro-managed to reduce child mortality in all areas. The pattern of disparity is not consistent over the four surveys in the case of both Rural and Urban Tamil Nadu. It can be concluded from the data and the disparity index that considering the vital health parameter achievements, in the case of Tamil Nadu, the rural population is at a greater disadvantage than the urban population. This calls for the attention of the policymakers and health officials to ensure equity in health care so as to achieve the SDG and the millennium development goals that will enable Tamil Nadu to achieve sustainable development over the long run. --- Conclusion and Policy Implications Health is an important indicator of the Human Development of a country. The present study analysed the disparity in the major health indicators among ruralurban areas in Tamil Nadu and the findings indicated that there exists increased Rural-Urban disparity in the vital statistics of health over the NFHS periods from 1992-93 to 2015-16. This disparity is owed to the major factors like lack of basic amenities namely health, education, clean drinking water, and sanitation facilities which affects the empowerment of the population and becomes impossible. Poverty and economic backwardness are still dominant in the rural areas that have affected the individuals to reap the benefits of inclusive health programs in the rural areas of Tamil Nadu. Hence, inequalities and disparities in health status among rural and urban areas do not indicate a sound and inclusive policy for the development and growth of the country. Therefore, an urgent need is required to adopt checks and measures that are targeted by and large to remove disparities and bring about inclusiveness in the rural and urban areas to minimise the rural-urban divide in the long run. The policymakers and the administrators have to plan to reduce the disparity in the vital health parameters among the rural and urban areas and this process should ensure people's participation with the help of the local self-government bodies, which will enable the grassroots levels to be monitored effectively.

The Sustainable Development Goal (SDG) on "Good Health and Well-being" holds the nucleus place of the study, which aims to ensure healthy life and promotion of well-being for all lives. Equal status in health care is considered as the main longterm principle of health policy in India which satisfies the need of poor and underprivileged people. The equity of health parameters is best achieved with the assessment and direction of all the states of India working towards the same. In this aspect, the present study analyses the state-level disparities in health parameters on various dimensions. The rural-urban disparity in health is a common challenge for all the states of India and hence, the study assessed the extent of rural-urban disparity in the vital healthcare parameters in the state of Tamil Nadu, as observed by the data of the National Family Health Survey (NFHS 1, 2, 3 and 4). The disparity index calculated with the NFHS statistics on the achievements with regard to total fertility rate, crude birth rate, infant mortality rate, and child mortality rate, the rural population is at a greater disadvantage than the urban population in the case of Tamil Nadu. This calls for proper and adequate consideration by health officials to ensure equity in health care to achieve the SDG and the millennium development goals that will enable Tamil Nadu to achieve sustainable development over the long run.

INTRODUCTION The COVID-19 pandemic has presented unique challenges for individuals with disabilities, and graphic novels have emerged as a powerful medium for representing and exploring these experiences. Historically, disabled individuals have been underrepresented and depicted in stereotypical ways, but graphic novels have challenged these narratives by offering authentic portrayals that humanize disabled characters. In the context of COVID-19, graphic novels provide a platform to address the intersectionality of disability and the pandemic, highlighting issues such as limited healthcare access, social isolation, and the impact of public health policies. These novels also explore themes of resilience, adaptation, and the triumph of the human spirit, showcasing disabled characters overcoming obstacles and utilizing their strengths and capabilities. Moreover, graphic novels have the potential to raise awareness, challenge stereotypes, and foster empathy and understanding among readers. By amplifying the voices of disabled creators, these novels contribute to a more inclusive literary landscape, challenging traditional narratives that have marginalized disabled individuals. Overall, graphic novels offer a unique opportunity to represent The COVID-19 pandemic has brought forth numerous challenges and hardships for people worldwide, impacting various aspects of life. Among those affected are individuals with disabilities, who have faced unique obstacles and vulnerabilities during these trying times. In the realm of art and literature, graphic novels have emerged as a powerful medium for exploring and portraying these experiences. This essay delves into the intersection of disability and COVID-19 within the realm of graphic novels, highlighting the significance of representation, the exploration of resilience, and the potential for social change. --- II. REPRESENTATION AND VISIBILITY Graphic novels have indeed played a pivotal role in challenging the historical underrepresentation and stereotypical depictions of individuals with disabilities. Through visual storytelling, these novels have the ability to humanize disabled characters and offer authentic portrayals of their lived experiences. In the context of COVID-19, graphic novels have become a powerful medium for shedding light on the unique challenges faced by individuals with disabilities during the pandemic. By featuring disabled protagonists, these novels can provide a platform to address the intersectionality of disability and the pandemic, highlighting the specific issues and barriers faced by disabled communities. Limited access to healthcare is one such challenge that graphic novels can tackle. The pandemic has exacerbated existing healthcare disparities, making it even more difficult for individuals with disabilities to access the medical support they require. Graphic novels can depict the struggles faced by disabled characters in navigating healthcare systems and showcase the barriers they encounter, such as lack of accessible facilities or inadequate support services. Social isolation is another significant issue that individuals with disabilities have grappled with during the pandemic. Many disabled individuals rely on community connections and support networks for their well-being and inclusion. Graphic novels can explore the profound impact of social isolation on disabled characters, capturing their feelings of loneliness, frustration, and the search for alternative ways to maintain connections in a socially distanced world. Moreover, graphic novels can address the impact of public health policies on disabled communities. These policies often fail to consider the unique needs and circumstances of individuals with disabilities, leading to further marginalization. By featuring disabled protagonists, graphic novels can showcase the consequences of such policies and advocate for more inclusive approaches that prioritize the well-being and rights of disabled individuals. An excellent example of a graphic novel that explores disability and COVID-19 is "Crip Camp: A Disability Revolution" by Jim LeBrecht and Sara Burs. Based on the documentary film of the same name, this graphic novel depicts the experiences of disabled activists at a summer camp in the 1970s and their later involvement in the disability rights movement. While not directly focused on the pandemic, it highlights the resilience and advocacy of disabled individuals, reminding readers of the ongoing challenges faced by disabled communities in various contexts, including healthcare and societal inclusion. In conclusion, graphic novels provide a unique visual medium for addressing the intersection of disability and COVID-19. By featuring disabled protagonists and authentically portraying their experiences, these novels can shed light on the specific challenges faced by disabled individuals during the pandemic. They have the power to raise awareness, challenge stereotypes, and advocate for more inclusive policies and support systems. Through their compelling storytelling and visual representations, graphic novels contribute to a more empathetic and inclusive society, where the voices and experiences of individuals with disabilities are valued and respected. --- III. EXPLORING RESILIENCE AND ADAPTATION Graphic novels have indeed been a powerful medium for showcasing the resilience, adaptation, and triumph of disabled individuals in the face of new challenges brought about by the COVID-19 pandemic. These narratives highlight the strength and capabilities of disabled characters, challenging preconceived notions and stereotypes. Through graphic novels, disabled characters can be depicted as active agents in navigating the obstacles imposed by the pandemic. They showcase the resourcefulness and creativity of disabled individuals as they find innovative solutions to overcome limitations and barriers. By portraying disabled characters as problem solvers and contributors, these novels challenge the narrative of disability as a limitation and instead emphasize the diverse talents and abilities of disabled individuals. The stories within these graphic novels can inspire readers, both disabled and non-disabled, by demonstrating the resilience and determination of disabled characters. They showcase the ways in which disabled individuals adapt to changing circumstances, utilizing their strengths and unique perspectives to overcome adversity. These narratives provide a sense of hope and empowerment, reminding readers of the human capacity for resilience and the ability to find new paths forward even in challenging times. Moreover, graphic novels have the advantage of visually depicting the creative strategies and adaptations employed by disabled characters. The visual nature of the medium allows readers to see firsthand the ways in which disabled individuals navigate and problem-solve in the face of obstacles. This visual representation can foster a greater understanding and appreciation for the diversity of disabled experiences, promoting empathy and breaking down barriers of misunderstanding and stigma. An excellent example of a graphic novel that explores resilience and adaptation during the COVID-19 pandemic is "Invisible Differences" by Julie Dachez and Mademoiselle Caroline. This novel follows the story of Marguerite, a young woman with autism navigating the challenges of the pandemic. The novel explores her coping mechanisms, adaptation strategies, and personal growth, shedding light on the unique experiences of individuals with autism during the pandemic. In conclusion, graphic novels have the potential to highlight the resilience, adaptation, and creative problem-solving of disabled characters in the context of the COVID-19 pandemic. By showcasing the strengths and capabilities of disabled individuals, these novels challenge stereotypes and foster understanding and appreciation for the diverse talents within disabled communities. Through the visual nature of the medium, graphic novels provide a powerful platform for inspiring readers and promoting empathy, ultimately contributing to a more inclusive and compassionate society. --- IV. SOCIAL CHANGE AND ADVOCACY Graphic novels have indeed proven to be a powerful medium for social change and advocacy, particularly when it comes to disability and the COVID-19 pandemic. By incorporating these themes into their narratives, graphic novels have the ability to raise awareness about the unique struggles faced by disabled communities and challenge existing stereotypes and myths. Through their visual storytelling, graphic novels can effectively depict the experiences and challenges of disabled individuals during the pandemic. They can shine a light on the barriers and inequalities that disabled communities face, such as limited access to healthcare, discrimination, and social isolation. By portraying these realities, graphic novels can educate readers and foster empathy and understanding, ultimately challenging stigmatizing attitudes and fostering inclusivity. Furthermore, graphic novels offer a platform for disabled creators to share their own experiences and perspectives directly. By amplifying the voices of disabled artists and writers, these novels contribute to a more diverse and inclusive literary landscape. Disabled creators bring unique insights and firsthand experiences to their work, allowing readers to gain a deeper understanding of the complexities of disability and the impact of the pandemic on disabled communities. This representation is crucial in challenging the traditional narratives that have historically marginalized disabled individuals and promoting authentic and diverse storytelling. An excellent example of a graphic novel that addresses disability and the COVID-19 pandemic is "Dancing After TEN" by Vivian Chong and Georgia Webber. This memoir-based graphic novel tells the story of Vivian Chong, an artist who becomes temporarily paralyzed due to a rare illness. The novel explores her journey of resilience, adaptation, and the social challenges she faces as a disabled individual. Through vivid illustrations and personal narratives, the novel sheds light on the experiences of disability and offers a powerful perspective on the impact of the pandemic on disabled individuals. In conclusion, graphic novels have the capacity to drive social change and advocacy by incorporating disability and COVID-19 into their narratives. They raise awareness about the unique struggles faced by disabled communities, challenge stereotypes and misconceptions, and foster empathy and understanding among readers. By providing a platform for disabled creators, these novels contribute to a more inclusive literary landscape and challenge the traditional narratives that have historically marginalized disabled individuals. Through their powerful storytelling and visual representation, graphic novels play a vital role in promoting a more inclusive and equitable society. --- V. CONCLUSION The convergence of disability and COVID-19 in graphic novels offers a unique opportunity to explore, represent, and advocate for the experiences of disabled individuals during these challenging times. Through authentic representation, exploration of resilience, and the potential for social change, graphic novels have the power to reshape narratives, challenge stereotypes, and foster greater empathy and understanding. As the world continues to grapple with the ongoing effects of the pandemic, it is essential that the voices and experiences of disabled individuals are given the platform they deserve. Graphic novels serve as a vital medium for raising awareness, promoting inclusivity, and inspiring meaningful social change. By incorporating disability and COVID-19 into their narratives, these novels can contribute to a more compassionate and equitable society, where the stories of all individuals are acknowledged, respected, and celebrated.

The COVID-19 pandemic has presented unique challenges for individuals with disabilities, and graphic novels have emerged as a powerful medium for representing and exploring these experiences. Historically, disabled individuals have been underrepresented and depicted in stereotypical ways, but graphic novels have challenged these narratives by offering authentic portrayals that humanize disabled characters. In the context of COVID-19, graphic novels provide a platform to address the intersectionality of disability and the pandemic, highlighting issues such as limited healthcare access, social isolation, and the impact of public health policies. These novels also explore themes of resilience, adaptation, and the triumph of the human spirit, showcasing disabled characters overcoming obstacles and utilizing their strengths and capabilities. Moreover, graphic novels have the potential to raise awareness, challenge stereotypes, and foster empathy and understanding among readers. By amplifying the voices of disabled creators, these novels contribute to a more inclusive literary landscape, challenging traditional narratives that have marginalized disabled individuals. Overall, graphic novels offer a unique opportunity to represent the experiences of disabled individuals during the COVID-19 pandemic, promoting social change and advocating for a more compassionate and equitable society.

Introduction Vikram Seth is a celebrated Indian novelist, poet, and travel writer, best known for novels and poems. He has been an Indian English writer for more than three decades and is considered as one of the most popular writers who emerged after 1980.He initiated his writing career with composition of poems. He published the first collection of poetry in 1980, named Mappings.After poetry and travel writing, he made his presence in the realm of fiction writing in 1986 with his first novel, The Golden Gate. Seth was honoured with the prestigious Sahitya Akademi Award in 1988 for this novel. However, it was Vikram Seth"s second novel, A Suitable Boy (1993) that brought him international fame and recognition as a writer. The novel consists of 1349 pages(1488 pages in paperback) as oneof thelongest novels ever written and published in the English language. "A very large novel by a very small Indian" as Seth puts it. 1 The first section of the novel begins with the wedding scene of the older sister of Lata, whose search for a suitable husband is the central theme of the novel. The novel explores the relations between fourIndian families against the backdrop of love and marriage in early post-independence years of India . The novel demonstrates social reality of match making for arranged marriages in the India of 1960s,which ranges from ill-fated inter religion love affair of Lata and Kabir to ethnic or class endogamous pre-marriage affairs. A SuitableBoy secured the Commonwealth Writer"s Prize in 1994 with WH Smith Literary Award in the same year. --- The Concept of Endogamy and Traditional marriage System The term endogamy is commonly used to refer to the marital choice of couples within the same religious group and specific social, ethnic or caste group rejecting those from other religion or outside their group as unsuitable for marriage. Endogamy is defined as the customary marriage choiceof peoplewithin their own cultural or ethnic group.Barnard (1997:475) defines endogamy as a ""system of marriage in which individuals can only marry those from within the same kinship group.""2 It is also knownas in-marriage system , endogamy is a custom of marrying within someone"s own ethnic , class, tribe or caste group over the many generations. According to Schaefer and Lamm (1998) the word, Endogamy, is derived from a Greek word "endon" which means within 3 . It refers to marital choice within the same religious, social class or caste groups within which a marriage must be arranged. Thus, there are many forms of endogamy such as caste endogamy, class endogamy, sub-caste endogamy, race endogamy, tribal endogamy and such other forms. Although it is rare today to see these rules in developed countries but it is still present in manycountries including India. --- Types of Endogamy Schwimmer (1995) in his book about Endogamy classified Endogamy in four divisions which are village, lineage, caste and class endogamy. 4 There may be several other types of Endogamy but chiefly these four have been widely seen. Now we will discuss the following types of Endogamy one by one. Village endogamy: This type of endogamy aims to arrange marriage within a specific village or territory units . It occurs when people residing in the same village or town, prefer to marry each other. It is most often arranged to maintain geographical boundaries or convenience since in the highly rural and hilly areas it is quite difficult to afford long journey in order to frequent face-to-face contact. Lineage Endogamy:This type of endogamy arranges marriage between people of the same lineage or blood relation. They are generally organised through the custom of parallel cousin marriage, between the children of two brothers, who belong to their father"s patrilineage.This practice aims to maintain property within the family lineage and saves from misuse of assets through marriage exchanges or female inheritance. Caste Endogamy:This type of endogamy aims to maintain the purity of caste and keeping in view the peaceful unity and resource exchanges within the same group of caste or sub caste. Marriages under caste endogamy have certain social customs that are to be followed by those who belong to a particular caste society. Class Endogamy: Class, like Caste Endogamy aims to maintain social status of the society according to wealth, and related criteria.It discriminates a person in favour of his wealth, social status, or other social aspects such as occupation. Class endogamy also gives preference to the ethnicity, race, and religion. A Suitable Boy : a quest for endogamous match making A Suitable Boy is set between the years 1950 and 1952 which were the early years of post-independence India that witnessed the rise of the Indian middle class and changes in society . The novel has a third person narrative.The novel begins with the wedding ceremony of Lata"s elder sister, Savita, to Pran Kapoor where her mother,Mrs. RupaMehrasays to Lata, "You too will marry a boy I choose." When Lata reply her indifferently she emphasizes her statement "I know what your hmms mean, young lady, and I can tell you I will not stand for hmms in this matter. I do know what is best. I am doing it all for you. Do you think it is easy for me, trying to arrange things for all four of my children without His help?" 5 Lata, a 19 years old lady, falls in love with a dashing young student at her university where she was a student of literature. His name is Kabir. Lata is Hindu, and Kabir is a Muslim by religion. Lata"s mother did not like any friendship between them, because she cannot bear her daughter"smarriage with a boy who belongs to other religion or community. She sends off Lata to Calcutta and start a search for a suitable boy who comes in the novel as Haresh Khanna, who is a Hindu and belongs to same caste (Khatri) as her. The plot of the story keepson the mystery as to whom Lata will marry. Will her mother"s prejudice about Kabir be changed and Kabir be accepted as suitable for marriage with Lata by her mother in the endor will Lata go against set rules of traditional marriage. Alternatively, readers also think that she may accept one of the her other suitors.Lata's mother likes Haresh Khanna because in terms of caste and class he stands first for her choice. She is a woman who prefers to be traditional rather than being modern. Women is morally trained to maintain purity of caste order and family honor while making relationship with someone.A woman as a victim of traditional endogamy has to compromise in marriage with an individual chosen from same class and caste group by her parents, sacrificing her individual love or choice of life partner.Affected by these factors and under familial obligations, Lata'smind-set changes towards Hareshand finally she startsloving and prepares to be married with a man found by her mother.It is simply believed that she follows her mother's prejudice. She follows what her mother permits for her. Meenakshi Mukherjee has commented that the conflict between an individual's desire and duty to family has been a pan-Indian concern. According to her "Sometimes the conflict resolves itself neatly into two issues: duty to the family, and personal fulfilment. The fulfilment of oneself, however, desirable a goal according to the individualistic ideals of western society, has always been alien to Indian tradition, especially when it is achieved at the cost of duty to the family." 6 The main themes of the novel isexploration of suitable boys for Lata. It is not difficult to interpret the dilemma of Mrs. RupaMehra regarding Kabir as an unsuitable boy. "Lata has to choose between the first love of her life (Kabir) and her mother"s happiness. The novel presents passion gone awry, and Seth emphasizes that the search should be not for love but for lifemate." 7 Seth does not believe that passion always goes wrong but according to him there are other things (besides true love), that do affect upon lives of people. Consequently, A Suitable Boy deals with social factors that affect an individual"s life while choosing a suitable husband or wife. Lata Mehra influenced by these social factors decides to get married with Haresh Khanna. Ultimately, the novel ends with endogamous traditional marriage of Haresh and Lata. Thus quest for a suitablematch forLata ends in the novel with the conception that class and caste play major role while making choices for marriage. --- Conclusion Endogamy plays a major role in the novel giving preference to the ethnic and social status for choosing a bridegroom having in view hierarchical concept of caste and religion. This traditional match making is primarily preserved through the institution of marriage and especially in arranged marriages. The very word 'Suitable' stands for suitability of an individual to the arranged marriage in terms of his religion, caste, ethnicity, class structure. If someone does not fulfil the said criteria for a particular Caste or Class structure that is sustained by traditional endogamy, It will be his or her unsuitability for marriage concerning that particular ethnic Caste or Class. Mrs. RupaMehrarefusesher daughter"s request of marriage with Kabirbecause he does not belongto her caste and religion. Ultimately, Latainfluenced by her mother's suggestion and makes a choice for life partner keeping in focus her own class and caste.Thus Lata Mehra's quest for a suitable husband ends with her endogamous marriage with Haresh Khanna who belong s to the same ethnic origin and clanas her. --- Cited Works

This paper deals with the themeof Endogamy which is, as a social problem, prevalent in the society in arranged marriageswith reference to the Vikram Seth"s novel, 'A Suitable Boy". The presentresearch paper aims at an-in-depth inquiry of the role of Endogamy in perspective of traditional marriages in the society and examines the role of endogamy while making choices for arranged marriage in a traditional family. It explores the facts through critical textual analysis of Vikram Seth's masterpiece novel, A Suitable Boy. It critically examines the mind-setsof Indian mothers while makingmarital choices fortheir daughters. Marriage institution is based on traditional norms rather than individual choice.Suitability of an individual for marriage,in most cases, depends on his class or caste. Class, Caste and Custom are chiefconcerns oftraditional marriagesrather than individual love.The effective factors of Class or Caste play a dominant role in the mindset of Lata and finally She comes to the reality that making a matrimonial choice is different than loving someone.

OLDER ADULTS' USE OF HOME AND COMMUNITY-BASED SERVICES: INDIVIDUAL ATTRIBUTES AND LOCATION DISPARITIES Chair: Karen Roberto Co-Chair: Tina Savla Home and Community-Based Services (HCBS) are designed to support older adults with functional and cognitive limitations. Yet, use of services is low, gaps exist in service provision, and available services do not always meet the person's need. This symposium focuses on idiosyncrasies surrounding HCBS use. Nah and colleagues identify individual (income, ADL limitations, informal support) and countylevel (poverty and public spending on services) factors associated with HCBS use among persons living with dementia in rural Appalachia. Shippee and colleagues' examination of services received/desired indicates that older adults who are Black/other race/ethnicity were more likely to receive ADS; individuals living with AD/ADRD consumed personal care services at the highest proportion. Cheng's and Li's assessment of generosity in supporting HCBS reveals that while overall state support for HCBS has increased, Medicaid and OAA programs expenditures for services varies substantially across states. Fortinsky and colleagues' examination of risk factors for emergency department use among older adult Medicaid HCBS users shows use was associated with high school education, more severe depressive symptoms, and more chronic conditions; non-Hispanic Asian individuals had the lowest likelihood of use. Konetzka and Wang provide national evidence that use of Medicaid HCBS influences Medicare post-acute care utilization among the dually enrolled. Collectively, the symposium highlights the importance of taking into consideration individual variations in care needs, local and state support for HCBS, and disparities in healthcare and service use influencing older adults' use of HCBS, and advances understanding of intersecting micro-and macro-level effects on service availability, use, and outcomes. --- Virginia, United States, 3. Virginia Polytechnic Institute & State University, Blacksburg, Virginia, United States Formal services have been shown to provide health benefits for care recipients and family caregivers. Despite prior efforts, it is still unclear which factors play a role in the decisions to use formal services by family caregivers living in under-resourced rural regions. Drawing upon the Andersen model of health service use, this study examined individual and county-level factors' associations with the utilization of support services (e.g., homemaker, respite) and personal services (e.g., home health nurse, personal care aide) by dementia family caregivers residing in rural Appalachia (N = 163). Results of multilevel models revealed that caregivers with higher income and care recipients with more limitations in activities of daily living tended to use more support and personal services. Greater informal support from family or friends was associated with less utilization of support services, but not personal services. Caregivers residing in counties with higher poverty and lower public spending on support services for older adults were more likely to use support services. Conversely, caregivers living in counties with more home health agencies were more likely to utilize personal services. These findings suggest that caregivers living in rural regions may depend more on informal support for meeting basic care needs of their relative living with dementia. However, if the care recipient requires more specialized care, living in resource-rich counties increases their chances of receiving appropriate care. Discussion will focus on strategies to allocate funds and resources to expand care coverage to vulnerable individuals such as people living with dementia in rural regions. Abstract citation ID: igad104.1497 Long-term services and supports delivered in the home or community (home and community-based services) continue to be favored by consumers and policymakers alike. Given that HCBS is largely state-directed, there is considerable heterogeneity in program design and eligibility, and no standardized tool by which quality is measured. In the absence of the widespread use of standardized and uniform measures of HCBS quality, unmet need is poorly understood. We examined the relationship between services received and desired as a means of predicting unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS (e.g., Medicaid, PACE, OAA) using data from the National Core Indicators -Aging and Disability survey. Our sample included 13,459 older community-dwelling adults, of which 60.0% were White, 23.2% were Black, and 17.0% of another race/ethnicity. Roughly 15% of older adults reported having AD/ADRD (54% White, 20% Black). Older adults with AD/ADRD were more likely to use personal care services (59.6%), followed by delivered meals (21.3%), and homemaker services (18.6%) compared to those without AD/ADRD. Adults with AD/ADRD desired more caregiver support services and transportation services vs what they were already receiving. Of 10% already receiving caregiver support services, approx. 9% desired additional support. Of 9.6% receiving transportation services, 7.3% desired additional support. We found variation in HCBS received and desired among older adults by both AD/ADRD status and race/ethnicity, suggesting gaps in unmet needs for these groups. To meet the needs of community-living older adults and reduce overall medical spending, home-and communitybased services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons. --- UNMET NEED AMONG A NATIONAL SAMPLE OF OLDER ADULT HCBS USERS

socialization and strengthened connections. In addition to pain and inability to walk (mBC linked disabilities) being recurring physiological challenges for many older women with mBC, forced retirement/inability to work, death anxiety, financial burden, and limited access to cancer care are some of the socio-psychological challenges they face. Therefore, the establishment of PSG in cancer treatment centers in Nigeria would improve QoL and reduce abscondment from treatment.

Introduction Organ transplantation is the only possibility of saving the lives of patients with terminal vital organ failure, as well as prolonging the possibilities of their surviving the wait for a transplant in the case of end-stage renal failure. This advance of science requires the full participation of a society fully aware of its fundamental role to consent to donation. However, a fully defined social behaviour towards consent to donation is not a generalized rule. Our objective is to review the role of social education programs on donation and as well, proposals aimed at improving the global understanding of the social nonconsent organ donation crisis [1], [2]. Data show discrete increases in organ donation over the years. In the United States, for example, transplants in 2022 increase by 3.7% compared to 2021. However, this positive data should be balanced by the growth of patients on transplantation waiting lists and the daily mortality rates [3], [4]. A significant change in the social behaviour toward organ donation requires understanding that the success of transplantation is based on a paradoxical concept: After life, the human body is needed to save other lives. A rational social education is a way for people to understand their role in resolving this urgent health crisis. Any modification of social education programs must strictly adhere to the essential concepts of utility, justice, and respect for individual autonomy [5]. The distribution of organs, exclusively according to the utility of the medical act, and without considering the equality established in the assignment, is unacceptable from an ethical point of view. An allocation that promotes fairness without considering the primary indication of its medical usefulness is equally paradoxical [6]. --- Professional and Social Education Surveys of medical and paramedical teams have determined the problems to the persistence of organ shortages. --- The inclusion of programs ensuring sufficient knowledge Organ Shortage, Waiting Lists, and Mortality: Inadequate or Discussed Social Education? --- Cantarovich of the problems currently caused by the lack of organs for transplantation should be systematically implemented in all medical schools. Studies of the causes and consequences of family nonconsent, particularly in the case of the deceased donor, demonstrate the effectiveness of carrying out brief information programs for nurses and paramedics in this regard. A review shows how infrequently the real usefulness of educational campaigns on donation and transplantation has been evaluated. In one study, 23% of people reported that their conversations with family members did not make them more likely to donate their organs [7]. This response indicates the need for designers of educational programs to analyse social education programs at all levels [8], [9]. The insufficient results of the slogan "Organ donation is a gift of life" indicate that altruism is subdued by the reluctance of relatives to donate parts of loved ones to strangers. To emphasize that organ donation is a social responsibility, it has been suggested that the slogan "Donation: a gift of life" be changed to "Donating organs is sharing life among all". The fear of death and bodily mutilation have been highlighted as the most significant emotional barriers. These non-cognitive factors led to the suggested new slogans: "After death, our body is a unique source of health" and "Throughout life, we are all potential transplant recipients". The public must recognize the use of organs and tissues for transplantation as a fair deal and a conscious social duty [10]- [15]. Social discussion and education about organ donation should consider the following aspects: • The specific legality for the practice of transplantation. • The relationship between cremation and organ donation. • The public needs to be very clear about the economics of transplantation. --- Specific Legality for the Practice of Transplantation The fundamental question is whether someone, before their death or a relative in the event of the death of a loved one, should have the power to deny life to another person. A point of view not yet defined is whether a negative attitude towards donation could be considered, from an ethical-moral aspect, as an action compatible with the abandonment of people in danger. Regarding this legal possibility and its consequences, R. J. Howard, from the Department of Surgery at the University of Florida School of Medicine, suggested a specific definition in 2006: "Rescuing a person in danger of death, when the action does not involve personal risk, is a legal responsibility" [16]. A clear pedagogical and legal explanation must be defined to justify this structural alternative. Organ donation for transplantation must be a fair agreement and a social duty consciously understood and accepted by all [17]. A national policy for the allocation of scarce organs for transplantation should be guided by clinical criteria and ethical standards, not by financial or other cost-effective considerations [18]. The criteria for the distribution of cells, tissues, and organs must be in accordance with human rights and not be based on the gender, race, religion, or economic situation of the recipient [19]. --- Relationship between Cremation, Mutilation, and Organ Donation The concept of mutilation that donation would mean for the potential donor is an inhibitory factor regarding consent to organ donation. This link justifies a comparison to the relationship between mutilation and cremation. Nowadays, 40% of French people choose to be cremated. This figure rises to 85% in Switzerland and 90% in the UK and Scandinavia. In the United States, the cremation rate was 53.1% in 2018. These figures might reflect the assumption that society makes no connection between cremation and mutilation concerning organ donation [20]. "Rights" over dead bodies should be recognized because people's bodies, mainly after death, are the only resource that can save the lives of thousands of patients. The ethical and moral complexity implied by these concepts requires a detailed study of social psychology education and, especially, the participation of representatives of all monotheistic cults [21], [22]. --- Economic Aspects of Transplantation The inconsistencies in the cost of this fundamental therapy worldwide make some potential donors hesitate. Differences in costs, for example, in kidney transplantation, ranged from e11,055 in India, to an average of e230,000 in the US in 2020 [23]. To establish global equality in the economy of transplantation according to each region's financial and social conditions, the cost of a transplant might be considered like the more complex surgery on an equivalent organ. Public knowledge of the economic criteria concerning organ transplantation would improve the tendency of people to give the required consent in the difficult moments of the death of a loved one. Likewise, and with the same objective, the pharmaceutical industry should set a different cost for the cases in which a medication is prescribed for an organ transplant without a foreseeable measure of time. Or when the same medication, or part of it, is indicated for the treatment of clinical diseases whose evolution is statistically predicted to have a limited indication during the patient's life [24]. Organ donation should be considered a national resource rather than a local or regional one. The WHO concluded that national and regional barriers persist because of the insufficient and asymmetric development of transplants related to: • the lack of national strategies for transplantation, • public ignorance about donation and the demand for the transplantation of vital organs, and • the lack of understanding and commitment among the public and health professionals in relation to sick donors [25]- [28]. The rejection of the possibility of economic incentives for organ donation considers the altruistic system currently in force has eliminated any feeling of coercion. In general, financial incentives violate the altruism of organ donation and commercialize it in an unacceptable way. Such commodification uses the human body as a means rather than an end and would generate an unacceptable trade in human life. On the other hand, a positive ethical assessment maintains that economic incentives for donation preserve human life by making more donors available to society [29]. --- Discussion and Conclusion Organ transplants and the social attitude towards donation have progressed significantly. In this regard, social and professional education has achieved significant success, as evidenced by the constant global scientific and statistical progress. However, the lists of patients waiting for an organ and their mortality remain unchanged. The paradox that transplantation represents, by turning death into a possibility of life through organ donation by deceased donors, has slowly been accepted by society. Clarification and understanding of the concept of "brain death", in cases of patients undergoing artificial respiration with the demonstration of irreversible damage to the brain and brainstem, clinically documented or with evidence of complete and utter lack of cerebral circulation, of the potential donor, has advanced, although is not yet sufficiently recognized worldwide [30]. Among the causes of the inadequate social response to the donation, the universally recognized slogan: "Organ donation, a gift of life" has been discussed. Non-cognitive barriers, such as fear of mutilation and death and even mistrust in medical teams, may also arise in grieving relatives when organ donation is requested from a brain-dead patient. The persistence of organ shortages has led medical teams to modify the classically defined condition of accepting functionally perfect organs, and they now accept organs that are not entirely "healthy". This critical solution has made it possible to save or improve the living conditions of many patients [13], [31], [32]. The deaths of patients on waiting lists make it essential to review the structure of social education programs on organ donation. We consider it significant to transmit to society at all levels these basic concepts: • Donating organs is sharing the possibility of life for all. • During life, we are all potential recipients of organs for a transplant. • The organs of a deceased donor are an irreplaceable source of life. • Organ donation should be considered a social duty [33]. In this review, we attempted to highlight, through evaluating novel ethical considerations, the idea that better social educational programs on organ donation might improve the social understanding of its vital role in transplantation. In 2006, Howard argued that donating organs from deceased individuals should be and is a moral obligation. Permitting organ removal after death poses no risks, discomfort, costs, or inconvenience. It is an obligation of easy rescue, and the transplant community should begin to frame the discussion in these terms [16]. We believe that clearly transmitting concepts concerning the value of the ethical principles of transplantation, mainly the real consequence that negative consent means condemning many patients to death, the relationship between mutilation and cremation, and an honest reappraisal of transplantation budgets might result in a social sea change and a global acceptance of the ethical responsibility that is organ donation. --- Ethical Approval No direct survey of patients has been carried out in this essay. --- Conflict of Interest The author has no commercial associations that pose, or have the appearance of posing, a conflict of interest in connection with the submitted article, including but not limited to employment, consultancies, stock ownership or other equity interests, patent-licensing arrangements, honoraria, paid expert testimony, and personal relationships.

Amongst the significant advances in current medicine, the successful transplantation of organs is undoubtedly of particular social interest. However, the increase in patients on waiting lists, as well as the consistent and sometimes frequent mortality of those patients, hoping for an organ that, unfortunately, will not arrive, has caused a health crisis called the "organ shortage". This severe health emergency requires a deep analysis of the potential reasons for the social ambivalence toward organ donation, particularly in the case of the death of a loved one. The possibility that misinformation and the lack of public knowledge are fundamental barriers to consent requires an analysis of the current educational programs with the aim of improving the awareness of the general population. Negative consent to donation is particularly frequent in cases of the death of a loved one. Considering the significant social importance of consent, mainly in the case of deceased donors, the review of social programs should prioritize all the potential alternatives to improve people's acknowledgment of the organ shortage crisis. New proposals, which might create further doubt and produce complex reactions at all levels of society, should be presented correctly in transplantation program reviews. Every proposal requires a didactic discussion by experts in social sciences on people's consent in the case of deceased organ donation.

INTRODUCTION Acculturative stress is the type of psychological stress the individual experience during cross cultural interaction. Immigrants are very vulnerable to acculturative stress as compared to other normal adjustment of international students. Length of stay has been examined in previous research as an important factor that has impacts on the level of acculturative stress and adjustment. 3 More length of stay is associated with lower level of acculturative stress and better adjustment in the host country. During cross cultural experience more length of increase linguistic ability and cultural knowledge which is essential for the adjustment process in the host country. 4 Financial support and employment status also found to be important predictors of acculturative stress and adjustment in the cross cultural experience of international students. International students often have three types of financial supports that may include scholarship, family support or self-support. Students who try to manage their fees and other expenses by self-support have additional stress as compared to those who study on the basis of scholarship. 5,6 International students get debit from banks due to high tuition fesses in host institutes and therefore they search for job to manage their expenses. 7 Job opportunities and financial support programs for international students are also found to be lacking in host countries. Lastly, satisfied relationships with fellows is also important factor that can have impact on acculturative stress and adjustment of international students. Interpersonal problems and relationship difficulties increases the level of acculturative stress. 8 Loneliness was also related to lack of adjustment and higher level of acculturative stress among international students. 9 These all predictors directly and indirectly impact on the adjustment of international students in host country environment. Our objective was to investigate the effect of psycho-social predictors on acculturative stress and adjustment in Pakistani institutions --- METHODS The cross sectional survey research was conducted on 450 international students who experienced acculturative stress from November 15, 2016 to January 18, 2019. Almost all students have some level of acculturative stress and it was confirmed by applying Acculturative Stress Scale for International Students. Data collection was done by using purposive sampling technique. The sample size of 450 participants was representative and sample size estimation was done by Kline criteria of sample size of unknown population. Kline suggested that sample size per parameter for unknown population should be 10 cases per parameter. Moreover he suggested that even for a complex model 450 cases are sufficient sample size for the unknown population. 10 Data was collected by using following scales; Relationship Assessment Scale is reliable and valid measure used to investigate the relationship satisfaction of the participants. It has seven items and it is likert type scale. 11 Acculturative Stress Scale for International is reliable and valid measure used to investigate the acculturative stress among international students. It has 36 items and it is likert type scale. 12 Psychological Adaptation Scale is reliable and valid measure used to investigate the psychological adjustment of international students. It has 10 items and it is likert type scale. 13 In addition, Revised Socio Cultural Adaptation Scale is reliable and valid measure used to investigate the socio-cultural adjustment of international students. It has 21 items and it is likert type scale. 14 After taking informed consent questionnaires were distributed to all participants. Each participant took 20-40 minutes in completing questionnaires. Data was collected from six reputed universities of Pakistan where most of international students were studying. These universities include conducted by using AMOS (Version-10). Multiple comparisons on socio-demographic characteristics are investigated by using Post Hoc Test (Tucky method) in SPSS (Version-23). The criterion for statistical significance for all tests was p values less than 0.05. --- RESULTS In the current study data was collected from 450 international students who experienced acculturative stress in which males and females were in equal counterparts with age range 19 to 28 years. The socio-demographic characteristics of participants are shown in Table - stress, psychological adjustment and socio cultural adjustment is shown in Fig. 1. --- Table-III shows Post Hoc Test for exploring multiple differences on length of stay and financial support and its impacts on acculturative stress and psychological adjustment. It was found that international students who were staying not more than one year in Pakistan significantly scored higher on acculturative stress (MD=80.53, p<0.05). On financial support results show that international students who were on self-support significantly scored higher on acculturative stress (MD=56.89, p<0.05). On the other hand those international students who had scholarship significantly scored higher on psychological adjustment (MD=4.23, p<0.05). --- DISCUSSION In the current study a behavioral model is tested that was based on psycho-social predictors of acculturative stress and adjustment among international students. It was found that relationship satisfaction, length of stay, and financial support significantly negatively predicted acculturative stress. Financial support significantly positively predicted psychological adjustment among international students. However these psycho-social predictors did not show effect on socio-cultural adjustment which means that these psycho-social predictors are more important for the psychological adjustment rather than socio-cultural adjustment of international students. Our study further confirmed that higher the length of stay was associated with lower level of acculturative stress. In a study, Ayoob et al. investigated differences in length of stay is related with acculturative stress and health. 15 Similarly better relationship satisfaction and financial support also associated with lower acculturative stress which creates better psychological adjustment. 16,17 Previous studies also supported these findings that those international students who have better relationships with family and host fellows had lower level of acculturative stress. 18,19 Irum, Ajmal, and Sabah found that disrespectable attitude from host fellows also creates acculturative stress among international students. 20 Those international students who study on family support or scholarship also found to be lower on acculturative stress. 21 In a more recent study, Lam investigated culture shock (acculturative stress) and found that supportive social network and individual personality factors are essential to manage the effects of culture shock. 22 Moreover, it was found that employment status did not predict acculturative stress, psychological adjustment and socio-cultural adjustment. Some previous studies have showed the effect of employment status on acculturative stress and adjustment. 23,24 The current findings are unique, non-significant effect of employment status may be due to that most of the international students do not expect to get employment in Pakistan because Pakistan is under developing country and most of international students who came to Pakistan are from well off countries of middle East and East Asia. --- Limitations and suggestions: The current study was based on cross sectional survey design, it will more better if a longitudinal study will be conducted in which researcher will able to investigate that how psycho-social factors develop acculturative stress and how international students manage these factors and reach at the point of adjustment. But in the current study due to time and resources constrains it was not possible to conduct a longitudinal study. Moreover, if researcher investigated acculturative stress among international students and other immigrant population then we will able to investigate that which type of immigrants experience higher level of acculturative stress. It is recommended that future research should also investigate international students and other types of immigrants' problems consecutively. --- CONCLUSION Based on the current study it can be concluded that general relationship satisfaction, higher stay in host country and better financial support is significantly important for the international students' management of acculturative stress as well as for better psychological adjustment in host institution. The current study has implication for health professionals, psychologists and other clinicians who are working for the betterment of physical and mental health of international students. Grant Support & Financial Disclosures: None. --- Authors Contribution: MAR: Conceived, designed, data collection and did statistical analysis. RR: Did review, manuscript writing, editing of manuscript and final approval of manuscript.

adults. International students or academic sojourns are such types of immigrants who experience an optimum level of acculturative stress when they study in the country that has different culture than the culture of their own country. 1 Even those international students who have better cross cultural experience also exhibit some level of acculturative stress. This acculturative stress impacts on the level of adjustment and mental health of immigrant population. Many studies have been conducted on international students' acculturative stress and adjustment however there is dearth of studies available in the indigenous context. 1,2 The existing body of knowledge is evident that some psycho social predictors including length of stay, financial support, employment status, and relationship with fellows effect on acculturative stress and psychological and socio cultural

THE SOUTHEAST FLORIDA VETERANS' COMMUNITY PERSPECTIVES ON THE MEANING OF WELL-BEING: A PHENOMENOLOGICAL INQUIRY Cheryl Birmingham, Florida Atlantic University, Fort Lauderdale, Florida, United States The Veterans are a unique community shaped by past military experiences that may have positive and negative effects on their well-being as soldiers. With nearly half of the 18.4 million Veterans in the United States living beyond 61 years the physical and mental health conditions may desolate the Veterans' well-being. Promoting Veteran well-being has been studied extensively but scant on how they define it. It is critical to understand how Veterans define well-being to inform future program development addressing mental health needs. The purpose of this study is to discover the meaning and the live experience of well-being among Veterans. A qualitative hermeneutic interpretative phenomenological approach was used to understand the meaning of Veterans' well-being. It allowed the phenomena to surface while exposing the essence of and the experience. Purposive sampling was used to recruit participants, with semi-structured interviews via ZOOM and observations at Veteran Service Organizations (VSOs). Fourteen Veterans participated in this study, 8 males and 6 females with majority greater than 61 years. 64% were White, 21% Hispanic and 15% African American. With the use of Max van Manen's analysis strategy, 3 major themes emerged: (1) A Connection to a Military Sisterhood/ Brotherhood; (2) The Lingering Effects of Military Service and (3) Healthy Companionship/Relationships advocating for Veterans' well-being. The lingering effects persisted and challenged the Veterans' emotional well-being; however, they were able express their military camaraderie continued in Veteran life. Programs based on social relationships that allow connections with Veterans and/or their significant others need to be established. Abstract citation ID: igad104.3667 --- THE UNIQUE CHARACTERISTICS OF "FAMILIES OF CHOICE" AND BIOLOGICAL FAMILIES OF LGBT ADULTS Ella Cohn-Schwartz 1 , Sigal Gooldin 2 , and Yaacov Bachner 3 , 1. Ben Gurion University, Haifa, HaZafon, Israel, 2. The Association for LGBTQ Equality, Tel Aviv, Tel Aviv, Israel, 3. Ben-Gurion University of the Negev, Beer-Sheva, HaDarom, Israel This study joins a growing body of research on the unique families of aging individuals in sexual minorities. We explore the "families of choice" (who are close enough to be considered as family) and biological families of LGBT adults and their associations with mental health. Data for this study was collected via an online survey with self-identified lesbian, gay, bi-sexual and transgender (LGBT) adults aged 50+ in Israel (n=483). The participants were asked about characteristics of the relationship with their families of choice and biological families and about experiencing depressive symptoms. Descriptive results indicated that most participants had a family of choice, numbering five people on average. These families of choice were mostly composed of partners and friends, but also of the family members of one's partner, and of ex-partners and colleagues. They reported having about four close biological family members, mostly children, parents, siblings, and nieces. Several differences emerged when comparing the two types of families: The relationships with biological families were more stable and their biological family members were contacted more often. On the other hand, families of choice were more likely to accept their sexual orientation and the relationship with them had fewer negative aspects. Regression analyses showed that individuals had more depressive symptoms if the relationship with their families of choice was less stable and if there were more negative relationships with both types of families. These findings shed light on the unique sources of support among LGBT adults and their associations with mental health. Abstract citation ID: igad104.3668 --- THE USABILITY AND ACCEPTABILITY OF THE AUGMENTED REALITY HOME ASSESSMENT TOOL (ARHAT) Beth Fields, Zachary Skrove, Ross Tredinnick, Bryce Sprecher, Jenny Lee, Rachael Shields, Kevin Ponto, and Jung-hye Shin, University of Wisconsin-Madison, Madison, Wisconsin, United States Gaining access to reliable home assessments for aging in place can be challenging and expensive for urban residents and particularly those living in rural areas. Evidence has shown that there is a substantial increase in the number of older adults nationally and globally, making the availability of home assessments scarce. As individuals continue to age and become more susceptible to disabilities it is important that they have a home that allows them to age in place and is compliant with housing standards. Technology has the potential to make home assessments more accessible to older adults who want to age in place. The aim of this study was to determine the usability and acceptability of a mobile-based app, the Augmented Reality Home Assessment Tool (ARHAT), across different groups interested in home assessment (occupational therapists (OTs), older adults/

state, care responsibilities for older individuals fall on the shoulders of family members. The study of informal care provision is acquiring centrality both in the social sciences and policy discourse, since the care load can bear negative consequences on a range of outcomes, from health (e.g., the "caregiver burden") to employment. It is important to gain a better understanding of which individuals are the most likely to provide informal caregiving and face its consequences. In the present study, we explore the educational and income differences in the probability of providing informal caregiving to individuals living outside the household in Europe, using the Survey of Health, Aging and Retirement in Europe (SHARE, 2004(SHARE, -2020)). As a contribution to the field, we aim at uncovering the mechanisms behind the socio-economic gradient in caregiving, such as differences in health and longevity and time constraints (due to employment and other care responsibilities) that are unequally distributed across social layers. Results show that individuals with tertiary education, and at the top of the income distribution, are more likely to provide care, net of several other factors. The study concludes with attempted explanations of the results, related to the fact that lower educated, and lower income individuals, can more often rely on publicly provided services and means-tested benefits.

IMMIGRANT EXPERIENCES AND CARE ARRANGEMENTS LATER IN LIFE: EVIDENCE FROM THE MARIEL BOATLIFT Freya Diederich, University of Bremen, Bremen, Bremen, Germany The role of public policy in older immigrants' use of and access to services has mainly been regarded with respect to its legal framework. However, the way public policies are framed and societies' perceptions of immigrant groups can additionally influence immigrants' experiences, with long-lasting effects on needs and services use later in life. Still, the importance of these mechanisms has rarely been analyzed. This study uses the Mariel boatlift in 1980 as a case study to assess the relationship between circumstances that surround an immigrants' cohort and their care arrangement later in life. Cuban immigrants from the Mariel boatlift were perceived in a different way by the federal government and the general population than Cuban immigrants who arrived previously. Based on data from the American Community Survey (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021), care arrangements of older Cubans who arrived in 1980, who are limited in daily activities, and who reside in the Miami area are compared to care arrangements of Cubans that immigrated before. Regression models are estimated and individual characteristics are accounted for. Compared to Cubans who arrived before 1980, Cubans of the Mariel boatlift are more likely to live in the community than in an institutional setting. However, among those living in the community, Cubans of the Mariel boatlift reveal a higher risk of living alone. The results suggest that Cubans of the Mariel boatlift are at higher risk for unmet needs. It is discussed how circumstances that surround immigrants' cohort of arrival shape immigrants' services needs and use. Abstract citation ID: igad104.1315 --- RACISM IN RESEARCH ON OLDER MIGRANTS AND ETHNO-RACIAL MINORITIES: INSIGHTS FROM TWO SCOPING REVIEWS Sandra Torres, Uppsala University, Uppsala, Uppsala Lan, Sweden The study of ethno-racialized minorities used to be primarily the domain of American social gerontologists. Metaanalyses of this scholarship have shown that this research has so far been characterized by two sets of practices: it engages in racialization but vaguely acknowledges racism, and it seems inequality-obsessed but justice-oblivious. Some gerontologists have therefore argued that the scholarly imagination that informs inquiries on older ethno-racialized minorities needs to be expanded, and that one way to do this could entail taking cues from European migration scholars' inquiries on aging and old age. These scholars place the social position that is migrancy (rather than ethnicity and/or race) at the center of their scholarly imagination. This presentation presents the results of a scoping review of peer-reviewed literature published between 1990-2022 that focuses specifically on how the literature on older migrants engages with racism (since literature on older ethno-racialized minorities was in focus in another scoping review; 1998-2017). The review shows that although scholarship on older migrants recognizes that these axes of oppression could have an impact in their life-courses, empirical inquiries on the ways in which older people experience such oppression are still quite rare. The presentation will juxtapose the results of both scoping reviews in order to argue that our failure to inquire into older migrants', and older ethno-racialized minorities' experiences of racism impedes us from furthering our understanding of how the social positions that are ethnicity, race and migrancy impact (on their own and together) people's experiences of aging and old age.

address these issues, each using a different methodology. Bilecen's study, using qualitative methods, examines the impact of the wording of questions on the ways in which older Turkish migrants in the Netherlands discuss loneliness. The paper helps us understand both perceptions of older migrants and the influence of methodology used on the types of responses collected. Diederich's paper on Cuban migrants to the United States uses census data to investigate the impact of changes in the environment of arrival at different points in time on care arrangements later in life. She demonstrates the value and limitations of using this type of data. Torres uses a survey of the scientific literature to ask questions about the impact of bigotry on the well-being of older immigrants and whether lack of attention to this topic means there is an important missing piece in our understanding of the experience of the older migrant. Glicksman et. al. use clinical data to describe interactions with the formal health and social service systems by persons of limited English proficiency, an opportunity to understand both actual service use and the benefits and limitations of using clinical data for this purpose. Schrauf's response will discuss both the findings and the relation of methods to goals in the study of older migrants. This is an International Aging and Migration Interest Group Sponsored Symposium.

Introduction The concept of quality of life is frequently used. The general public, as well as governments and local, national, and international organisations, use it. The idea of quality of life basically refers to how a person evaluates the goodness of multiple areas of their existence. The subjective assessment of happiness is one of the most well-liked global indicators of quality of life. The general well-being of people and society is known as quality of life (QOL), which describes both the bad and positive aspects of existence. It tracks various factors that affect life happiness, such as physical health, family, education, employment, wealth, religious convictions, finances, and the environment. It is a wide-ranging notion that intricately considers a person's physical and mental well-being, level of independence, social connections, and religious convictions, as well as their interactions with key environmental elements. (Barcaccia, 2013). A woman's quality of life is the happiness and fulfilment she experiences as a result of the role she plays. Its importance to a woman's life is undeniable. (Anand and Sharma, 2019). The health and happiness of every member of the family is affected by the many responsibilities that women perform in the family. The ability of women to care for their families and earn a living at the same time may clash, which could have significant effects on the welfare of children. --- Objectives of the study: • Assessing the women's quality of life among high school girls and college girls • Finding the differences in women's quality of life among high school girls and college girls Hypotheses of the study: • There is moderate level of women's quality of life among high school girls and college girls • There are significant differences in women's quality of life among high school girls and college girls --- Review of literature --- Procedure of data Collection: For data collection, school principal was approached personally to take response of the girl students, after explaining the aim of the study. Then a list of girl students was prepared from high school and college. The measurement tool was executed upon selected girl students by face to face contact. --- Statistical analysis of the data To draw the inferences as per different objectives data analyzed using appropriate statistical tests i.e., frequency and percentage, means, standard deviations and z test. --- Results --- Assessment of women's quality of life among high school girls and college girls Table 1 illuminated the level of women's quality of life among high school girls and college girls. It can be seen from Table 1 that more than half of students (56.7%) had moderate level of physical health followed by low (23.3%), and high (20.0%) level of physical health in 14-17 years old age group. In 18-21 years, old age group similar results depicted that majority (70.0%) of girl students had moderate level of physical health followed by low (16.7%) and high (13.3%) level of physical health. It was clear from the results that most of (63.4%) 14-17 years of respondents had moderate level of mental health, followed by low (20.0%), and high (16.6%) level of mental health. Further, results indicated that half of respondents had moderate level of mental health followed by high (26.7%), and low (23.3%) level of mental health in 18-21years old age group. Findings of investigation showed that 14-17 years of respondents had moderate (46.7%) level of social health followed by high (36.6%) and low (16.7%) level of social health. It is evinced that most (63.3%) of respondents had moderate level of social health, 23.3 of per cent girl students had high and 13.3 per cent had low level of social health in the age group of 18-21 years old. In the age group of 14-17 years old, results further exposed that forty percent of respondents had high level of spiritual health, another forty per cent respondents had moderate and twenty per cent had low level of spiritual health. In the age group of 18-21 years old, results portrayed that more than half (53.3%) of respondents had moderate level of spiritual health, 33.4 per cent of respondents had high and 13.3 per cent had low level of spiritual health. Results of 14-17 years of respondents were revealed as 63.4 per cent perceived moderate level of overall women's quality of life followed by low (20.0%) and high (16.6%). In the age group of 18-21 years old, results depicted that more than half (56.7%) of respondents had moderate level of overall women's quality of life, 26.7 per cent of respondents had high and 16.6 per cent had low level of overall women's quality of life. --- Comparison of mean scores of women's quality of life among high school girls and college girls as per personal variables. Table 2 illustrated that there were significant differences in women's quality of life of respondents on the basis of ordinal positions, (F=3.35*), p<0.05. Women's quality of life of first-born students was significantly greater (Mean=2.08) as compared to second born (Mean=2.00) and third or later born (Mean=1.98). It was also observed that there were no significant differences in women's quality of life on the basis of number of siblings. It was apparent from results that there were significant differences in women's quality of life of respondents on basis of type of mobile phone used by them, (z= 3.96*), p<0.05. Respondents who were using Smartphone had significantly greater women's quality of life (Mean=2.35) as compared to respondents who were using keypad mobile phones. Further data displayed that there were significant differences in women's quality of life on the basis of their time spent on mobile, (F=3.22*), p<0.05. Respondents who spent time on mobile for 3-4 hours in day had significantly greater women's quality of life (Mean 2.15) as compared to 1-2 hours (Mean=2.09) and more than 4 hours in day (Mean= 2.05) spent on mobile phone. --- Comparison of mean scores of women's quality of life among high school girls and college girls as per socio-economic variables. Table 3 disclosed that there were no significant differences in women's quality of life on the basis of caste, (F=3.00), p>0.05. Results showed that there were significant differences in women's quality of life of respondents from nuclear and joint families, (Z=2.64*), p<0.05. Respondents belonged to joint family (Mean= 2.24) had significantly greater women's quality of life as compared to respondents belonged to nuclear family. Further probing of data indicated that there were significant differences in women's quality of life on the basis of their family size, (F=3.43*), p<0.05. It was demonstrated that students from medium size families (Mean=2.21) had significantly higher women's quality of life as compared to large (Mean=2.13) and small (Mean=2.05) sized families. It was evinced from the data that there was significant difference in women's quality of life of respondents on the basis of their paternal education, (F=4.22*), p<0.05. Students whose father educated up to high to senior secondary (Mean=2.20) had significantly higher level of women's quality of life as compared to graduate to post-graduate level (Mean=2.10), primary-middle (Mean=2.04) and illiterate (Mean=1.96). Results portrayed that significant differences were observed in women's quality of life of respondents on the basis of their maternal education, (F=3.24), p<0.05. It can be interpreted that students whose mothers educated up to graduate to post-graduate level (Mean=3.09) had significantly higher women's quality of life as compared to high to senior secondary (Mean=2.14), primary-middle (Mean=2.12) and illiterate (Mean=1.94). Further, Results revealed that there were significant differences in women's quality of life of respondents on the basis of their paternal occupation, (F= 4.54*), p<0.05. It was observed that respondents whose father engaged in service (Mean=2.21) had significantly higher women's quality of life as compared to respondent whose father were farmer (Mean=2.15), engaged in self-employment (Mean=2.03) and whose father were laborer (Mean=1.98). Further, data elaborated that significant differences were observed in women's quality of life of respondents on the basis of their maternal occupation, (F= 3.17*), p<0.05. It was represented that respondents whose mothers were home-maker (Mean=2.21) had significantly higher women's quality of life than whose mothers were laborer (Mean=2.10), self-employed (Mean=2.07) and whose mothers were in service (Mean=2.06). Results illustrated that there were no significant differences in women's quality of life on the basis of paternal age, (F=0.43), p>0.05 and maternal age, (F=1.38), p>0.05. As presented in Table 3, no significant differences were observed in women's quality of life of respondents on the basis of their family income, (F=1.98), p>0.05. --- Comparison of mean scores of women's quality of life among high school girls and college girls Independent sample z-test was used to examine whether there existed differences in women's quality of life among high schoolgirls and college girls. As presented in Table 4, that there were significant differences in women's quality of life among high school girls and college girls, (z= 3.27*), p<0.05. High school respondents had significantly greater women's quality of life as (Mean=2.18) compared to college girls. --- Conclusion It can be concluded that most of respondents had moderate level of women's quality of life. There were significant differences in women's quality of life among high school girls and college girls. High school girls had significantly greater women's quality of life as compared to college girls.

Adolescence is the time of transition from childhood dependence to early adulthood freedom and responsibility. The general well-being of people and society is known as quality of life (QOL), which describes both the bad and positive aspects of existence. It tracks various factors that affect life happiness, such as physical health, family, education, employment, wealth, religious convictions, finances, and the environment. The present study was conducted in Hisar district of Haryana state. The sample of study included 30 respondents were school girls and 30 respondents were college girls from Hisar district, thus total sample comprised of 60 respondents. Women's Quality of Life questionnaire developed by Gehlert et al. (2006) was used to assess the quality of life of high school girls and college girls. The results of study revealed that most of respondents had moderate level of women's quality of life. There were significant differences in women's quality of life among high school girls and college girls. High school girls had significantly greater women's quality of life as compared to college girls.

Introduction Organisation of crowded events in general, is a complex management exercise. But to organise such an event during a crisis or pandemic requiring social distancing and other restrictions would involve different sets of skills and rules, which may be challenging to implement. Currently we are passing through the COVID-19 pandemic [1][2][3][4], which started in 2019 in China. So far, over two hundred million people have been infected with the virus, and over four million have lost their lives. Global efforts to check the spread of the virus has so far received mixed success. Most of the countries have witnessed multiple waves of the virus. Sadly, since its start, several variants of COVID-19 have emerged. Currently, Delta variant, which was first detected in India (Reference), is creating havoc in many countries. The World Health Organisation (WHO) has approved several vaccines for emergency use, but their effectiveness is questionable. No one knows about any successful treatment of the COVID-19 disease. However, certain measures are universally agreed and have been proven effective to contain the COVID-19 virus. These include social distancing, limiting exposure, wearing masks in public places, regular clearing, especially hands, and sensitisation. Crowded event organisations during a pandemic must follow and implement universally accepted precautions and norms. Indeed, during the ongoing coronavirus pandemic, we have witnessed many events organised in accordance with the requirements of the pandemic. However, unfortunately, we have also witnessed several other intensely crowded events which did not follow the norms. Some of these events have turned out to be super spreader of coronavirus into many communities and neighbourhoods. On the other hand, some events have given the go-ahead in the hope of gaining political advantage. Many events could have been cancelled altogether or organised with mandatory restrictions. The success or failure of these events must be attributed to the country's management and the governing administration. When a government does something wrong, it usually goes unpunished. Organising Al-Hajj Al-Akbar (major hajj) and Al-Hajj Al-Asghar (minor hajj) during pandemic have adhered to all the required norms, which form some examples of perfect management of crowded events during COVID-19. Al-Hajj Al-Akbar is an annual pilgrimage to Makkah (Mecca), and Al-Hajj Al-Asghar, popularly known as Umrah, is an ongoing pilgrimage to Makkah, which takes place during all months and days of every year. In normal times, about ten million people travel from different parts of the world to participate in these pilgrimages. During the pandemic, however, the story is quite different. In the rest of the article, both Al-Hajj Al-Akbar will be referred to simply as the Hajj and Al-Hajj Al-Asghar as the Umrah. More details of Hajj and Umrah can be found in [5,6]. In this article, we shall analyse various aspects of the Hajj in normal times and during the ongoing pandemic. In particular, we shall explore the involvement of modern technology in managing these events. We shall also provide some suggestions to improve the management of Hajj during the pandemic. In doing so, we shall briefly discuss the history of the Hajj, its rituals, timing and places of its organisation. --- Background Here we shall provide information about critical activities of the Hajj and Umrah. --- The Hajj and Umrah The Hajj, an annual pilgrimage to Makkah, takes place during 8-13 Dhu'l-Hijjah, the 12th and last month of Hijri (Islamic or Arabic) calendar. The Hijri calendar is lunar, meaning any month would have either twenty-nine or thirty days. So, each lunation is approximately twenty-nine and half days [7]. A lunar year, is 354 days, 8 h, 48 min, 34 s (354.36707 days). In other word, Hijri year is shorter by 11 or 12 days as compared to Gregorian (solar) calendar, and hence the hajj season shifts by 11 or 12 days each year. The Hijri or Islamic calendar is a lunar calendar, and so dung the Hajj would pass through all seasons of a solar year over the course of a 33-34 lunar-year cycle [7]. Makkah is an ancient city of the Kingdom of Saudi Arabia (KSA), which houses Ka'bah, which currently is a cuboid with 36.2 feet as its width and 43 height, as is shown in Fig. 1 [8]. Ka'bah is the centre of pilgrimages of the Hajj and Umrah. According to Qur'an, Prophet Ibrahim, together with his son Prophet Ismaa'eel (Ishmael), raised the foundations of Ka'bah around 2130 BCE [9]. That led to the habitation of what we now know as Makkah. Prophet Muhammed ( ) was also born in Makkah in 570 CE. During the Hajj and Umrah, tawaf (circumambulation) is one of the obligatory and most important ritual. At peak times, tens of thousands of pilgrims perform tawaf at the same time. Many researchers have extensively studied different aspects of Hajj and Umrah. A compressive account of Hajj and Umrah, and their management issues can be found in [5]. --- Crowded events of Hajj and Umrah Hajj has several intense crowding rituals which require en mass participation. Let us look at only three of them. Assembly in Arafat. Standing in Arafat valley, shown in Fig. 2 [10], on nineth Dhu'l-Hijjah is obligatory, and most crowded ritual of the Hajj. It requires all pilgrims to travel to Arafat and spend some part of the day light. Missing this ritual amounts to missing the Hajj. During the Hajj in 2012 [5], about four million people had gathered there, making the place very crowdie. After the sunset, all pilgrims must depart to spend the night in Muzdalifah, which now is a small town of Makkah and Arafat. Stoning the Jamaraat. Stoning, known as Rami, the Jamaraat (three symbolic stations of Satan) on 9th, 10th and 12th Dhu'l-Hijjah is also an obligatory ritual of the Hajj. The Jamaraat and roads leading to them can be very Fig. 1 Ka'bah in grand mosque in Makkah crowded (Fig. 3) [11], and have witnessed a number of stampedes (reference) including one in 2015. Tawaf. Walking seven times around Ka'bah, known as tawaf (Fig. 1), is also an obligatory ritual of the Hajj and Umrah. The tawaf can sometimes become intensely crowded. During the heat of the Saudi Arabian summer months, tawaf is an arduous ritual to perform. Some people can get heatstroke during the intense crowding on hot days. Many researchers have studied different aspects of crowded events, and in particular those of the Hajj and Umrah. For details, refer to [5,12,13]. --- Management of Hajj and Umrah under COVID-19 Restriction In March 2020, the WHO declared COVID-19 as a global pandemic, which prompted lockdown in Saudi Arabia and suspension of Umrah and normal congregation prayers in all mosques including the grand mosque. The mosques were reopened in October 2020, but with COVID-19 restrictions. --- The web apps During the ongoing pandemic, entry to the grand mosque is allowed only through online permits. In addition, every citizen is mandated to subscribe to government-sponsored web Apps to display their health status. Tawakkalna, as shown in Fig. 4 [14], is the kingdom's national health app. It was developed by the Saudi Data and Artificial Intelligence, which facilitates the processing of permits for pilgrims, maintains contact tracing, and provides a range of other functionalities, including the health status of the individual users. By 5 September 2021, twenty three million Saudi residents had subscribed Another App, which can be accessed in seventy five countries. Eatmarna, also facilitates the booking of Umrah and other pilgrimages to the grand mosque. Yet another App, Sehaty [15], processes appointments for vaccinations, coronavirus test, and other health check-ups and displays health records. --- Umrah and access to the grand mosque Umrah is a journey to the grand mosque in Makkah, where a set of rituals are carried out. The most important ritual is the tawaf of Ka'ba. It takes less than 3 h to complete all rituals of Umrah. In October 2020, the government of Saudi Arabia reopened the entry to the grand mosque and entire mosques, including the performance of Umrah. However, Umrah is still being staged under the same conditions. The Saudi Arabian Ministry of Hajj regulates it through permits. During the pandemic, the Umrah management devised six shifts of two and half thousand to three thousand pilgrims in each of them. Permits are mandatory and issued only to those who are vaccinated. Health checks at different points are carried out. Wearing masks is mandatory and social distancing is enforced strictly. During the entire journey and span of stay of pilgrims in the grand mosque, strict social distancing, wearing of face masks, use of sanitization, and other related conditions are mandatory, which are supervised by the ground staff physically. Umrah under these policies has turned out to be very easy, smooth and has not posed any serious health risks. Umrah permits in 2020 were also offered to pilgrims of selected foreign counties but were later stopped for health reasons. However, Umrah permits have again been issued in August 2021 for foreigners who can comply with underlying conditions. This is also producing very encouraging results. --- Management of Hajj during Covid-19 The Hajj is a journey and set of very complex rituals to be performed in and around Makkah. In normal circumstances, two to three million pilgrims from different countries take part in the Hajj. In view of the coronavirus pandemic, the Hajj management decided to admit only ten thousand pilgrims in 2020 Hajj. By permitting a much fewer pilgrims, coupled with all the safeguards of coronavirus, the Hajj in 2020 was organised very successfully. Figure 5 [16] shows tawaf during Hajj 2020, which has less than two thousand pilgrims as compared to tens of thousands in earlier years. In 2021, the hajj management decided to permit sixty thousand local pilgrims for the Hajj 2021. As discussed earlier, a normal tawaf can have more than fifty thousand people. As usual, it turned out to be a very convenient and successful hajj with all precautions and restrictions. As we can see, the Hajj and Umrah management during Covid-19 has been very successful and has not contributed to spread of the virus. The international community can learn from the experience of management of these events. Learning from the experience of Hajj and Umrah management during Covid-19, it is logical to draw some guidelines for organisation of crowded events during a crisis like the pandemic. Here we gather guidelines to organise crowded events during a pandemic. As a starting point, all events must be approved by the Regulatory body of the country/region, who should check health, social, and cultural environment and space before granting the approval. In addition, the area of the event should be inspected and measured and the maximum number of the participants at any given time should be stipulated. Audio visual systems for displaying guidelines and warnings should be checked. The permits for participation should be issued to those who have an acceptable level of vaccination and pledge to comply with the health and crowding regulations, including contact tracing and other relevant apps. The permit should be visible to organisers at all times and be RFID enabled for tracing purposes. These and other aspects of crowded event organisation are collected in Table 1. --- Conclusions Proper organisation of crowded events is extremely important to check the spread of virus. Unfortunately, many religious, social and recreational events have contributed to the spike in the cases of coronavirus in many countries. Religion or recreation is not above the safety of people. If deemed dangerous to organise an event, be it religious or political, it must be cancelled or scaled down to an acceptable level. Hajj and Umrah organisation has provided the international community with a way forward to deal with sensitivities of religious event organisations.

COVID-19 has changed the way crowded events are organised. Every year thousands of crowded events are organised around the globe. Majority of the crowded events are religious in nature, with sensitivities and emotions attached. Organisation of crowded events, especially during a pandemic like COVID-19, poses a considerable challenge. To contain the spread of a human to human contagious disease, several restrictions, including wearing face masks, maintain social distancing, and adhering to regular cleaning and sanitisation, are critical. These restrictions stress the need for the event organisers, including the local or central government, to overhaul policies and practices about crowd management during a pandemic. Some crowded events are regular, whereas the others are occasional, which could be spontaneous such as a protest march, a political rally or a funeral procession. Controlling spontaneous crowded events can be quite difficult, especially during a crisis like COVID-19 pandemic. In this article, we shall review several crowded events which have taken place during the ongoing pandemic and investigate their impact and contribution in the spreading or containing COVID-19. We shall also provide a framework for effectively organising crowded events during the ongoing and future pandemics.

Introduction Cosmopolitan cities have become a pool of migrants. With the influx of people from different corners of the world, cultural beliefs and superstitions travel with them around the globe. This paper emphasises on a taboo of tooth enucleation practiced in the rural populations of sub-Saharan and eastern Africa. Such practice has been published in the literature previously but it is important to reiterate that these misbeliefs are still practiced in the urban population. It is not uncommon to encounter such cases in a cosmopolitan city like London. Canine gouging is a kind of infant oral mutilation (IOM) which is widely practiced among rural population of Africa where the primary tooth bud of the deciduous canine is enucleated. The belief is that the life threatening illnesses in children like vomiting, diarrhoea, and fevers are caused by worms which infest tooth buds. Some believe that the tooth follicle itself resembles worms as they are soft, unmineralized mass of tissue. These teeth have been known by different names as Ebinyo, or Ebino, nylon or vinyl teeth, killer teeth, and Lugbara [1][2][3][4][5][6]. The other reasons for such practice have been general malaise or ill health, itching gums, crying with an unknown cause, failure to suckle, and sometimes even being performed as a preventive measure to keep illness at bay [7,8]. Enucleation of the tooth bud is believed to cure the infants from any such ailment. This practice has run in families of local "healers" who practice this without using any anaesthesia or antiseptics. Another belief as reported by Kenyan Massai women believe that bovine calf is not prone to diarrhoea or febrile illnesses as it does not possess canines and hence removing the canine can cure diseases [6,9,10]. The technique involves rubbing of herbs or ashes got from burring leaves on the gums to prevent the child from getting disease. This process is called silencing [6]. If the child is ill, then the process is usually conducted by middle aged Massai women (in Kenya), older women, family member, priest, teachers, religious healers, or the tribal head [7,11,12]. The instrument used to enucleate the tooth can be finger nails, pointed knife, hot needle, bicycle spokes, rusty nails, or wires [7,8,12]. Although there are reported cases of deaths of young children following canine gouging due to septicaemia, anaemia, meningitis, osteomyelitis, and tetanus, the practice still continues [13]. The origin of this practice is unknown but could be speculated on the fact that incising the gingiva with a lancet to help an erupting tooth would relieve pain and discomfort to the patient. In 1575 Ambriose Pare, a French army surgeon, incorporated this method to help the problem of "breeding tooth." In 1668, Francois Mauriceau insisted to use lancet instead of knife or coins to conduct the procedure. In 1742, Joseph Hurlock encouraged such practice to prevent child deaths caused because of teething [7,14]. It would be ironical to understand if such a practice transformed to gouging. One of the earliest literature reports on canine gouging comments on such practice in the pagan tribes of Nilotic Sudan in 1932. The Shilluk tribes practiced a custom of removing the deciduous lower incisors. The Acholi tribe from Uganda were known to remove the lower canine tooth buds. It is speculated that such a practice was initiated and spread in Uganda by Lugbara tribe. Pindborg in 1969 was the first who shed light on the topic and its relation to the superstitious beliefs in Uganda [2,6]. This is not the first time the western world has come across such practice in the African continent. Evidence of canine gouging practice has been documented from different parts of Africa like Uganda, Angola, Tanzania, Somalia, Kenya, Sudan, and Nigeria and has been in the literature [1,3,4,9,13,[15][16][17][18][19][20][21][22]. In Cape Flats (Western Cape) in South Africa a culture of removing incisors has been followed for the last 60 years. The incidence of such practice was higher in lower income areas [23]. The prevalence of this practice has been different from place to place ranging between 15 and 80% in children below the age of 4 years [12]. This practice has also been reported in non-African countries like Maldives, United States, New Zealand, Israel, and Sweden especially in migrant population [12,[24][25][26][27]. There are also reports of such practice in the United Kingdom by Somalian and Ugandan migrants who are currently residents of UK [1]. The aim of this paper is to present a complication of the practice of primary canine extraction in young children and spread awareness among the general dental practitioners to be vigilant of such practice and plan the treatment accordingly. It is also important to counsel the individual and their family to prevent performing such practice. It is the duty of every dental professional to educate and safeguard the oral and dental health of the general public. --- Case Report This is a case report of a 15-year-old Somalian born boy, who presented at the paediatric dentistry department. Consent was obtained from the patient and parent to use the following information for this publication. Patient had intermittent pain in his lower right permanent canine which was associated with a discharging intraoral buccal sinus. He was concerned with the aesthetics of this tooth. On further questioning it was revealed that at the age of five the boy suffered from high temperature, diarrhea, and vomiting. The local dentist in Somalia performed a traditional tooth enucleation procedure to cure the boy from illness. His family history revealed he has seven younger siblings. No such enucleation was seen performed on other siblings as all others were born in the UK. The patient was medically fit and well. On clinical examination the lower right permanent canine appeared hypoplastic as shown in the pretreatment figure (Figure 1). Draining sinus was noted in the buccal sulcus. The tooth presented grade 1 mobility. In addition to this all the permanent teeth showed fluorosis. A panoramic and periapical radiograph taken showed coronal tooth loss and demonstrated an open apex (Figures 2 and3(a)). Patient was given an option to undergo endodontic treatment or extraction. Endodontic treatment of this tooth was the most suggestive treatment and was carried out in successive appointments (Figure 3(b)). This was followed by fibre post/everstick post and coronal structure was restored by indirect composite buildup (belleglass composite). The permanent teeth were finally bleached to improve his dental aesthetics as shown in the posttreatment figure (Figure 4). The patient and the parent were given additional counselling about the practice of canine gouging and its ill effects on the teeth. --- Discussion The present case shows the result of a previous enucleation procedure and how it has led to the changes in the permanent tooth. The practice of canine gouging may result in trauma or infection to the permanent canine tooth bud which can leave the tooth to be hypoplastic or completely atrophied. Hypoplastic teeth are known to be predisposed to caries [10,28]. An early loss of deciduous tooth especially when it is unilateral can result in shift of the midline [29]. Rather sinister consequences are excessive bleeding, infections, osteomyelitis of jaws, noma, tetanus, meningitis, aspiration bronchopneumonia, HIV infections, hepatitis, and even death [8]. There are other dental mutilation practices including transformation of teeth by shaving of the teeth, placing jewellery on tooth, gold crowns on normal sound anterior teeth, tattooing on the lips, and uvulectomy. Canine gouging is one of such dental mutilation practices. Some of these practices have been culturally determined [30]. A deeper cause for such superstitious beliefs is lack of education, poverty, lack of belief in medical practice, and failure of good medical infrastructure. With the high prevalence of infectious diseases like diarrhoea, tuberculosis, HIV infection, and malaria and inadequate medical supplies and reduced access to trained dentist, it is easy to access local "traditional healers" through traditional rituals. It is always seen that such practices are common in lower income group. Matee and Helderman [18] studied the prevalence of nylon teeth practice in Tanzania in subjects (𝑛 = 3267) within the age group of 3 to 19 years. 95% of the missing teeth were canine [17]. Hiza and Kikwilu (1992) accounted such extraction in Tanzania to be 37.4% in children (𝑛 = 262) and found 99.4% teeth involved to be canines bilatarally [3]. In another study by Kikwilu and Hiza (1997) they examined children with missing primary teeth, scars, or wounds in gingivae and found such practice was more in villages where traditional healing with extraction of tooth buds was recently reported. Such prevalence was reported to be 60% in a group of children (𝑛 = 1052) [4]. Similar studies conducted by Hassanali et al. (1995) in Kenya showed the occurrence was as high as 87% in children (𝑛 = 95) between the age group of 6 months to 2 years. The peak age group which reported such practice has been 4-18 months of age [9]. A study conducted by Ngilisho LA et al. in 1994 in five villages of Tanzania found that most of the traditional villagers were trained by their father or grandfather and the tradition has passed on in family [7]. The traditional healers also believed that they treated on average at least 3 dental patients per month. It is important to note that the absence of primary canine in these ethnic populations could indicate the practice of canine gouging. Such practice can be endemic and sometimes associated with other rituals practiced by the community. One needs to be aware of such practice and associated social factors and its effect on the dental and physical and psychological well-being of the patient. A close examination of the dentition, absence of deciduous or permanent canine, scarring along the area, and loss of alveolar ridge height could indicate previous practice of canine gouging [31]. In the present case we came across similar observation and a comprehensive history revealed the practice of canine enucleation in the past. --- Case Reports in Dentistry The risk of morbidity and mortality from these practices needs to be explained to the patients especially from these ethnic backgrounds. Educating and counselling pregnant women and parents of young children about canine gouging and associated risk it imposes on the health and life of the child need to be addressed. Its ill effect on the primary and secondary dentition needs to be explained. As a dental professional one needs to be cautious in identifying such unknown tradition and provide the right guidance and advice. --- Conclusion Canine gouging or canine enucleation is a superstitious belief and is still practice in some migrant populations. General dental practitioners need to be aware of such practice and observe patient with such problem when coming across unilateral missing tooth. A comprehensive history from the patient or parent can be helpful in identifying the root cause for such missing tooth. It is also important to counsel the individual and their family to prevent performing such practice. --- Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper. Submit your manuscripts at http://www.hindawi.com

Cosmopolitan cities have become a pool of migrants from different parts of the world, who carry their cultural beliefs and superstitions with them around the globe. Canine gouging is a kind of infant oral mutilation (IOM) which is widely practiced among rural population of Africa where the primary tooth bud of the deciduous canine is enucleated. The belief is that the life threatening illnesses in children like vomiting, diarrhoea, and fevers are caused by worms which infest on tooth buds. This case report is of a 15year-old Somalian born boy, who presented at the dental institute with intermittent pain in his lower right permanent canine which was associated with a discharging intra oral buccal sinus. The tooth was endodontically treated and then restored with composite. General dental practitioners need to be vigilant when encountered with tooth presenting unusual morphology, unilateral missing tooth, and shift in the midline due to early loss of deciduous/permanent canines. Identification of any such dental mutilation practice will need further counselling of the individual and family members. It is the duty of every dental professional to educate and safeguard the oral and dental health of general public.

INTRODUCTION Ajwain (Trachyspermum ammi) is an annual herbaceous plant belonging to Apiaceae family. Mediterranean region in Egypt is the origin place of Ajwain. Ajwain falls under minor seed spices and is widely cultivated in arid and semi-arid regions. It is cultivated in India, Iran, Egypt and Afghanistan. India is one of the leading countries in the world with respect to area, production and export of different seed spices. Rajasthan and Gujarat have emerged as "Seed Spices Bowl" and together they contribute 80% of the total seed spices production in the country. Madhya Pradesh, Uttar Pradesh, Punjab, Haryana, Maharashtra, Andhra Pradesh, Karnataka and Tamil Nadu are also contributing to the total seed spices production of the country (Anonymous2020). Ajwain is mainly cultivated for its seed and volatile oil (Thymol). Ajwain seed generally contains 2.5 to 5% essential oil and 26% fatty oils (Raghavan, 2007). The greyish brown seeds of Ajwain are usually considered for medical and nutritional purposes. Rajasthan is a leading state in cultivation of spices. It has most suitable Agro-climatic conditions for the cultivation of different spice crops. India, Rajasthan has secured an unique place as it produces about 8-9 lakh t seed from about 8 lakh hectares area (Anonymous 2020). Therefore, it is high time to analyze correlation between socio-demographic profile of tribal farmers with knowledge and adoption to know the reasons hindering the adoption of improved production technology of Ajwain by the Tribal farmers in Pratapgarh districts Rajasthan. --- OBJECTIVE Analyzing correlation of socio-demographic profile of tribal farmers with knowledge and adoption of improved production technology of Ajwain. --- METHODOLOGY The present study was conducted in Pratapgarh districts of Rajasthan. Pratapgarh district was selected purposively due to the reason that Pratapgarh district has the highest area (222 ha) and production (333 t) of Ajwain crop among all tribal districts of Rajasthan (Anonymous 2019-20). https://doi. org/10.56572/gjoee.2023.35.2.0011 Pratapgarh district comprises of 5 tehsils. Out of which Choti Sadari tehsil selected as it has highest area and production under Ajwain crop among all tehsils of Pratapgarh. From the selected tehsils, 5 Ajwain growing villages were selected; namely; Karzu, Manpura Jagir, Rawatpura, Bambori and Raghunathpura. From each of the selected villages, 13 tribal farmers were selected randomly. In this way a total sample of 65 tribal farmers was selected.. The ex-post facto research design of social science was used for the present investigation. Selected tribal farmers were interviewed and the desired information was collected with the help of pre-tested interview schedule. After collection of data, all the tribal farmers were divided into three categories namely low, medium and high. The categorization was based on mean and standard deviation. Data were tabulated and analysed with various statistical tools like frequency, percentage and correlation analysis. --- RESULS AND DISCUSSION --- Socio-demographic profile of tribal farmers The data in table 1 revealed that majority of the tribal farmers (70.77%) belonged to middle age group and it was found that 44.62 per cent tribal framers were illiterate and 16.92 and 10.77 per cent of the tribal farmers were educated unto secondary and senior secondary, while 3.08 per cent of the tribal farmers had education upto graduation level. These findings are in line with the results of Meena (2010) and Yasmin (2017). Then majority of the tribal farmers (69.23%) were from joint family and rest of the tribal farmers (30.77%) were from nuclear family. The probable reason behind this might be that tribal farmer prefer to live in joint family and follow agriculture as source of living while giving least importance to education. These results are in agreement with the results of Meena (2006). It was observed that from Table 1 that majority (38.46%) of the tribal farmers were marginal farmers followed by (35.39%) small farmers, (20.00%) semi medium farmers and Only (06.15%) medium farmers. These findings are in agreement with the findings of Badhala (2012) and Yadav (2021) who also reported that majority of tribal farmers were small and marginal. The result presented in table 1 indicated that majority of tribal farmers (64.62%) had medium level of annual income, followed by (23.08%) high and (12.30%) low level of annual income. The probable reason might be majority of tribal farmers were local farmers having marginal to semi-medium farm size, which has attributed to the major share of income coming from tribal business coupled with agricultural farming. Then majority (58.46%) of tribal farmers had medium extension contacts while 27.69% and 13.85% were having low and high extension contacts, respectively. It was also observed (2015) and Yadav (2021) who reported majority of the tribal farmers were medium social participation. More farmers had used the medium sources of information while lesser per cent of the tribal farmers had used high and low level of sources of information. It could be due to the organization of campaigns, tours, kisan call centres, exhibition, strong network of technical and field staff of KVKs and the free and common access to the electronic media. The results in the Table 3 indicate that, Out of 7 variables studied 6 important variables namely, Age, Land Holding, Income, Family Type, Education and Social participation were highly significant (P<0.01) with knowledge level while a significant relationship (P<0.05) was observed only with Extension contacts of tribal farmers. The highly significant positive correlation coefficient of Age, Land Holding, Income, Family Type, Education and Social participation and only significant correlation of Extension contacts with knowledge level of tribal farmers improved production technology of Ajwain may lead to conclusion that these socio-economic independent variables play a pivotal role in increasing the dependent variable knowledge of tribal farmers. These results are in agreement with Badhala (2012), More et al. (2015), Chavhan (2019), andYadav (2021) who explored that there was positive and highly significant relationship between socio-economic independent variables like age, education, annual income, social participation and extension contacts with knowledge. The findings of the study are similar with Meena (2006), Meena (2010) who reported that family type and size of land holdings have highly significant relationship with knowledge level of farmers about improved production technology of Ajwain. The results in the Table 3 indicate that, out of the seven selected characteristics of tribal farmers, Income, Family Type, Education and Social participation exerted highest positive correlation coefficient (P<0.01) with extent of adoption. Variables like Age, Land Holding and Extension contacts had positive significant relationship (P<0.05) with extent of adoption of improved production technology of Ajwain. The findings of the study are in conformity with Meena (2006), Meena (2010), Badhala (2012), Chavhan (2019) and Yadav (2021). --- Relationship between socio-demographic profiles of tribal farmers with knowledge about improved production technology of Ajwain --- Relationship between socio-demographic profiles of tribal farmers with adoption of improved production technology of Ajwain --- CONCLUSION In conclusion Ajwain production is an important part of Indian agro based economy; it not only provides but also offers employment opportunities to the poor and weaker sections of the society. Today Indian agriculture is at cross roads of industry which has been dominated by government sector and working in co-operative mode. So in order to improve the same an extension agent has to work on the social participation of the tribal farmers which is having direct effect on knowledge and adoption of Ajwain production followed by the tribal farmers. Education and sources of information are also having significant relation which can be effectively utilized by the extension agent for disseminating improved production technology practices of Ajwain in tribal areas. Training programs should be organized frequently in order to improve adoption. While, extension agencies should work on increasing awareness in order to increase knowledge level. --- RECCOMENDATIONS To improve the extent of adoption of improved production technology of Ajwain by the tribal farmers training on certain aspects may be organized to improve their extension contacts and social participation. It is also recommended that the government, state agriculture department, village cooperative societies should ensure availability of inputs like improved seeds, fertilizers, insecticides, pesticides etc. to the farmers at cheaper costs. Credit facilities should be made available to the farmers at lower interest rates so that farmers with lower income group can easily purchase and adopt new technologies. --- ACKNOWLEDGEMENT I am grateful to all of those with whom I have had the pleasure to work during this research. Each of the authors has provided extensive personal and professional guidance in this research work. --- CONFLICT OF INTEREST This is to declare that there is "No conflict of interest" among researcher.

The present study was conducted in Pratapgarh district of Rajasthan with the objective of correlational analysis of socio-demographic profile of tribal farmers with knowledge and adoption of improved production technology of Ajwain. 5 villages from Choti sadari tehsil of Pratapgarh were selected randomly. From each of these selected villages 13 tribal farmers were selected randomly and a sample total of 65 Tribal farmers were selected. The data from these tribal farmers was collected using a well-structured and pre tested interview schedule during the year 2022. The ex-post facto research design of social science was used for the present investigation. On correlation analysis of socio-demographic profile of tribal farmers with knowledge level, it was found that age, education, size of land holding, family type, annual income and social participation were found to be positive and highly significant relationship (p<0.01) and extension contacts was found positive significant (p<0.05) with knowledge. Findings regarding relationship between adoption of improved production technology of Ajwain shown that, education, family type, annual income and social participation positive and significant correlation coefficient (p<0.01) and age, size of land holding and extension contacts was found positive significant (p<0.05) with extent of adoption of improved production technology of Ajwain.

Introduction Since the optimistic earliest work of science-fiction (sci-fi) movies such as "A Trip to the Moon" (1902) by Georges Méliérs, movies categorized as such have been describing the state of possible future development of technology such as "Ralph 124C 41+ (one to foresee for many)" (1911) by Hugo Gernsback (though not a movie) as well as monsters and aliens as the subjects of entertainment. On the other hands, there are some serious movies that described the life in the future society. I point out that future societies described in such movies tend to be mostly dystopian ones, rather than utopian, although some of their stories have positive endings in order to satisfy the audience. --- Utopia and Dystopia The criterion that differentiates dystopia from the utopia may vary, depending on the movie analyst's viewpoint. Some could claim that even a free and wealthy country can be categorized as a dystopia, if people living there cannot have a positive attitude and mindset, which will lead to a negative result, the opposite of a happy life. What is such a life? The PERMA Model describes it. The PERMA Model was developed by a positive psychologist, Martin Seligman, and was published in his influential 2011 book "Flourish". PERMA, an acronym for a model of well-being, proposes five building blocks of well-being and happiness: ─ Positive emotions: feeling good ─ Engagement: being completely absorbed in activities ─ Relationships: being authentically connected to others ─ Meaning: purposeful existence ─ Achievement: a sense of accomplishment and success However, in this discussion, I believe many sci-fi movies describing the life in the future society take an opposite view, and I shall focus on their self-evident dystopia and, in particular, totalitarianism. "1984" (1984) by Michael Radford In Table 1, I tentatively listed sci-fi movies that deal with a future society under the control of totalitarianism. This table excludes sci-fi movies that are not focused on the totalitarian organization of a future society even though the situation is set in the dystopian future. This is the reason why such movies as "Shame" (1968) by Ingmar Bergman, "A Clockwork Orange" (1971) by Stanley Kubrick, "Futureworld" (1976) by Richard T. Heffron, "Time of the Wolf" (2003) by Michael Haneke, etc., were not included in the table. The table is not yet complete; upon further analysis, additional movies could be added. --- Dystopia in the Real World I am a movie lover and watch one to two movies per day! I have found it rather difficult to find sci-fi movies that describe a utopia. One reason for the imbalanced proportion between utopian and dystopian movies might be the historical facts of human civilization, in which there have been many totalitarian and autocratic societies. We can remind ourselves of such cases as Germany under the regime of Hitler, the Soviet Union under Stalin, China under Mao Zedong, Cambodia under Pol Pot, and more and more if we limit the list just to World War 2 and afterwards. Most movies are made to entertain audiences. Sometimes, however, serious themes, such as the nature of dystopia, will be adopted for raising the consciousness of people about their own futures, so they will be able to avoid the circumstances that will lead them again into dystopia. --- 4 How Can Dystopia Become Possible? Some dystopian movies include an explanation of the process by which the society has come to accept such a regime. For example, "1984" refers to a nuclear war, "Soylent Green" mentions a population explosion and the consequent shortage of food, and "ZPG" and "Logan's Run" also refers to a population explosion. "Metropolis" and "THX-1138" do not have such causes; hence the audience is placed into an unexpected situation from the beginning without any explanatory narrative. So, how were the totalitarian and autocratic societies possible in the real world? Examples that I have cited in the previous section were cases in which an older regime was destroyed, and people believed in propaganda that a better society will come about. This belief delivered controlling power to a totalitarian leader. Today, many of the countries mentioned above are more democratic, which seems to suggest that a totalitarian society is a transitional state before the eventual emergence of a democracy. This leads to a next question: Is democratic society the final form that will last forever? If we think about the future not far from present time, with the likely circumstances of an energy crisis, the shortage of underground resources, the shortage of food, the population explosion, and the cost of upgrading developing countries, it seems reasonable to think the entire world will be thrown into turmoil. --- Table 2. Negative aspects in dystopian sci-fi movies Dystopia and Future Technology From the viewpoint of user experience, it would be good to focus on the development of devices and systems to achieve positive objectives, like those described in the PERMA Model. However, we should also consider how the future devices and information/communication technology (ICT) can be used to control society, which would lead us into a negative life experience. Table 2 shows how domination, propaganda, behavior monitoring, and mind control are described in several dystopian sci-fi movies. Domination concerns social organization and is less related to ICT. Future technology may be related to propaganda and mind control, but here I shall focus on behavior monitoring. Regarding this aspect, the ubiquitous technology will be one of the plausible means to achieve the controlled totalitarian society. The following technologies are available now and will be reinforced in the near future. They all have the potential to deliver information to those in control of governments, systems, communication networks, and devices: Mobile Device. Devices such as laptops, tablet PCs, and smart phones equipped with global positioning system (GPS) can send the location of the device user. Internet-Related System. Internet-related system gives personal information such as preferences, political attitudes, social groupings, and other personal information to those in control by analyzing the contents of SNS, blog, email and the log data of illegal access to the prohibited sites. Such technologies for the Big Data as data mining, massively parallel machine, grid computing, distributed file system and others have already been realized. Small Chips. Small chips such as RFID and IC-tags, implemented in many varieties of personal and professional objects, will send the location and handling information of the object (or the person) to people in control. Video Cameras. Video cameras are now set up at various places in and out of homes, business and government buildings, travel-system stations and routes, and commercial shops of all kinds and are already used to trace the move of suspects. Surveillance by Satellite or Airplane. This kind of system will provide the detailed pictures and specific locations of particular objects and people. Although it is influenced by the weather condition and the vegetation and is unable to make the reconnaissance of people in underground, video camera will give some supplemental information. Biometrics. Biometric system including physiological, psychological, and behavioral measures will give information about and provide accurate identification of the person. --- Scene Analysis and Pattern Recognition. This kind of technology analyzes the pictures taken by organizations, government, and individuals that will give sufficient information to identify people, places, and objects in almost any environment or location. When such technologies are in the hands of those who have a strong will to control people, the world drifts quickly and inexorably to a state far worse than those described in dystopian sci-fi movies. To wake us up and to help us prepare for the future, we can thank and learn much from sci-fi movies, even the most dystopian, about the possible future state of the world. Then we, as the audience, can and should utilize that information to stimulate our good-natured imagination to navigate better alternatives.

The author proposes a view that most science-fiction movies that described not just the future technological development but the life in the future social organization are pessimistic and depict dystopian, rather than utopian societies. They can provide useful guidance to increase our awareness of what technology might bring to the user experience and of how we should take care for not falling into such a social organization.

I T is with regret that we report the death of Dr. J. P. Cassidy of 2112 Yonge St., Toronto, on December 12th, 1938. Dr. Cassidy was the victim of two automobile accidents occurring within a few seconds of each other. He was thrown from his own car when it skiddecl on an ice-glazed pavement and was injured further when a second auto struck him as he was lying in the ditch. Dr. Cassidy was a native of Tweed, Ontario, and graduated from the Ontario Veterinary College in 1935. Following his graduation, he located on North Yonge Street in Toronto where he es- tablished a lucrative small-animal prac- tice. While of a somewhat retiring nature, he was well liked and highly regarded by neighbouring practitioners. The sympathy of the profession is extended to the bereaved relatives. R. N. Walsh, D. V. S. D R. R. N. Walsh, Huntingdon, died on December 31, 1938, in the Mont- real General Hospital where he had been confined for six weeks. Dr. Walsh was born in Huntingdon on October 1, 1863. He attended the public schools and later graduated from the Huntingdon Academy. Entering McGill University he graduated from the Fa- culty of Comparative Medicine and Ve- terinary Science with the degree of D.V.S. in 1890. Returning to his home he set up practise and almost immediate- ly enjoyed a large clientele. The re- spect in which he was held was evidenced by the many municipal offices to which he was elected and later by the highest honour which the constituency could bestow-election to the House of Com- mons. In this body he sat for several years being finally defeated by the Hon- ourable James Robb. Dr. Walsh was in religion a life long Presbyterian and in politics a Conser- vative. Not only has Dr. Thompson served the profession well in so far as his personal activities are concerned but, also, for the future, since two of his sons, Dr. K. H. Thompson and Dr. S. N. Thompson, who have recently graduated are now as- sociated with the Health of Animals Branch on Field work in the Province of Manitoba. A third son, D. Thompson, en- tered the freshman class of the school this year. --- Family of Veterinarians Dr. Thompson is taking a well-earned holiday and, on his trip, has visited the Ontario Veterinary College at Guelph, the New York State Veterinary College at Ithaca and has also been to New York, Toronto, Chicago, and Minneapolis. [29] o]Canadian Journal of L30] Comparative Medicine Twenty-Fifth Annual Meeting WNestern New York Veterinary Medical Association BY A VISITING VETERINARIAN T HIS Association, with head-quarters in Buffalo, N.Y., is a local organiza- tion designed to serve the interests of the profession in the Western extremity of New York State. Summer meetings are held at various centres in the area but the annual meeting is always in Buffalo. The date of the meeting this year was December 15th, 1938, and it was held in the S.P.C.A. building. The afternoon from 1 p.m. to 4.30 p.m. was devoted to the examination, diagnosis and operative procedure of a number of clinical cases submitted for the occasion. One case of considerable interest had been diagnosed as intestinal obstruction by a foreign body. A laparatomy was performed with the intention of removing the obstruc- tion. When the abdominal viscera was exposed, a diffuse peritonitis and enteri- tis were evident. In a portion of the in- testine, an obstructing mass of foreign material mixed with feces was found. In- corporated in the mass was a thread which extended forward in the gut and could not be removed by traction. It was then decided to destroy the animal and, after searching the viscera, a needle was found which had passed completely through the wall of the intestine and to which the thread was attached. Following the clinic, a business meet- ing was held in which the President, Dr. J. V. Hills of Gowanda, N.Y., gave a re- port of his tenure of office. The Secretary then submitted a financial report for the year and other items connected with the business of the organization. The meeting then adjourned to the Hotel Touraine where a dinner was served and which was graced by the presence of the wives of many of the Veterinarians. Fol- lowing the dinner, Dr. W. A. Dennis of --- Case Reports January 1939 Vol. III-No. I Jamestown, N.Y. entertained the assem- bly by putting on several reels of motion pictures which he obtained on his Eu- ropean trip to the International Veteri- nary Congress held in Switzerland this last summer. The pictures were in color and proved to be highly instructive, as well as, entertaining for they depicted scenes and places of note in the British Isles, Holland, Belgium, Germany, Aus- tria, Italy and back through the Alp Mountains to Switzerland. Owing to the press of time, all of his reels could not be viewed which was to be regretted. The remainder of the programme con- sisted of the presentation and discussion of the following items:-a paper on "Diseases of Small Animals" by Dr. L. J. Desson of Rochester, N.Y., the "Pre- vention and treatment of Encephalomyelitis in horses" by Dr. E. B. Igmand of the Field Research Department of the Pitman-Moore Co. of Zionsville, Ind. This address was illustrated by the use of two motion picture reels of the clinical aspects of the disease and discussed by Dr. H. R. Potter of Niagara Falls, Canada. The latter gentleman having had considerable experience with an outbreak of the disease in the Niagara peninsula during the summer. Other members anid visitors present also took part in the discussion of these topics. Canadian visitors at the meeting were Dr. F. J. Cote of Guelph, President of the Ontario Veterinary Association, Dr. W. J. Rumney of Hamilton, Secretary of the Ontario Veterinary Association, Dr. Rice of London, Ontario, and Dr. R. A. McIntosh of the Ontario Veterinary College, Guelph. WANTED a position as assistant either mixed or small animal practice. Graduate O.V.C., 1914. Avail- able at once. R. L. Dove, V.S., Dunville, Ont.

WE regret to announce the death of Major Daniel LeMay, V.S. (Montreal) D. V. S. (McGill) on the 28th De- cember, 1938, at the age of 80. Born at St. Martin, P. Que., on June 19, 1858, Major LeMay was educated lo- cally and in Montreal. He graduated in 1879 from the Montreal Veterinary Col- lege and in the same year, entered practice in Baltimore, Maryland, where in 1880 he became State Veterinarian. In 1886, he was appointed Veterinarian to the 1st. United States Cavalry and he served with various cavalry and artillery regiments in the United States and Cuba until 1916. During this period, he took part in such historic events as the march from Fort Douglas, Utah, to Fort Ethan Allen, Vermont, (600 miles in 20 days) and Pershing's punitive expedition into Mexico in 1916. He intermitted his army work in 1886 to obtain the degree of D. V. S. from McGill. In 1916, he retired owing to ill health but rejoined the colours the following year. In 1919, he retired to civil life. Major LeMay is sur- vived by his sister, Mrs. James Cochrane King, and by his soIn, Vincent Le- May, both of Montreal. The Major was highly respected both at home and in the United States and his colleagues in Canada mourn the loss of a fine person- ality. .

Introduction: Children of today's generation are being raised in a media-rich environment, including social and It makes it possible for groups with shared interests, such as student groups, to collaborate on initiatives outside of the classroom. It encourages innovation and teamwork among a diverse group of critics on a range of topics, including education, the economy, politics, race, health, and relationships. Although it has many advantages, including making it simple for people to stay in touch with friends and family throughout the world, allowing everyone to overcome cultural and international obstacles. (2,3,4) . Generally it is preferred texting to talking on the phone, online chat to in-person meetings, and many Pages have abandoned in-person interactions in favor of using social media sites like Facebook, Twitter, and Instagram. According to Jonathan SafranFoer, "Each advance in social media has made it slightly simpler, to escape the emotional work of being there, to give information rather than people" in his piece "How Not to Be Alone." These words get more and more accurate as time goes on. The term "social media" refers to a group of online communication platforms that focus on user-generated content, collaboration, and community involvement. Among the various forms of social media are websites and programs devoted to forums, micro blogging, social networking, social bookmarking, social curating, and wikis. (2, 3, 4,) According to a recent study, those who use social The present study revealed that more than half (56.0%) of the study group have both sex male and female.  d = 0.05 mistake coefficient                              1 50 . 0 1 1 50 . 0 The present study reflects that (46.0%) of study groups reported that the T.V is the type of social media available in their home, this result agrees with previous study done by Valck (2010) which reports in his study most of the mother's reported that the TV is the type of social media available at their home. (7) This study revealed that less than one half (44.0%) of them spending 6-4 hours in social media this result agrees with previous study done by Wang (2005 ) that reported most of the children spend 4-7 hours in social media . (8) This study revealed that more than two third of them had poor knowledge regarding changes that appears in their children attitude, this result opposes with previous study done by Weiler (2005) in London that reported in his study most of the mother's had good knowledge about the change shown in their children. (9) As regarding to how the mother's deal with over use of social media, less than half of study group (42.0%) reported that they were reduced the uses of social media. This result agrees with previous study done by Warren (2012) in Malaysia that reported in his study that the parent had good control toward their children in uses of social media. (10) This study revealed that more than two third (76.0%) of study group had fair knowledge in regards to the negative effects of social media in child education this study disagree with previous study done by Liau (2015) in Singapore that reported in his study most of the mother's had good knowledge about the negative effect of social media on the child education. (11) This study clarified that more than half (56.0%) of study group had fair knowledge regarding positive effect toward the child education ,this result agree with previous study done by Valcke (2010 ) in Belgium that reported in his study majority of parent had good knowledge about the positive effect social media on child education . (12) This study revealed that more than two third (78.0%) of study group had fair knowledge toward positive effect of social media on child health this result disagrees with a previous study done byCho, Y, Bae, J (2010) in London that reported in his study most of parent had good knowledge about the positive and negative effect of social media on child health . (13) The present study addressed that more than two third (68.0%) of study group had fair knowledge toward the child sleep this result were similar with previous study done by lees.s(2013) in Korean that reported in his study most of mother's had fair knowledge regard effect of social media on child sleep. ( A study reflect that more than two third (72.0%) of study group had fair knowledge regard negative effect of social media on child relationship, while tow third (68%) of them had fair knowledge regarding positive effect of social media on child relationship, this result agrees with previous study done by Greenfield, PM (2008) in United State hat showed in his study majority of parent had fair knowledge regarding positive and negative effect of social media on child relationship (14) The study reflects that tow third (60.0%) of study group does not see the effect of social media on their children this result were agree with previous study done by McDaniel,(2017)in United States that reported in his study most of does not see the effect of social media on their children. (15) No significant statistical relationship between

Background: Social Medias are forms of electronic communication such as websites for social networking through which users create online communities to share information. Objectives: To assess mothers awareness regarding impact of uses of social media in school age children.: This descriptive cross sectional community based study was conducted during period extended from December 2019 -October 2020in El-matamma locality. Convenience sample was used, data was collected by questionnaire designed by researchers composed of (21) questions, 50 mother were included calculated by Data was analyzed by using SPSS version (21). Results: The study revealed that (76.0%),(56.0%) of study groups had fair knowledge regarding negative and positive effects of social media on children education respectively, (68.0%)of study groups had fair knowledge regarding effects of social media on children sleep. (78.0%),(64.0%) of study groups had fair knowledge regarding negative and positive effects of social media on children health respectively. Conclusion: The study concluded that most of the mothers had fair Napata scientific journal December, 2023 Volume 2 (2) pp 223-232 knowledge regarding positive and negative effects of social media on children education, health, and sleep Recommendations: Enforcement of the concept of good using of social media and reaps positive results for children, encourage mothers to educate themselves and their children about the advantages and disadvantages of social media.

Introduction: The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society. Objectives: To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society. Methods: An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field) Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10. Results: 500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81AE1.43) and the lowest for the Digitalization line (7.18AE1.92). In the Action Lines, the highest score was for Suicide (9.03AE11.5) and the lowest for Elder people (8.04AE1.94). Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040) Image: Introduction: A well-established principle is that informed consent is an obligatory requirement for any medical intervention; a patient's decision-making capacity to consent is a requirement for legally valid consent. Some individuals may be unable to give valid informed consent due to their limited mental capacity. In such cases, laws permit substitute decision-making and involvement of the patient as far as possible (Art.6, Oviedo Convention). National laws of European countries allow persons with mental health problems to be deprived of their liberty and undergo involuntary treatment, namely treatment without a patient's informed consent, in certain circumstances. Procedural safeguards must be secured, and a court must review its lawfulness (FRA, 2012). The legality of involuntary treatment is highly debated by various audiences (CRPD committee, CoE bodies). In Latvia and other countries, the requirement to assess a person's decision-making capacity in the application of involuntary treatment is not required. Objectives: This study was conducted to reveal the role of a person's decision-making capacity to consent to the treatment of mental disorders in cases where involuntary treatment was approved by courts. Methods: A retrospective case law study method was applied. Anonymised decisions of Latvian courts at www.manas.tiesas.lv in cases of involuntary treatment in Latvian adult psychiatric hospitals since 2010 were collected and analysed. The content of decisions concerning persons' decision-making capacity and applicable legal regulations were studied. Results: The case law revealed that the decision-making capacity had not been addressed regularly and in detail. Latvian law does not require an assessment of capacity, and as a result, the courts do also not require any data. Some elements of decision-making abilities, such as the limited ability to comprehend or process information, are mentioned in the decisions of courts. Conclusions: There is a need to address the significance of decision-making capacity in the application of patients' rights law in clinical and legal settings when involuntary treatment is suggested or applied. There is a need to amend the laws justifying the limitations of patients' rights, particularly concerning involuntary treatment. Acknowledgements: This paper has been prepared within the research project "Towards a human rights approach for mental health patients with a limited capacity: A legal, ethical and clinical perspective", No. lzp-2020/1-0397 and the project "Strengthening of the capacity of doctoral studies at the University of Latvia within the framework of the new doctoral model, identification No.8.2.2.0/20/I/006" Disclosure of Interest: None Declared --- EPP0860 Smoking in an Inpatient Psychiatric Unit in Ireland with a "Tobacco Free Campus" policy: the prevalence, the associated factors, the social consequences and what can be done to address this K. Srikumar1 *, A. Adam 1 , F. Sargaison2 and M. O'Grady 1,2 Introduction: Smoking is highly prevalent in patients with mental health disorders and although most literature describes the physical health impact of smoking, there is little which addresses the poverty and social consequences associated with nicotine addiction. In 2022, Ireland's HSE (Health Service Executive) published clinical

consumers, to identify their experiences and perceptions in relation to OJ and focus groups with rehabilitation employees and managers. Data analysis was a multi-staged process using a systematic and inductive procedure. Results: Based on our analysis, the three key themes clarifying the interviewees' experiences with the OJ concept were a) the importance of and barriers for achieving meaningful participation, b) the required resources for implementing OJ, and c) principles for practice. These elements comprise a holistic OJ construct, affording a practical understanding of what a service that implements OJ means. Such a service would use the resources and practices discussed in this study and address meaningful participation as the desired outcome to achieve. Conclusions: Unlike other forms of justice, OJ emphasizes the need for flexible and tailor-made services that address the consumer's changing needs and circumstances. It considers the consumers' role as active rather than passive service recipients. Recently, the fields of health and rehabilitation have increasingly acknowledged the importance and applications of involving consumers. Their genuine involvement would enhance OJ and provide a basis for more accurate assessments and customized interventions.

Introduction Dengue hemorrhagic fever (DHF) is a vector-borne disease carried by female mosquitos that affects nearly 3.97 billion people worldwide, especially in the 128 tropical and subtropical countries at risk [1]. New infections with Dengue virus were estimated in 2013 to be nearly 400 million per year worldwide with various clinical manifestations causing a 3-fold burden of disease occurrence above the estimated burden by the WHO [2,3]. The spread of Dengue virus involves several factors such as climate, socio-economic, and viral evolution [3] and in Indonesia (2017-2018) the incidence rate of DHF reached 78.85 per 100,000 inhabitants, and endemic areas extended to 90.07% of the districts and municipalities [4]. --- Infection with Dengue virus occurs when infected female Aedes aegypti mosquitoes which are the primary vector, (Aedes albopictus acts as a secondary vector) transfer the virus to human blood during feeding [5]. Since there are no Dengue antiviral drugs or an effective prophylactic vaccine available, programs for vector control measures against Dengue virus are a priority [3]. This program aims to reduce the population density of the mosquito vectors. Vector control measures include biological, physical-mechanical, and chemical, as well as community participation [6]. The main indicators of vector control program achievements are a decline of the main Aedes index in residential environments, namely the house index ≤ 5%, as well as decreasing incidence rate and case fatality rate [5]. Unfortunately, people in the Dengue virus endemic areas, including Indonesia, prefer chemical methods of vector control [7]. This practice has caused the emergence of insecticide resistant (mainly pyrethroids and organophosphates) strains of Aedes mosquitos [8][9][10][11]. However, community participation in the physical control of Dengue vectors has not shown optimum results. It was observed in studies in Indonesia during 2017 and 2018 that the House Index was higher than the prophylactic transmission threshold [12,13]. --- DHF in --- Material and Methods --- Study sites This was a cross-sectional survey carried out in 16 subdistricts of the Semarang municipality. The survey covered 37 Public Health Center work-areas, which included 141 of 177 (79.7%) villages in the Semarang municipality. --- Participants and sampling The study population were members of the community from various social-role groups who had interacted with DSWs and their activities. There were 1,018 participants selected according to 12 social-roles, namely head of sub-districts, social welfare staff of sub-districts, head of Public Health Centers, staff of diseases prevention and control of Public Health Centers, head of village, social welfare staff to village, Dengue virus vector observer to village, leader of the Family Welfare Community (FWC) of sub-village, Dengue virus vector observer to sub-village, head of the FWC to neighborhood association, Dengue virus vector observer of neighborhood association and headmasters. Participants from these 12 social roles represented various community groups from all subdistricts in the Semarang municipality. --- Questionnaire design The questionnaire in this study was modified from a previously published questionnaire and was designed to evaluate the existence, role, and performance of the DSWs [16]. This instrument consisted of participant characteristics, evaluation of perception, acceptance, satisfaction, and expectation of the community regarding the DS Ws. --- Data collection A permission letter from Semarang municipality government, and ethical approval from the Ethics Committee of Faculty of Public Health of Universitas Diponegoro Semarang No.22/ EC/FKM/2017 was obtained. This study was conducted from May to June 2017, and informed consent from each participant was given. Before the interview with participants, interview simulations were conducted among enumerators to control the bias of perception. Data from the participants was collected by direct interview, based on a structured questionnaire. --- Statistical analysis Data for each variable were analyzed descriptively using SPSS statistical software Version 15.0 (SPSS Inc., Chicago, IL, USA). --- Results There were 1,018 participants interviewed, and the majority were female (79.37%), with the majority of participants aged between 31 to 59 years (Table 1). There were 12 groups of both formal and non-formal social roles related to the "Dengue control" program (Table 2). The majority of participants thought that DHF cases had decreased in the last 3 years (80.6%), and the perception that there was an increasing rate of Dengue virus vector free residential areas (901.3%). These perceptions matched with an increase in community awareness to problems associated with Dengue virus and participation in the Dengue virus vector monitoring and control activities (Table 3). Almost all participants answered that they understood why DSWs were present (99.2%) and that they played an important role in the community's involvement (98%), and in increasing the attention and participation in "Dengue control" programs. These roles resulted in increasing the perception of Dengue virus vector-free residential areas and reducing DHF The majority of respondents had a good perception of the 7 of key performance indicators of Dengue control measures in Semarang municipality. The existence and activities of the DSWs were well known by the members of the community and were perceived as very good in all 6 evaluated aspects. DSWs = Dengue surveillance workers. There was no significant difference between the respondent role and the expectations of the DSWs empowerment for the years ahead in Semarang municipality. DSWs = Dengue surveillance workers. occurrence in the community. The majority of the participants also answered that the DSWs were needed in the future (Tables 4 and5). Almost all the participants perceived that DSWs had a good knowledge about DHF and understanding of the service areas. The perception of the community was that DSWs also had a mature attitude, were confident, and skillful at implementing their tasks and also always accompanied the community during "Dengue control" program activities. More than 95% of participants answered that DSWs ability was good and were serious in their approach at increasing the motivation of the community, and advocating in the community, and campaigning for the "Dengue control" program. These conditions drive increased attendance of the community to Dengue forums held by the DSWs (Table 6). The majority of participants answered that the community has a good acceptance and satisfaction of the DSWs roles and performance (Table 7). --- Discussion Empowerment of DSWs by GHOSM in the context of Dengue virus control efforts, is a form of policy reform that enhances public health services [15]. This strategic policy resulted in a significant impact on the key performance indicators of the "Dengue control" program. It was perceived by the public to decrease new cases of DHF in the last 3 years and increase the level of community participation in the efforts to control this endemic disease. This finding showed that the majority of survey participants from the community responded positively to this strategic policy. The majority of members of the community in the study perceived that this policy had a positive impact on the key performance indicators of the "Dengue control" program, mainly increasing community attention to and participation in the efforts for control measures of Dengue virus. This finding supports a previous study reporting that changes in the health service system resulted in an increase in community satisfaction with public health services [17]. The strategic policy of GHOSM is in line with the Ministry of Health's policy on the Movement of One House One Larvae Controller. This movement invites the active participation of each family to eradicate breeding places for mosquitoes simultaneously in their respective homes, under the coordination of local community leaders. In this case, DSWs had a strategic role in building effective communication in the community, providing knowledge and vector survey skills, and directly providing support to the communities [18]. In comparison, this current study was more comprehensive than the previous study, which was limited to 1 subdistrict, namely the Tembalang sub-district and was conducted qualitatively with the Head of Tembalang subdistrict, therefore, the results were very locally specific [19]. This current study covered all of the sub-districts and involved participants from 12 social groups in the Semarang --- Conflicts of Interest The authors have no conflicts of interest to declare.

The aim of this study was to assess community participation in Dengue virus control measures, and community satisfaction in the Dengue surveillance workers (DSWs) performance in Semarang municipality after 3 years of empowerment. Methods: A cross-sectional survey involved 1,018 selected participants from 12 groups of social roles in 141 villages in Semarang municipality, Indonesia. A direct interview was performed using a structured questionnaire to evaluate the acceptance, and satisfaction of the community towards the DSWs. The data were analyzed descriptively.The majority of the members of the community considered that the DSWs play an important role in reducing Dengue cases, and vectors of the Dengue virus, as well as increasing the community participation in Dengue control measures. The survey showed that DSWs performance, attitudes, and abilities regarding their main tasks were perceived to be good. Conclusion: Overall, people in Semarang municipality were satisfied with the performance of the DSWs, and considered them important enough to be maintained and strengthened in the future so that Dengue could be controlled. This new policy needs to be disseminated to other regions that may encounter the problems associated with Dengue virus.

and scheduling among nodes in cloud storage. Moreover, it uses intermediate idle nodes in preprocessing and batch processing to avoid starvation and to mitigate unwanted delay. In [5], Huang et al. proposed an intelligent trading method based on Naive Bayes algorithm and AdaBoost algorithm. This method first employs dual clustering to detect transaction patterns, and then uses the discovered trading patterns to predict market trends based on the Naive Bayes algorithm. Finally, the Adaboost algorithm is used to promote the naive Bayes classifier as a robust classifier and compared with the other four existing algorithms. In [6], Huang et al. proposed a CAD system to overcome opacity in new CAD systems. The experimental results show that the proposed system has good performance in the diagnosis of mammary glands and can effectively identify whether it is a benign breast tumor in breast diseases. In [13], Rao et al. proposed an active learning scheme to utilize the labeled and unlabeled images to build the initial Support Vector Machine (SVM) classifier for image retrieving. In [15], Wan et al. proposed the development of a suitable coding framework and provided developers with the right coding skills. In this process, the paper designed a probabilistic expert ranking model, added the regularity of the project as a regularization of the graph to the expert ranking, and added the correlation propagation graph. In [21], Zhang et al. proposed a new feature selection method for data classification that efficiently combines the discriminative capability of features with the ridge regression model. It first uses linear judgement analysis to establish the global structure of training data to help identify discriminative features. And then, the ridge regression model is used to evaluate the feature assurance and discriminant information so as to obtain a representative sparse matrix. Finally a new subset of the selected features is applied to the linear support vector machine for data classification. In [18], Wen et al. proposed a spectral clustering method especially to process the highdimensional data, via first using an affinity matrix leaning method to learn a high-quality affinity matrix from the intrinsic feature space, and then utilizing the local PCA to clip the affinity matrix for solving the intersection problem. Finally, this paper employed a robust clustering method to conduct the clustering tasks directly on the affinity matrix, so that it can overcome the cluster-specification problem and the initialization sensitivity problem. In [16], Wang et al. proposed a type of node similarity, based on the frequency of connections between nodes to describe the changeable relationships between entities over a period. In [14], Sood proposed a new concept of free space fog to collect available free resources from all assigned jobs to eliminate Deadlock. In [10], Liu et al. proposed a new data clustering algorithm based on potentiality model. The algorithm merges sub-clusters using clustering merging criteria to automatically terminate the clustering process. In [9], Li et al. proposed a new problem in dynamic traffic networks. It first considers two dynamic transportation networks, which are the traffic software spatial network and the dynamic public transportation network, and then uses uncertain trajectory data to establish a spatial network of traffic areas. In [19], Xie et al. proposed a method based on information theory to optimize the tag interaction with high efficiency. In order to generate a recommendation list, this paper applies probabilistic matrix decomposition techniques to predict user preferences and overcome level sparsity. It enhances level sparsity by embedding similar user and resource information. In [29], Zhu et al. proposed a unsupervised feature selection method by embedding subspace learning regularization (PCA) into a feature selection framework. In [3], Hu et al. proposed a popular route construction method named GRID based on collective knowledge. The experimental results on two real data sets show that this method is superior to the most advanced methods in terms of efficiency and efficacy. In [2], Gu et al. proposed a strategy to resolve the ambiguity problems in short text categorization. By using Bi-directional Recurrent Neural Networks (Bi-RNN) and linear discriminant analysis (LDA), the proposed method can catch more contextual and latent semantic information for categorization. Apart from that, it uses topic model to enhance the neural network which represents short texts. In [12], Pan et al. uses a multi-scale fully convolutional neural networks for regression based on density maps. It applies regression on the structured proximity space for patches to get larger value, and then uses convolutional regression networks to detect different kinds of cells based on features maps. In [17], Wang et al. tried to apply self-representation of each feature to make the data set sparse, then used Frebenius norm and Locality Preserving Projection (LPP) as regularization term to avoid over-fitting and preserve local relations. In [1], Gao et al. proposed a bin-based attack model to re-identify social individuals in social networks. Besides that, it also proposes the k-anonymity scheme to protect social individuals. Experiments showed that the proposed method is effective. In [11], Menasria et al. concentrated on private information protection of Accelerometerbased activity recognition by leveraging the connection between irrelevant private information and relevant private information. By doing this, it can reduce the usage of the irrelevant information to protect our private information. Experiments illustrate that the proposed method can reduce the leakage of privacy. In [20], Zhang tried to proposes a target-source framework to minimize the total cost by controlling another cost while minimizing one kind of cost scale. Besides, it also proposes a cost-sensitive learning model to help analyze the complex information. Experimental results showed that the proposed method works well on real medical data. --- Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The internet revolution has made information acquisition easy and cheap so that it has been producing massive Web/social data in our real life. The emergence of big social media has lead researchers to study the possibility of their exploitation in order to identify hidden knowledge. However, a huge number of issues appear in obtained big social data [23,24,26,28]. First, there are incomplete social data due to all kinds of reasons, such as security and private information. Second, the structure of social data is different, including structured data (e.g., social Web data), semi-structured data (e.g., XML data) and unstructured data (e.g., social networks). Third, the Web data are often highdimensional. However, current computer techniques can only deal with structured, complete and moderate-sized-dimensional data. Moreover, current computer technologies can only mine the basic structure and are not capable of mining their natural complex structure (or deep structure). Hence, there is a huge gap between existing technologies and the real requirements of actual big social data. In this case, deep mining of big social data (such as data preprocessing, deep pattern discovery, pattern fusion, and outlier/noise detection) stands as an interesting promise to relief such a gap [4,8,22,25,27] . In [7], Komarasamy et al. proposed a multi-phase scheduling method to deal with parallel jobs in hierarchical model. The proposed method includes job preprocessing, prioritization, Xiaofeng Zhu

the 2016/17 nationwide survey to 2,142 NH administrators at NHs that previously responded to our 2009/10 survey, and the response rate was 74% (1,584). From responses, we created index scores for the practice domains of physical environment, staff empowerment, resident-centered care, end-of-life care (a subset of resident-centered care), leadership, and family and community engagement. Indices had good internal consistency, and positive associations between index scores and quality indicators supported the criterion validity of the indices. At 82.6 (of 100), the (weighted) standardized index score for resident-centered care practices was the highest, and 76.2 for end-of-life care practices the next highest. Across all domains, there were higher domain index scores in NHs with higher leadership index scores and in states with Medicaid culture change pay-for-performance. We surveyed Nursing Home Administrators (NHA) from 2,142 nationally-representative long-term care facilities about culture change practices with a response rate (RR)=74% (n=1584) and no evidence of non-response bias. We first verified contact information for the NHA. Each NHA was then mailed a questionnaire, self-addressed return envelope, cover letter with a user-name and password for web-response if preferred, a letter of support from the two major nursing home associations, and offer of a $25 gift card for participation. Telephone/e-mail/mail follow-up contacts were initiated with non-respondents two weeks after the initial mailing and tailored thereafter. During follow-up, a telephone option was also offered. Of the completed surveys, 55.9% were completed by web, 39.6% by mail, and 4.5% by telephone. Up to 20 follow-up contacts were made to each facility. Challenges included NHA turnover, time needed for data collection (17 months), and cost ($170 per case; $240 per completed interview). We collected survey data from 1565 U.S. nursing homes (NHs) in 2009/10 and 2016/17 on three indexes aligned with NH culture change. Among NHs without high baseline scores (therefore having potential to improve), 49% improved over time in their physical score, 40% in staff empowerment, and 60% in resident-centered care. NHs in states with payment incentives for performance (p4p) at baseline were significantly more likely to improve in physical and staff empowerment scores compared to NHs in non-p4p states. NHs with higher proportions of black residents and residents with Medicaid were significantly less likely to improve in physical scores. Other NH and market characteristics were not associated with improvement. Among facilities with low index scores at Time 1, improved staff empowerment scores were associated with lower aide turnover and fewer health and quality of life deficiencies. Improved physical environment and resident scores were not significantly associated with these facility-level outcomes. Specialty palliative care (PC) provides services similar to hospice without the need for terminal diagnosis. We used 2016/2017 survey data for 1,362 NHs to evaluate whether differences in PC consult use is associated with end-of-life (EOL) specific culture change practices, and assessed the relationship between EOL care and outcomes. EOL care was measured using six questions related to care for dying residents. NHs were categorized as offering: no PC consults, only external consults, or any internal consults. We used logistic regression to evaluate the relationship between consult type and EOL score above the median, controlling for NH structure, staffing, and case-mix. Compared to NHs with no PC consults, the odds of having an EOL score above the median were 1.71 (95%CI: 1.21,2.13) for NHs with only external and 2.19 (95%CI: 1.55,3.27) for NHs with any internal consults. Better EOL scores were associated with increased hospice use, but not reduced hospitalizations. --- SURVEYING NURSING HOME LEADERSHIP: SUCCESSES AND CHALLENGES --- CHANGE IN CULTURE --- USE OF PALLIATIVE CARE CONSULTS AND END-OF-LIFE CULTURE CHANGE PRACTICES --- SESSION 1505 (SYMPOSIUM) SUSTAIN: IMPROVING INTEGRATED CARE DELIVERY FOR OLDER PEOPLE WITH COMPLEX CARE NEEDS ACROSS EUROPE Chair: S.R. de Bruin, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands, de Bilt, Utrecht Discussant: R. Schreiber, Fallon Health/University of Massachusetts, Worcester, Massachusetts Due to population ageing, health and social care systems face the challenge of providing care and support to an increasing number of older adults. Numerous integrated care initiatives have been rolled out in a range of settings and contexts, in order to improve care and support for frail older adults living at home. Despite this rich and varied

Previous research suggests cultural variations in caregivers' perceptions of caring for people with dementia. The purpose of this study was to describe the caregiving experience in a subset of African Americans from a previous study (N=14). Measures included the Zarit Burden Interview and Finding Meaning through Caregiving (FMCG). Content analysis was performed on narrative comments. Caregivers were primarily female (64%), provided care for people with dementia for > 60 months (64%) and had a mean age of 74.6 years. Caregivers reported low burden (M= 31.6) and scored high on the FMCG scale (Mean=177.4). Findings from FMCG subscales of Provisional Meaning, Ultimate Meaning, and Loss/Powerlessness have potential to elucidate cultural variations in African American's response to caregiving. Narrative comments were categorized into unmet needs, benefits, and challenges.

INTRODUCTION In order to improve the quality of human resources, it is necessary to expand the rights, obligations, positions, capacities, roles, opportunities, independence, and mental and spiritual resilience of women (Hubeis, 2010). Strong determination with the ability they have to be able to help the household makes women complete the work that is their responsibility. This strong determination is shown by a multitasking attitude, namely women are able to do several jobs at the same time. This multitasking attitude is an advantage of women compared to men, but this attitude also causes the results of work done by women to be not optimal. The results of the work that are not optimal are caused because women do their work not focused and in a hurry. --- REFERENSI

Prosperity provides opportunities for households to achieve economic resilience. Economic resilience is a condition and ability to recover and rise from problems in economic aspects. The welfare condition of women in freelance daily labor households in Tiyingtali Village has not been able to reflect the economic resilience of households. This research reveals the motivation and role of women in Tiyingtali Village who work as casual daily laborers in the household to achieve prosperity and economic resilience. By using a qualitative approach, these two problems become a complex thing to discuss. Through qualitative analysis with stages: 1) data collection; 2) Data reduction; 3) Presentation of data; 4) Conclusion drawing/Verification, the welfare and economic resilience problems of women's freelance daily laborer households can be explained. To ensure the validity of the research data obtained, triangulation of sources is then carried out. Research findings show that "Gunakaya" (fighting spirit to have wealth alone or with a husband) is a motivation. This motivation leads to the condition of a prosperous family. Not having savings for supplies, makes for a lack of household economic resilience. The inability of freelance daily working women to set aside their income makes it an obstacle to realizing household economic resilience. Efforts to fulfill the household economy of husband and wife must help each other to create economic resilience.

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, self-transcendence, and health during prolonged periods of isolation and stress for the older population. Abstract citation ID: igad104.0396 --- THE ROLE OF WISDOM IN ADAPTING TO LATE-LIFE SPOUSAL LOSS Kiana Cogdill-Richardson, and Susan Bluck, University of Florida, Gainesville, Florida, United States Death of one's spouse is normative but one of life's most challenging events (Carr et al., 2001). Wisdom involves compassion, tolerance for uncertainty and reflection, so may be particularly useful in dealing with spousal loss. Past research has related personal wisdom to well-being and life satisfaction in general (Ardelt, 2019). Almost no research, however, has examined wisdom as a resource in the context of bereavement. We (1) expected that higher wisdom would predict better grief adaptation in widowed older adults and, (2) explored whether wisdom effects might be moderated by older adults' physical status. Participants (N = 54, Mage = 81; SD = 7.57, 62.3% female) completed the Brief Wisdom Screening Scale (Glück et al., 2013) and two assessments of grief adaptation: Inventory of Complicated Grief (Prigerson et al., 1995) and Integration of Stressful Life Experiences (Holland et al., 2011). Hierarchical regression, F(2, 51) = 4.25, p <.05, showed greater wisdom, β = -.27, t(52) = -2.061, p < .05 and higher physical functioning (β = -.27) both predict lower symptoms of complicated grief, with no moderation. A second regression, F(2,51) = 4.44, p < .055, showed a similar trend with greater wisdom associated with better integration of loss, β = .46, t(52) = 1.96, p = .055. Though preliminary, these findings suggest wisdom may serve as a resource for individuals facing loss in later life. Results are discussed in terms of theoretical models (Glück & Bluck, 2013) identifying reciprocal relations between wisdom development and life challenges. Abstract citation ID: igad104.0397 --- DECLINING HEALTH AND SENSE OF MASTERY CAN EXPLAIN THE INVERSE RELATION BETWEEN OLDER AGE AND WISDOM Monika Ardelt 1 , and Dilip Jeste 2 , 1. University of Florida,Gainesville,Florida,United States,2. University of California,San Diego,San Diego,California,United States Previous research found an inverse U-shaped association between age and three-dimensional wisdom with the apex in late midlife. What might explain the negative relation between age and wisdom during the later years of life? We investigated the impact of physical health and mastery, using data from the Successful AGing Evaluation (SAGE) study of 976 adults between the ages of 51 and 99 years (M = 77.23, SD = 12.18). Physical health tends to decline with advancing years and, therefore, might reduce older adults' sense of mastery and control over their life. Ill health and feelings of diminished control, in turn, might lead older adults to focus on improving their health and regaining control and reduce their desire to comprehend the deeper truth about life (cognitive wisdom dimension), look at things from different perspectives (reflective wisdom dimension), and care about others (compassionate wisdom dimension). As expected, results showed that age correlated negatively with subjective health, wisdom, and mastery, while health, wisdom, and mastery were positively correlated. In multivariate regression analyses, age and ill health remained negatively related to mastery even after controlling for education, gender, and race and the positive association with wisdom. By contrast, the negative relations of age and ill health on wisdom became non-significant after mastery was entered into the model. If wisdom declines with age in the later years of life due to ill health that results in a perceived loss of mastery, enabling older adults to maintain their sense of control might offset this decline. Advocacy and scholarship grounded in the productive aging paradigm have evolved over 40 years. From an agedrain to an age-as-asset perspective, productive aging scholars have focused on programs and policies to optimize the vital engagement of older people in paid and unpaid work (working, volunteering, caregiving). I have contributed to this body of work and I have evolved with it. I have changed what I study, how I think about later life, and what I think is important for gerontologists to consider. In this presentation, I will review the development of productive aging literature, including tensions that have existed in the scholarship. Themes of ageism and diversity, equity and inclusion have gained prominence in this work; and I will suggest future directions. I will reflect on how my own aging and experiences have shaped my thinking on productive aging. --- SESSION 2000 (AWARD LECTURE) --- SESSION 2005 (SYMPOSIUM) Abstract citation ID: igad104.0400 --- FAMILY FUNCTIONING: BRIDGING THE RELATION BETWEEN GRANDFAMILY HEALTH AND WELL-BEING Chair: Nancy Mendoza Discussant: Youjung Lee In research, it is important to utilize theories to ask and answer questions about a specific phenomenon. In

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 The aging of the world's population is a global phenomenon with extensive economic and social consequences [1], and the poor understanding of elderly life under changing economic and social norms has led to a weak care and support of them [2]. The rapid increase in the elderly population has engendered public concern about issues associated, such as successful aging and social factors [3]. Factors that affect social engagement in the elderly are various, including physical function, mental function, and socioeconomic issues [4]. Despite growing concern with the elderly population, little attention has focused on their mental health [5]. Depression and cognitive impairment (CI) are two common mental health problems among elderly [6]. Detecting these two health problems in medical inpatients is important as they are associated with limitations in physical and social functioning [7][8][9]. Also, the recognition of depression and CI is of importance because they may respond to treatment, thereby reducing some of the clinical complications in management of elderly [10]. However, these two conditions are often underdiagnosed in medical settings or simply dismissed as inevitable consequences of aging [11,12]. One of the main features of the Egyptian population over the last few decades is the gradual increase in the number of older people [13]. However, there has been a dearth of studies on geriatric mental health problems in Egypt. So, this work was constructed in order to screen for the prevalence of depressive symptoms and CI among hospitalized elderly in Internal Medicine wards, Zagazig University hospital, Zagazig, Egypt, and to study the associations between sociodemographic profile of patients and these two mental health problems. --- Methods This was a cross-sectional study conducted in the Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. The duration of this study was one year from April 2012 to March 2013. Two hundreds, randomly selected, elderly (age ≥ 65 years) medical inpatients were included. We first looked at medical charts and decided not to include patients with emergency conditions, history of mental illness, psychotropic drug intake, and communication problems, for fear of obtaining inaccurate results. Twenty-two patients were approached for consent but refused or were unable to consent for various reasons (CI, illness, etc.) and were not included among the 200 participants. All the 200 included participants gave informed consent and the study had approval from local ethical committee. A comprehensive geriatric assessment was done for each participant including full history intake, complete clinical examination, and assessment of sociodemographic characteristics through personal interviews with the patients and family members. Sociodemographic variables included inquiry about age, gender, residency, level of education, income, marital status, presence of offspring, and doing exercises. Screening for depression was done using the 15-items Geriatric Depression Scale (GDS) which has shown good sensitivity and specificity for predicting depression in different settings. It consists of 15 questions in a yes/no format, with total scores that ranged from 0 to 15 [14]. A cutoff value of ≥6 was used to predict depression and to compare the data with other studies. Assessment of cognition was done using the Mini-Mental State Examination (MMSE) Scale which is one of the most commonly used global cognitive screening measures because it is quick and easy to administer. It includes specific questions related to attention, orientation, memory, calculation, and language. The test score is based on 30 total points, and CI is indicated by a score of ≤23 [15]. --- Statistical Analysis. Statistical package for social sciences (SPSS) version 10 was used for data entry and analysis. Descriptive statistics were used to present distribution of study population. Analysis of variance (ANOVA) and Chi square (𝜒 2 ) were used to examine significant associations between variables. A 𝑃 value < 0.05 was considered statistically significant. --- Results The study included 200 participants (Table 1), 112 males (56%) and 88 females (44%). Most of the participants came from rural areas (𝑛 = 168, 84%) and 168 (84%) were illiterate. According to age, 164 (82%) had ages that ranged from 65 to <75 years (young old), 28 (14%) had ages that ranged from 75 to <85 years, and 8 (4%) were above 85 years old. Financially, incomes did not suffice 112 (56%) of the participants. Interestingly, no participant was performing physical exercises. Table 2 shows the prevalence of depressive symptoms and CI as indicated by the GDS and MMSE, respectively. More than two-thirds (𝑛 = 144, 72%) of the participants were screened positive for depressive symptoms, and nearly onethird (𝑛 = 60, 30%) had cognitive impairment. There was significant association between MMSE scores and age, while GDS scores insignificantly associated with age. Meanwhile, GDS scores were significantly associated with income, while MMSE scores were not (Table 3). No significant association was noticed between either GDS or MMSE scores and both gender, education, residence, and marital status. Approximately 40 (28.5%) of people that screened positive for depressive symptoms also had evidence of CI and they represented two-thirds of total patients with CI. --- Discussion Data in this cross-sectional study are not general epidemiologic data but rather data on hospitalized inpatients. The prevalence of depressive symptoms among 200 elderly medical inpatients was 72% according to GDS. Prevalence rates of depression showed wide variability in studies that assessed it among elderly [16]. These differences may be due to the differences between communities. Also, these differences can be explained by the allocation of subjects, variety of instruments, staff (psychiatrics and nonpsychiatrics), and type of sample. The high rate of prevalence of depressive symptoms noticed in this study was also noticed in some Egyptian studies. Hamza et al. [17] reported a rate of depression of 64% among 100 elderly patients recruited from the inpatient unit, Ain Shams University hospitals, a result that is near to ours. On the other hand, Shehata et al. [18] reported a prevalence rate of depression of 31.4% among 86 elderly subjects in suburban community in Egypt, while Eman Mohamed and Mohamed Abd-Elhamid [13] found a prevalence of 25.3% among 466 elderly subjects attending geriatric clubs in Assiut city, Egypt. The higher rates of depressive symptoms observed in our study and that of Hamza et al. [17] may be explained that the participant elderly in both studies were hospitalized patients, while the participants in the other two studies [13,18] were free-living patients. Higher rates of depression were observed in hospitalized elderly versus community-dwelling elderly [5]. Adding to the evidence of this observation, Hadi et al. [19] found that 53% of their cases (hospitalized inpatients in Internal and Surgical wards) were borderline cases of depression and 42% were probable cases of depression. Also, a very recent study in Alexandria reported higher prevalence of depression among hospitalized elderly (79%) compared to institutionalized (36%) and community-dwelling (24%) elderly [20]. Higher rates of depression among hospitalized inpatients may be explained that the patients are sick and may be depressed by being ill, being away from their families, being unable to work, and facing a risk of death. In this study, the prevalence rate of cognitive impairment was 30%, a result that is near to that obtained by Hamza et al. [17] who also used the MMSE scale. Shehata et al. [18] reported also a near prevalence rate (26.7%). On the other hand, Shawky Khater and Fawzy Abouelezz [21] identified CI in 38.3% of their 120 elderly living in elderly homes. Also, Joray et al. [22] reported a prevalence rate of 32% out of 401 elderly medical inpatients, and Buurman et al. [23] reported high prevalence rate of CI (40%) among acutely hospitalized older patients. As in case of depression, prevalence rates of cognitive impairment also vary in different studies all over the world which may be due to the same causes as in case of depression. In this study, significant association was noticed between depressive symptoms and low income, while no significant association was noticed between depressive symptoms and other sociodemographic variables. Various associations between depression and sociodemographic variables were noticed in various studies. Hamza et al. [17] did not notice any significant association between depression and sociodemographic variables, while Sidik et al. [1] found significant association with income (as in our study). Also, Shehata et al. [18] found significant association with gender only, while Hadi et al. [19] found significant associations with age and education. This variation in the associations of depression with sociodemographic variables may be due to the same causes of variation in prevalence rates mentioned earlier. As regards cognitive impairment associations in this study, significant association was noticed only with age, a result that is similar to that obtained by Ortiz et al. [16]. Also, Chen et al. [24] found that cognitive changes in hospitalized elderly were predicted by age. It is worthy to note that different studies reported contradictory associations between CI and sociodemographic variables. Sidik et al. [1] found significant association between CI and living alone, while Ortiz et al. [16] reported the reverse. Also, while we found insignificant association with educational level, both Sidik et al. [1] and Ortiz et al. [16] found significant association between CI and illiteracy. A possible limitation to this study is the high prevalence of illiteracy (84%) and the lack of distinction between levels of educational attainment which might affect MMSE scores. Although Dimitrov et al. [25] found in a Bulgarian population that lower education was associated with poorer MMSE performance but not with higher prevalence of dementia [25]; it might be better to use a different measure of cognitive function in future studies. The differences between this study and studies from elsewhere in the associations between different mental health problems and sociodemographic variables suggest that some of these associations may depend on cultural context. It is also worthy to note that no participant in this study was performing any physical exercise, and whether there is a relation between exercise and mental health requires future studies to elucidate. --- Conclusions and Recommendations In this study, mental health problems, namely, depressive symptoms and cognitive impairment, were highly prevalent (72% and 30%, resp.) among elderly medical inpatients. They were also significantly associated with some sociodemographic variables (low income and old age, resp.). Psychosocial intervention, counseling, and psychiatric consultation are needed for inpatients whose screening results were positive. Our findings may be an alarm for health service authorities to increase their awareness of these social and mental health problems. It is also important for physicians and staffs Current Gerontology and Geriatrics Research concerned with the wellbeing of elderly subjects to recognize the impact of social and mental health dimensions. Our findings may be used as a baseline for larger in-depth studies to identify factors associated with these problems and to develop community-based health programs that screen for, and accurately deal with, social and mental dimensions.

Background. Depression and cognitive impairment are two common mental and public health problems especially among elderly. In this study, we determined the prevalence of these problems and their associations with sociodemographic factors among hospitalized elderly in Egypt. To achieve this, 200 elderly medical inpatients were included in this cross-sectional study. Methods. Comprehensive geriatric assessment was done for every participant. Sociodemographic variables were assessed by interviews with patients and their family members. Depressive symptoms were screened for by the 15-item Geriatric Depression Scale (GDS), and the presence of depressive symptoms was defined as a GDS score of ≥6. Cognitive impairment was assessed by the Mini-Mental State Examination (MMSE) Scale, and cognitive impairment was defined as a MMSE score of ≤23 out of a total score of 30. Results. The prevalence of both depressive symptoms and cognitive impairment was 72% and 30%, respectively. Significant associations were noticed between each of depressive symptoms and cognitive impairment, and low income and advancing age (𝑃 < 0.01), respectively. Other associations were insignificant. Conclusions. The findings of this study may be an alarm for health authorities and staffs involved in elderly care to increase their awareness of social and mental health problems among the elderly.

The article by Spillane et al 1 awakened my memory of this reflection, shared by an Alaska Native patient in a tribal residential treatment program with which I work. His words acknowledged the widespread consumption of alcohol in many of these communities, its interface with personal identity, the acceptance of alcoholism as an inevitable part of life, and the denial of its harmful consequences, apparent as they may be. Tribes have made remarkable progress in reducing the stigma surrounding addiction in their communities and in developing prevention as well as treatment programs. There are bright lights of success in curbing the nature, extent, and consequences of alcohol use and dependence. Yet, as the trends described by Spillane et al 1 underscore, alcohol-induced mortality in general continues to rise and heralds many battles still to be fought in Native communities. A major strength of the article by Spillane et al 1 is the location of these trends within the broader national landscape, not just in comparison with white individuals as the primary reference group, which is typically the case. In this regard, Spillane et al 1 report that in 2016, the age-standardized rates of alcohol-induced deaths were highest among American Indian and Alaska Native (AIAN) men and women, substantially greater than those among their counterparts in the other major racial/ ethnic populations. Moreover, these rates increased steadily and significantly for both sexes during the 17-year period of observation. This increase among AIAN individuals stands in sharp contrast to a significant decrease among black individuals, little or no change among Latino individuals, and a general but less significant increase among white individuals. Consistent with the early onset and more prodigious consumption of alcohol among AIAN individuals, their peak mortality occurred earlier (ie, ages 45-59 years) compared with all other groups (ie, ages 55-64 years). Lastly, the rates of alcohol-induced deaths tended in general to be highest in the western United States; most AIAN individuals live west of the Mississippi River. By placing these observations among the population at large as well as other subgroups at risk, the authors depart from the all too common practice of singling out AIAN individuals and, thereby, reduce the likelihood of further stigmatizing the latter's particular struggle with alcohol use and dependence. The findings justify the authors' call to arms to address alcohol-related morbidity and mortality of this long-recognized yet growing public health crisis among Native people and other segments of the US population. Spillane et al 1 appropriately acknowledge several limitations of their work and the ensuing results. Those not mentioned are worth further consideration in this instance and by others as they pursue similar lines of inquiry. Early in the article, the authors underscore the challenge of accounting for racial misclassification in the death certificates used to enumerate alcohol-induced deaths. However, they fail to mention the implications of this very likely and potentially substantial shortcoming for the findings and the confidence readers can place in them. Espey et al 2 -and many other investigators-emphasize this persistent problem, which bears repeating. Because the usual implication of racial misclassification in the case of AIAN individuals is to underestimate the condition of interest, the high reported rates of alcohol-induced deaths render the observed rates even more concerning. --- + Related article + Audio Author affiliations and article information are listed at the end of this article. It also is important to acknowledge that more than 72% of AIAN individuals live in urban and suburban areas 3 ; the article by Spillane et al 1 focuses largely on rural, reservation-dwelling Native people. Caution is in order about generalizing these findings to all AIAN individuals, when, in fact, they do not speak to nearly three-quarters of this population. A related concern revolves around the manner in which we estimate trends for small populations and then extrapolate those trends to national levels for comparison with other, larger subgroups. 4 With respect to rurality, Spillane et al 1 operationalize residence in terms of Purchased Referred Care, a common convention that other studies characterize as Contract Health Service Delivery Areas or Tribal Service Delivery Area counties. Careful attention to the strengths and weakness of these decisions is in order. Regional variation is extremely important, given that social determinants of health differ geographically in terms of poverty level, health care access, and other factors. 5 For example, the highest death rates for a wide range of health conditions are evident in Alaskan and Northern and Southern Plains Contract Health Service Delivery Area counties, which reflect such differences. 6 studies for the general population (ie, 53%-88%). 7 However, of those who completed detoxification, 36% subsequently accepted referral to and 21% actually entered into alcohol use and dependence treatment programs 7 ; these rates are substantially lower than those among other populations. --- Open Ongoing work among another detoxification program in a different region of Alaska revealed that, during a 5-year period, less than 1% of more than 1100 unique, largely AIAN participants in a medical detoxification program successfully transitioned to alcohol use and dependence treatment within 1 year of discharge (S.M.M., unpublished data, 2019). These findings imply a revolving door of admissions to detoxification that accomplishes little with respect to addressing the needs of those who experience the consequences of alcohol use and dependence, notably the increased morbidities that heighten their risk of death. The availability of all the treatment programs in the world holds little hope of making a difference if we cannot successfully support the transition to appropriate care for those most in need. This challenge precedes others, including whether the options most likely adopted by AIAN communities offer the best, most well-informed, and most effective treatments. 8 As Spillane et al 1 note, alcohol-induced deaths are the tip of the iceberg. Alcohol-related deaths-notably suicide, motor vehicle collisions, drowning, and homicide-remain high among AIAN individuals and continue to rise. Combined, they underscore the urgency of the authors' call to action. Recent concerns about the opioid epidemic sweeping through AIAN populations are well founded and demand immediate attention. However, attendant shifts in funding and programming emphases threaten to overshadow the continued, growing crisis of alcohol use and dependence in this population. We forget this peril at great risk to the future of Native peoples.

Alcohol was a way of life for me, my family, my friends, my community. I used to think being Indian was about drinking. That I couldn't stop because I was Indian… and if I did, I would no longer be Indian. The bad things about being a drunk were all around me-liver disease, domestic violence, car accidents, suicide, PTSD [posttraumatic stress disorder]. But I never really thought about dying. Drinking was what I and others just did.

Introduction Evidence suggests that social support is protective for both mortality and morbidity [1,2]. However, both the definition and measurement of social support are prone to considerable heterogeneity [1]. In prior work, we have demonstrated that higher social support was associated with lower mortality; however, this relationship was not apparent in older adults who were unhealthy [3]. Functional ability or disability has been identified as an indicator of overall health status among older adults. High levels of social support and engagement may in fact help sustain good health and functional ability [4,5] but findings have been inconsistent. For example, recent studies have reported both a positive association between social support and everyday functioning [6] and no relationship between social support and limitations in either activities of daily living (ADLs) or instrumental activities of daily living (IADLs) [7,8]. Social relationships change with age as older adults modify their social networks to maintain optimal support in the face of limitations such as physical declines [9]. The size of social networks may be less influential on functional ability than the subjective relevance of support offered. The aim of this analysis, therefore, was to explore the effect of social network size and subjective social support on subsequent disability in a group of community-dwelling older women and men. --- Methods Data were obtained from the Men, Women and Ageing (MWA) project, which incorporates data from two population-based longitudinal studies that began in 1996: the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH) and the Perth Health in Men Study (HIMS). Detailed methods for both studies have been described elsewhere [10,11]. The human research ethics committees of the University of Newcastle and the University of Queensland approved the research protocol for the Australian Longitudinal Study on Women's Health (ALSWH). The Health in Men Study (HIMS) research protocol was approved by the ethics committee of the University of Western Australia. Baseline and follow-up data were drawn from the second (1999) and fifth (2008) ALSWH surveys and the second (2001) and third (2008) HIMS surveys, respectively. At baseline, participants in HIMS were aged 69-87 years and ALSWH participants were aged 73-78 years. Additionally, HIMS participants live in an urban area (Perth, Western Australia), whereas ALSWH participants are a national sample including regional and rural areas. To increase consistency, the current analyses were restricted to participants with valid data for both baseline and follow-up, who resided in urban areas and were aged between 73 and 78 years at baseline. The final sample included 2,013 older women (baseline mean age = 75.19, SD = 1.23) and 680 older men (baseline mean age = 76.36, SD = 1.08). --- Baseline variables Social support was measured by an abbreviated version of the Duke Social Support Index (DSSI) [12]. The two subscales of the DSSI measure number of social interactions ('network') and subjective social support ('satisfaction'). Scores for the network subscale ranged from 0 to 21, with higher scores indicating more social contacts. Satisfaction scores ranged from 6 to 18 with higher scores indicative of greater satisfaction. The satisfaction scores were positively skewed, so the median score of 17 was used to dichotomise the variable so that ≥17 was categorised as satisfied, and <17 as not satisfied. Participants reported if they had ever been diagnosed (yes/no) with any of the following chronic medical conditions: arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, stroke, heart disease, hypertension and diabetes mellitus. --- Outcome variable Disability at follow-up was assessed by asking participants 'In the last month have you had any difficulty (for example needing to take extra time, changing the activity or using a device to help you) in completing any of these activities?' Responses were scored as 'no difficulty = 0', 'some or major difficulty = 1' or 'unable to do = 2'. The ADLs included grooming, eating, bathing or taking a shower, dressing upper body, dressing lower body, getting up from a chair, walking inside the house and using the toilet; the IADLs included shopping for personal items or groceries, doing light housework (e.g. washing up), doing heavy housework (e.g. vacuuming), managing money, preparing meals, taking medications, using the telephone, and doing leisure activities or hobbies. The questions and response options were informed by Gill et al. [13] and the list of activities was derived from the Katz Index of Independence in ADL [14]. Summed scores of the ADLs and IADLs ranged from 0 to 16 with higher scores indicative of greater disability. The majority of participants scored 0 and 1, therefore, the summed ADLs and IADLs scores were converted into the ordinal categories of '0', '1' or '>1'. --- Statistical analyses Ordinal logistic regression was conducted to examine whether the social network size and satisfaction predicted subsequent difficulties in ADLs or IADLs. Separate analyses were conducted in women and men. A P < 0.05 level was chosen for significance. To control for potential confounding of existing morbidity, the regression model adjusted for chronic conditions at baseline. --- Results Baseline and follow-up characteristics of the current sample are presented in Table 1. Women reported a higher prevalence of arthritis, osteoporosis, asthma, heart disease and hypertension. Men reported a higher prevalence of stroke and diabetes mellitus. Women had a significantly larger network size, and were marginally more likely to be satisfied with their social support. The majority of both women and men scored 0 in ADLs. Women experienced higher levels of disability associated with IADLs than men. Odds ratios (ORs) for subsequent ADLs and IADL status associated with baseline social network size and satisfaction are shown in Table 2. Overall, the social network size was not associated with subsequent disability in either women or men. A small association was observed in women, with larger network size associated with lower odds of having difficulties with IADLs in the adjusted model [OR: 0.93, 95% confidence interval (CI) 0.86-0.99]. In contrast, lack of satisfaction with social support was more strongly associated with subsequent disability, with lower satisfaction associated with greater difficulties in ADLs and IADLs. This result was apparent in both women and men, after adjusting for baseline morbidity. In the unadjusted model the association between satisfaction and ADLs in men (OR: 1.34, CI: 0.92-1.96) did not reach statistical significance, but this is likely to be due to insufficient power as only a very small number (n = 17) of older men scored >1 in ADLs. --- Discussion In this community sample of older women and men, our findings demonstrate that aspects of social support are associated with a lower risk of subsequent disability in both older men and women, after controlling for the presence of chronic conditions. Importantly, it was not the number of interactions with a social network, but subjective satisfaction with the support provided, that was most highly related to a lower risk of subsequent disability. This finding is consistent with previous research suggesting that functional disability is most closely associated with lower subjective social support [4,5]. The social networks of older adults change over time and generally decline in size with advancing age [15]. This may be due to the loss of members of the networks to illness and death, the inability to physically maintain contact or decreased motivation related to perception of life-time remaining [16]. Social networks are affected by gender with older women reporting larger networks and more social engagement than men [17]. The women in this study had on average larger networks than the men, and the size of these networks was associated with less difficulty in performing IADLs. However, the strongest findings of this study show that, for both women and men, the perception of satisfaction with social support was the more important predictor of subsequent disability. This is consistent with the socioemotional selectivity theory which identifies older adults as active participants in regulating their social environment, particularly utilising social selection to maintain well-being [9,16]. A limitation of this study is that we were unable to measure ADLs and IADLs at baseline, thus it was not possible to explicate a clear causal pathway. It is possible that reverse causality may explain our findings in that those men and women who were mildly disabled at baseline were unable to maintain the level of social contact that they perceive as optimal. However, we did control for a number of baseline chronic conditions which could be expected to affect physical functioning in late adulthood. Difficulties with household tasks and mobility (IADLs) represent less severe disability than difficulty with self-care tasks (ADLs). As would be expected in a group of community-dwelling older men and women, most were able to manage the more personal self-care tasks represented by ADLs, so our results may not generalise to older adults with greater functional disability. A particular strength of our study is our reliance on a measure of multiple aspects of social support that has been well-validated among older adults. Our results suggest that the provision of social support is insufficient to limit subsequent disability: support provided must be subjectively perceived to be relevant and adequate. --- Key points • Women in this study had more chronic conditions and larger social networks at baseline than men. • Women's larger social networks were associated with less difficulty performing IADLs.

Background: high levels of social support and engagement may help sustain good health and functional ability. However, the definition of social support in previous research has been inconsistent and findings are mixed. The aim of this analysis was to explore the effect of two aspects of social support on subsequent disability in a group of community dwelling older women and men. Methods: data were drawn from two concurrent prospective observational cohort studies of community-based older Australian women (N = 2,013) and men (N = 680). Baseline and follow-up data were drawn from the second (1999) and fifth (2008) surveys of the women and the second (2001) and third (2008) surveys of the men. At baseline, social support was measured by the two subscales (social network and subjective support) of the Duke Social Support Index (DSSI). The outcome measure was Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Results: overall, social network size was not associated with subsequent disability in either women or men. After adjusting for health status at baseline, lack of satisfaction with social support was associated with greater difficulties in ADLs and IADLs for both women and men. Conclusions: our results suggest that the provision of social support is insufficient to limit subsequent disability: support provided must be subjectively perceived to be relevant and adequate.

INTRODUCTION In this era of globalisation and liberalisation, where all the countries of the world have come closer to each other, new dimensions of development are developing. At the same time, much attention has not been paid to the status of women in this period of development, due to which there has not been any significant improvement in the status of women. Therefore, today efforts are being made not only for the empowerment of women but also to include women in the mainstream of development all over the world at all levels of economic, social, and political development. By Tanima Banerjee: "It is impossible to think of the welfare of the world until the condition of women is improved. Just as it is impossible for a bird to fly with only one wing". Similarly, no country can be developed without improving the status of women. "Woman is the companion of man, gifted with equal mental capacities. She has the right to participate in the minute details of man's activities, and she has the same right to freedom and liberty as he does. She is entitled to a supreme place in her own sphere of activity as man is in his." Mahatma Gandhi Gender equality is considered a fundamental aspect of modern democratic governance and political participation, indicating that both men and women have equal opportunities and rights to participate in political action. Despite this, exercising these rights has been more challenging for women. In the Constitution of India, the rights of women include equality, freedom from discrimination, dignity, and various laws governing their rights. Further, it allows for making special provisions in favour of children and women. Despite giving equal status to women and men in the Indian Constitution, the social, political, and economic role of women in Indian society is considered negligible. Due to patriarchy in society, the self-sufficient image of women never came to the fore. His abilities and leadership have always been viewed with suspicion. This is the reason that today women are counted among the weaker sections of society, and even after getting equal social, political, and economic opportunities, there is no improvement in their condition, nor is much attention paid to their empowerment. --- REVIEWS OF LITERATURE India is a country of villages, and most of its population lives in villages. In the words of Brajraj Chauhan, "7 out of 8 people in India live in villages, while in other countries, half or more people live in cities. The main feature of the Indian rural community is the Gramme Panchayat. The Gramme Panchayat is such an institution through which the internal and external threats of the rural community are dealt with. Panchayati Raj is a system of decentralising power. In this system, the common man has to participate in the formulation and implementation of welfare schemes at the village level. Prime Minister Manmohan Singh said in the National Conference organised on the achievements of 15 years of the Panchayati Raj system in the capital Delhi and on the issues of making local democracy more empowered, "The biggest success of Panchayati Raj is that it has done political empowerment of women." "Panchayats were completely independent institutions. The New Panchayati Raj was formed in independent India against the background of Panchayati tradition. To make Gandhiji's dream come true, Panchayats were given a place in the new constitution implemented in independent India in 1950 AD. Mahatma Gandhi had envisioned the Panchayat Raj system before the country's independence. Evelyn Wood (1964), Parvatham (1964), JR Reddy (1967), MN Srinivasan (1976), Indra Awasthi (1982), Rekha Bisht (1998), Shakuntala Narasimhan (1999), Sumanalatha (2002), Brajmohan Rawat (2004), Dhan Singh Rawat (2010), Reena Arya (2011), Mamta Mehra (2014), Shyam Sunder Prasad (2016), and Semwal (2018) have analysed the number of women members, caste composition, education, Has rendered his research findings on information technology, communication, political activism and awareness, gender equality, and women's empowerment. --- Objective:  To study the reservation of women in Panchayati Raj Act 73.  To examine the participation of women in the political system. The 73rd Constitutional Amendment is a revolutionary step taken in the direction of providing revival to the dying Panchayati Raj Institutions. Through the new amendment, the three-tier Panchayat Raj system will be strong, empowered, and self-governing, and it will have such powers, authority, and financial resources that these institutions will be able to work as autonomous institutions and will be able to maintain the concept of rural development and democratic decentralisation. For this, the Panchayati Raj Institutions have been made autonomous and self-reliant. Panchayats have been given such powers and authority so that they can provide economic and social equality and justice to the people of the villages. Under the 73rd Constitutional Amendment Act, Karnataka, Madhya Pradesh, and Rajasthan passed new Acts on Panchayati Raj in 1993 and 1994, respectively. Its meaningful implementation was also done in other states of the country. With the provisions of the Panchayat Extension to Notified Areas Act, 1996, panchayats have reached tribal areas in eight states: Andhra Pradesh, Bihar, Gujarat, Himachal Pradesh, Maharashtra, Madhya Pradesh, Odisha, and Rajasthan. This act has come into force as of December 24, 1996. All states except Bihar have passed laws implementing the provisions of this 1996 Act. Thus, the 73rd Constitutional Amendment Act has added a new dimension to India's democracy by giving recognition and importance to the Gramme Sabhas. There have been many studies on women's participation in the last 50 years. In which a lot of information has been revealed about the similarities and differences in their circumstances in different states of the country. In North India, there is a practise of wearing curtains or veils. Many people are of the opinion that this practise is a big hindrance in the way of women's development, whereas in South India, where women are not seen wearing veils, they are equally subordinate to men, as in North India. Women may belong to any state, caste, class, or religion; when asked about this, almost only one answer came some posts in panchayats have been reserved for women. That's why my husband got me to fill out the nomination papers.Some of these women campaigned from house to house, but many women stayed at home and their husbands or other family members went to seek votes. Women are given opportunities to be empowered in every field by the Indian constitution. Today, women in rural and urban areas are becoming empowered through Panchayati Raj. But his political condition is not satisfactory. The superiority or inferiority of any society is decided by the condition of the women in that society. Here, the status of women refers to the place of women in society, their prestige, their respect, their pride, and their condition as compared to men in that society. At present, there has been improvement in the condition of women, but this improvement has mostly come in the condition of women in urban areas; not much improvement has been visible in the condition of rural women. At present, it is necessary that by removing the obstacles to the social, economic, and political development of women, they can be connected to the main stream of development, they have an important role in the process of development, and their active participation can be respected. --- Empowerment of women in politics: Out of the total population, 70 percent of women live in rural areas. The political participation of women in India is not as impressive as that of men. This situation can be seen in many countries around the world. But there has been a lot of improvement in the political participation of women as compared to earlier. The number of women in Parliament in India is very low. In the 16th Lok Sabha elections, the number of women parliamentarians increased from 59 to 61, which is the highest since independence. India ranks 148 out of 193 countries in terms of the number of women elected to Parliament. The participation of women in the Rajya Sabha was 31 out of 244 members. The percentage of women in Parliament has increased in the 16th Lok Sabha. --- Women members in lok SabhaWomen members in Rajya Sabha ( Table -1.1)(Table -1.2) Tables 1.1 and 1.2 show that the percentage of women in the Rajya Sabha and Lok Sabha in terms of number of seats has increased over the years. In 2019, it was 11.6 percent and 14.58 percent, respectively. This table shows that the percentage of women in the Lok Sabha and Rajya Sabha has increased, but the representation of women is still not more than 15 percent. Reservation for women in Vidhansabha and Lok Sabha has been a contentious issue. On the other hand, India already has a 50 percent reservation for women in village panchayats. Political participation of women in Haryana: Haryana has had only four women Members of Parliament in the last 30 years. Three of these four women MPs got tickets because of their families will. In 1999, two women MPs were elected together in Haryana. In the 1984 Lok Sabha elections, where 190 men were running for seats, the number of women was just 10. Even after 10 years, there was no improvement in the situation. In 1996, there were 9 female participants, and the number of males was 285. In 2014, there were only six women representatives in the constituency, while the number of men was 152. .4 shows that of the total 90 seats, the share of women does not exceed 11, which is 12 percent of the total seats. In 1967, the participation of women was 5 percent, which increased to 12 percent in the 2014 elections, but in the 2019 elections, only 9 out of 90 women reached the assembly. The participation of women in Haryana's state assembly has been negligible compared to that of men, which averages 7.75 percent. --- Women Members from Haryana in Lok Sabha Gramme Panchayat is considered an important step of Panchayati Raj, which acts as an important link in the rural development programme of the government. There should be participation by all citizens in these programmes. Therefore, keeping these things in mind, one-third of the total seats at all levels have been reserved for women. 1.5 shows that since 1994, the representation of women as members in Panchayats has been almost 33.46 percent. Which increased to 38.11 percent in 2000. In 2010, it was 34.21 percent. Women constitute almost half of the total population, but their representation is only a third. Due to the 33 percent reservation given to women in the constitution, the participation of women in Panchayati Raj has become very necessary. The representation of women in the last four elections has averaged around 35 percent. But in 2016, the participation of women increased to 41.46 percent. Which is a very positive improvement. --- Women Representatives in village --- CONCLUSION The goal of women's empowerment cannot be achieved only by giving them reservations; other social and demographic factors also affect their active participation in the Panchayati Raj system. More efforts have to be made to speed up this process. From the present study, it cannot be said that women are clearly empowered, but it cannot be denied that they have some degree of empowerment in the form of reservation for women in Gramme Panchayat.Women's participation in state and national politics has been very limited. But the participation of women has increased in the last few years, mainly due to reservation. There has been some improvement in the number of women in parliamentary elections. In 2009, when the number of female candidates was 59, it increased to 78 in 2019. This is the highest number of seats for women in the Lok Sabha so far. In such a situation, it can be said that the trend towards women's politics is increasing. Although the representation of women is still low, there has been some increase in the political empowerment of women.

Empowerment is a multidimensional social process that empowers people in society. Empowerment varies at economic, social, and psychological levels. Women's empowerment is only one of these, which includes many things. like the right to property, economic opportunity, political and social equality, etc. In this paper, an attempt has been made to examine the political empowerment of women in India through the Panchayati Raj system. From which it is known that there are about 50 percent women in the total population, yet they do not contribute even 15 percent to the politics of India. But the participation of women in Panchayats has increased in the last two decades. The presented research paper is based on secondary data.

Objective: To establish how participant and informant reports of cognitive decline may differ between groups or remain consistent based on race and level of education in a large, national sample. Participants and Methods: Participants were selected using the National Alzheimer's Coordinating Center (NACC) database. Participants who were cognitively healthy at baseline and at least 65 years of age were selected. All informants either lived with the participant or visited the participant weekly (N = 9300). Participant racial groups included White American (n = 7534), Black American (n = 1453), Native American/Alaskan (n = 68), or Asian American (n = 239). Native Hawaiians were not included in this study, given the small sample size (n = 6). Participant education-levels included less than high school degree (n = 395), high school degree or GED (n = 1326), some post-secondary education (n = 1727), bachelor's degree (n = 2184), and graduate studies (n = 3668). Pairwise comparisons examined each racial and educational attainment group by subjective reports of cognitive decline using Bayesian contingency tables to find reliable evidence to support the null or alternative hypothesis. Participant and informant reports of decline were coded to create a single variable to express no reported decline, participant reported decline, informant reported decline, or agreed decline. Results: Pairwise race comparisons found moderate evidence that Native Americans reliably reported cognitive decline differently than Black (BF10 = 6.973) and White Americans (BF10 = 3.634). In both cases, the Native American group reported more cases of decline than expected in all groups and reported no decline less than expected. Further analysis found very strong evidence for the null hypothesis when comparing White Americans with Black (BF01 = 60.506) and Asian Americans (BF01 = 65.72). A comparison of Black and Asian Americans found extremely strong evidence for the null hypothesis (BF01 = 199.464). No conclusive evidence was found when comparing reports of Native and Asian Americans (BF01 = 2.401). Pairwise comparisons of educational attainment with subjective reporting of cognitive decline found no evidence of reliable differences between groups. No conclusive evidence was found when comparing the reporting pattern of individuals with some post-secondary education and individuals who did not complete high school (BF01 = 1.257). Moderate evidence for the null hypothesis was found when comparing individuals with a bachelor's degree with those who did not complete high school (BF01 = 8.57). Strong evidence for the null hypothesis was found when comparing individuals who did not complete high school with those who have studied at the graduate level (BF01 = 17.141) and those who completed high school (BF01 = 16.306). When making all other pairwise comparisons (BF01 > 100), there was extremely strong evidence for the null hypothesis. Conclusions: These findings suggest that how participants and their informants report cognitive decline does not differ based upon educational attainment in almost all cases, and no evidence was found supporting differences based upon educational attainment. There is evidence that Native Americans/Native Alaskans and their informants report more cognitive decline compared to White and Black Americans. However, the findings suggest that White, Black, and Asian Americans do not differ in how participants and their informants report cognitive decline. --- It was suggested by Walker and colleagues (2017) that the deficits in cognitive awareness may be due to brain injury. Confrontational naming tasks (e.g., Boston Naming Test) are used to evaluate language abilities. The Cordoba Naming Test (CNT) is a 30-item confrontational naming task developed to be administered in multiple languages. Hardy and Wright (2018) conditionally validated a measure of perceived mental workload called the NASA Task Load Index (NASA-TLX). They found that workload ratings on the NASA-TLX increased with increased task demands on a cognitive task. The purpose of the present study was to determine whether the Dunning-Kruger effect occurs in a Latinx population and possible factors driving individuals to overestimate their abilities on the CNT. We predicted the lowperformance group would report better CNT performance, but underperform on the CNT compared to the high-performance group. --- Participants and Methods: The sample consisted of 129 Latinx participants with a mean age of 21.07 (SD = 4.57). Participants were neurologically and psychologically healthy. Our sample was divided into two groups: the lowperformance group and the high-performance group. Participants completed the CNT and the NASA-TLX in English. The NASA-TLX examines perceived workload (e.g., performance) and it was used in the present study to evaluate possible factors driving individuals to overestimate their abilities on the CNT. Participants completed the NASA-TLX after completing the CNT. Moreover, the CNT raw scores were averaged to create the following two groups: low-performance (CNT raw score <17) and high-performance (CNT raw score 18+). A series of ANCOVA's, controlling for gender and years of education completed were used to evaluate CNT performance and CNT perceived workloads. Results: We found the low-performance group reported better performance on the CNT compared to the high-performance, p = .021, ηp² = .04. However, the high-performance group

test (WCST) and Trail Making Test (TMT) were reviewed.The WCST and the TMT, with its variant, was the most normed EF cognitive test currently available. The Keio version Japanese-Trail Making Test (J-TMT) and a simplified version of the Trail Making Test (S-TMT) has been utilized in Japan, however norms are still lacking. Of the available studies, the S-TMT and J-TMT were found to be moderately correlated with the TMT. The Keio version WCST (KWCST) (Kao et al., 2012) was correlated to education level (Abe et al., 2004), appropriately differentiating severity of social anxiety disorder (Fujii et al., 2013), patients with schizophrenia (Banno et al., 2012), and cognitive impairment in Parkinson's disease (Yoshii et al., 2019). Conclusions: Information regarding translated and normed tests are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. The J-TMT and the S-TMT may be clinically useful as an evaluation of attention for the Japanese population. The KWCST has also been found to be an appropriate tool for this population. However, publicly available norms for these assessments are still sparse, and there is very limited information about administration of these tests by English-speaking neuropsychologists with the use of interpreters. Further work is needed to increase access to and awareness of linguistically and culturally appropriate versions of clinical measures to better serve the Japanese and Japanese-American population.

Over the past decades, the UK has introduced pension and labour market reforms that aimed at increasing the length of working life among the older working population. Behaviourrelated risk factors such as low physical activity level, alcohol consumption, smoking as well as obesity are associated with labour market participation and early retirement. However, the extent to which the co-occurrence of these behaviourrelated risk factors predict how long people stay in employment (working life expectancy) has not yet been investigated. We used a large nationally representative sample of older people in England participants of the English Longitudinal Study of Ageing (ELSA), from 2002 to 2018. We applied multistate life table models to repeated measures to estimate sex-specific working life expectancy from the age of 50. We considered the following behaviours: smoking, daily alcohol consumption, being physically inactive and being obese. At the age of 50, men with no behaviour-related risk factors could expect to work on average 11 years (95%CI:10.96; 11.44) longer (9 for women, 95%CI:8.98;9.44), whereas men with 2+ behaviour-related risk factors could expect to work on average 9.2 additional years (95%CI:9.19; 9.85) (7.4 for women, 95%CI:7.3; 7.8). Men and women engaging in one behaviour-related risk factor had slightly higher lower working life expectancy than those not engaging in any behaviour-related risk factors. Abstract citation ID: igad104.1049 --- WORKING LIFE EXPECTANCY AND UNPAID CAREGIVING: HOW WORKING LIVES DIFFER ACROSS CAREGIVER GROUPS Lawrence Sacco 1 , and Brian Beach 2 , 1. Stockholm University,Stockholm,Stockholms Lan,Sweden,2. University College London,London,England,United Kin gdom Informal or unpaid caregiving (i.e. unpaid and untrained help and support to an ill relative or acquaintance) is becoming more prevalent as a result of population ageing and policies promoting ageing in place. Informal or unpaid caregiving is most common in mid-to-later life and can generate conflict with individuals' participation in paid work at a time when working lives are being extended in several countries. Few studies have examined the impact of unpaid caregiving on working life as a whole. The current study examines how unpaid caregiving affects working life expectancy (WLE) among people aged 50 or older. Measuring paid work through WLE allows engagement in paid work in later life to be examined accounting for the fact that retirement transitions have become more complex due to the diversity of retirement pathways (e.g. un-retirement, phased retirement). Furthermore, using longitudinal data to measure WLE in the context of unpaid caregiving over several years enables us to differentiate among frequent caregivers and sporadic spells of caregiving. Data from the English Longitudinal Study of Ageing (ELSA) and the Swedish Longitudinal Occupation Survey of Health (SLOSH) were used to evaluate how WLEs are affected among individuals who provided unpaid care. We highlight the impact of different trajectories in unpaid caregiving on WLE, distinguishing caregivers according to intensity (hours and frequency per week) as well as provision of care over time.

without considering transitions in different states of work over time. A better approach is based on multi-state survival models considering transitions among states over time using longitudinal data. These models assume a Markov Process to estimate transition probabilities. WLE is the weighted sum of duration of stay in a state weighted by the transition probabilities. The method adopted in IDEAR consortium is a multistate survival model assuming a first-order Markov process in continuous time to estimate transition probabilities. Transition probabilities are estimated by the msm package. This model takes care of interval censoring where the exact dates of transitions from one state to another is not known. WLEs are estimated by using the package elect (van den Hout, 2019) incorporating age as a time dependent variable by using a Gompertz model instead of the exponential model. The method is demonstrated to estimate WLE using Swedish Longitudinal Occupational Survey of Health (SLOSH).

INTRODUCTION The inverse association between educational attainment and health, including all cause and causespecific mortality, has been long established. [1][2][3] However, the educational gradient differs over time and between populations. For example, analysis of official data from 22 European countries found considerable differences in the magnitude of educational inequalities between countries. 4 This suggests that sociopolitical context plays an important role in shaping social inequalities in health. 4 5 A relatively recent example of rapid societal change is the postcommunist transition in Central and Eastern Europe and the former Soviet Union. Macroeconomic data suggest a rapid increase in income inequalities, reappearance of unemployment and falls in living standards in the early stages of the transition. 6 7 With democratic reforms in Central and Eastern Europe, the importance of education as a route to higher income rapidly increased, contributing to increase in income inequality by education. 8 Published studies suggest that social inequalities in mortality in the former Soviet Union and the Baltic countries increased considerably after 1990, 9-11 but there is less evidence from Central Europe, where the transition was less dramatic than in the former Soviet Union. Geographical studies in Hungary and the Czech Republic suggest increasing socioeconomic inequality in mortality after 1990. 12 Estimates based on official unlinked data on death registration with census data in the Czech Republic and the Baltic states also show a short-term increase in all-cause mortality after 1990. [13][14][15] In most reports, the educational inequalities increased very quickly, over only a few years. However, as most of available studies used unlinked routine data, the numerator-denominator bias makes them less reliable. 16 In this paper, we analysed data from two Czech cohorts using identical protocol established in 1985 and 1992 to assess changes in educational inequalities using individual-level (ie, linked) data. We hypothesised that the educational gradient would become steeper in the later cohort and this would be apparent in both men and women. --- WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Previous studies reported an increase in social inequalities in mortality during the early stage of postcommunist transition. However, there has been less evidence from Central Europe, especially based on individual-level (linked) data. There has also been a lack of studies assessing educational gradients for men and women separately. --- WHAT THIS STUDY ADDS ⇒ Although the educational gradient in mortality existed before as well as during the political transition, there was no evidence for the expected steeping of the gradient in our study. Our results suggested that the educational gradient in mortality was substantially stronger among men than in women. Further research is needed to understand trends in health inequalities during socioeconomic transitions emphasising the differential patterns between sexes. --- Short report METHODS We used data from the 1985 and 1992 population studies conducted as part of the WHO MONICA Project 17 in a 1% random age-sex-stratified sample of men and women aged 25-64 in of six Czech districts (more detail is available elsewhere 18 ). In total, 2573 and 2353 participants were recruited in 1985 and 1992 (response rate 84% and 73%), respectively. Participants with missing data on education, marital status and cardiovascular risk factors were excluded, leaving 2530 and 2294, respectively, in the analytical sample. Education was assessed by two indices. First, educational attainment was reported in categories, which were classified into primary, secondary and university education. Second, participants reported how many years they spent in education; this information was used both as continuous variable (years of schooling) and classified in tertiles by cohort. Covariates (potential confounders or mediators) included marital status (recoded into binary variable married vs single/widowed/divorced), ever smoking cigarettes (yes vs no), height (metres), body mass index (BMI, calculated as kg/m 2 ), high-density lipoproteins cholesterol (mmol/L), total cholesterol (mmol/L), high blood pressure (yes vs no; greater than or equal to 140 mm Hg/90 mm Hg or current treatment with antihypertensive medication). Deaths among study participants were ascertained via linkage with the national mortality register. For the present analysis, the follow-up time was restricted to 15 years for each cohort (ie, until 31 December 2000 for the 1985 cohort and until 31 December 2007 for the 1992 cohort). Cox proportional hazard regression was conducted to determine the association between education and all-cause mortality in each cohort in both sexes combined and separately for men and women. Age-adjusted models were estimated first, followed by multivariable models adjusted for covariates (age, BMI, height, cholesterol, high blood pressure, smoking status and marital status). The HRs along with their corresponding 95% CIs were estimated using Cox regression. Terms of interaction between educational variables (one per model) and cohort were fitted to assess whether the educational gradient differed between cohorts. All analyses were performed in Stata software (V.16.1). --- RESULTS The descriptive statistics of the characteristics of the combined analytical sample and stratified by sex are reported in table 1. Over 15-year follow-up, there were 291 deaths in the 1985 cohort and 281 deaths in the 1992 cohorts. There were only minor differences in covariates between the two cohorts. However, the numbers and proportions of deaths during follow-up were substantially lower in the 1992 vs the 1985 cohort. Table 2 presents the age-adjusted and fully adjusted HRs of all-cause mortality for both sexes combined and separately for men and women. For both sexes combined, the gradient in all-cause mortality by all educational indices was significant in age-adjusted models in both cohorts. Each additional year of schooling was associated with reduction in mortality risk by 6% (HR 0.94, 95% CI 0.90 to 0.98) and 7% (HR 0.93, 95% CI0.90 to 0.97), respectively. After adjustment for covariates, the HRs were attenuated and only the association of years of schooling remained significant in both cohorts. When data were analysed separately by sex, a clear educational and statistically significant gradient was only seen in men. Crucially, the gradients, in both sexes, were similar between the cohorts, and there was no suggestion that the gradient became steeper in the 1992 cohort. None of the interactions between cohort and any educational indicators were statistically significant (all p>0.5, not shown). --- Short report --- DISCUSSION The main objective of these analyses was to compare educational gradients in all-cause mortality in two cohorts established before and during the early stage of the postcommunist transformation in the Czech Republic. The results suggested that (1) educational gradients in mortality existed in both cohorts, (2) were pronounced only among men and (3) the gradients were of similar magnitude in both cohorts. These data, therefore, do not suggest a major divergence of educational inequalities of mortality. Some of findings are unexpected. First, the lack of clear gradient in women was surprising, since official statistics have shown educational inequality in mortality in both sexes. 13 The stronger association between educational level and mortality in men might be explained by differences in health behaviours among women and men (men are more likely to follow unhealthy and risky behaviours) that might consequently contribute to higher specific mortality to, for example, accidents, lung cancer. 19 Second, since the majority of published reports suggest an increase in social inequalities in mortality during the early stage of postcommunist transition, 9 12 15 we expected a similar pattern in these cohorts. However, there was no evidence for the expected steeping of the gradient. Previous studies in the Czech Republic generally found increase in educational differences in all-cause mortality, despite some exceptions between particular categories for both men and women. 12 13 20 Increasing inequalities were also reported in Poland, Hungary, Estonia and Lithuania from 1990 to 2000, 15 Russia from 1989 to 2001 9 and Estonia from 1989 to 2000, 14 indicating that the --- Short report postcommunist transition exacerbated educational discrepancies in mortality. One potential explanation for the unexpected findings may be the numerator-denominator bias. A previous study conducted in Lithuania between 2001 and 2004 revealed an overestimation of the educational gradient in mortality in studies that used unlinked data rather than linked data, due to overreported deaths in lower educational groups and underreporting for those with higher education, 10 although the extent of the bias seems dependent on the context and country. 16 In addition, at least one prospective cohort 21 and one retrospective study, 9 both using individually linked observations, reported diverging mortality inequalities in Russia, suggesting that numerator-denominator bias is not a major alternative explanation. A second potential reason for our findings may be the lower response rate in the 1992 vs 1985 survey (73% vs 84%). Given this large difference and the literature consistently suggesting that non-respondents tend to be less healthy and more likely socially disadvantaged than respondents, the potential changes in educational gradients between cohorts may be obscured by differential response rate. 22 Lower response rate may partly explain the lower mortality risk in the second study. Third, the observation period between the two compared cohorts (1985 vs 1992) might be too short (7 years) to distinguish the potential effect of the educational gradient in all-cause mortality. In order to obtain a sufficient number of deaths for the analysis, a 15-year follow-up was used and the calendar years during follow-up, therefore, partially overlap between the cohorts. Restricting analyses to non-overlapping first 5 years of follow-up reduced the number of deaths in the analyses and did not provide any additional clues. Finally, the sample sizes of the cohorts may have been too small to detect modest changes in associations between education and mortality between cohorts; this is particularly pertinent to women, among whom the lower deaths rates further reduce the statistical power. --- CONCLUSION Notwithstanding these limitations, this first individual-based prospective investigation outside of the former Soviet Union found evidence for an educational gradient in mortality in both cohorts, which was largely driven by gradients among men. However, we found no evidence for the gradient becoming steeper in the later cohort. These findings warrant re-examination of this important question in larger individual-based datasets. Correction notice This article has been corrected since it first published. In the last row of table 1, 'Deaths during follow-up', data has been corrected. This data has also been corrected in the main text. --- Contributors CP and AD contributed equally to this paper. CP, MB and HP conceived and designed the study. CP and WL analysed the data, and CP wrote the first draft of the manuscript. AD and MB contributed to writing of drafts. JH contributed on designing of the overall research study. All authors provided critical revisions. All authors read and approved the submitted manuscript. Medicine. This publication reflects only the author's view and the European Commission is not responsible for any use that may be made of the information it contains. --- Funding --- Competing interests None declared. Patient consent for publication Not applicable. --- Ethics approval The study was approved by the ethics committee at University College London, UK (99/0081) and the ethics committee at Institute of Clinical and Experimental Medicine, Prague, Czech Republic.

Objectives We investigated whether social gradient in all-cause mortality in the Czech Republic changed during the postcommunist transition by comparing two cohorts, recruited before and after the political changes in 1989. Methods Participants (aged 25-64 years) in two population surveys (n=2530 in 1985, n=2294 in 1992) were followed up for mortality for 15 years (291 and 281 deaths, respectively). Education was classified into attainment categories and years of schooling (both continuous and in tertiles). Cox regression was used to estimate HR of death by educational indices in each cohort over a 15-year follow-up. Results All three educational variables were significantly associated with reduced risk of death in both cohorts when men and women were combined; for example, the adjusted HRs of death in the highest versus lowest tertile of years of schooling were 0.65 (95% CI 0.47 to 0.89) in 1985 and 0.67 (95% CI 0.48 to 0.93) in 1992. Adjustment for covariates attenuated the gradients. In sex-specific analysis, the gradient was more pronounced and statistically significant in men. There were no significant interactions between cohort and educational indices. Conclusions The educational gradient in mortality did not differ between the two cohorts (1985 vs 1992), suggesting no major increase in educational inequality during the early stage of postcommunist transition. Further research is needed to understand trends in health inequalities during socioeconomic transitions. Provenance and peer review Not commissioned; externally peer reviewed.

Introduction The fisheries sector is a sector that plays an important role in national development [1] . It is stated that if managed properly, the Indonesian capture fisheries sub-sector is expected to become the main driver of the national economy [2] . This is based on the fact that first, fishery resources in Indonesia are large in quantity and diversity; second, the industries in the fishery sector in Indonesia are related to various other sectors; third, the fishing industry in Indonesia is based on national resources; and finally, reflected in the potential of existing resources, the fisheries sector in Indonesia has a high advantage [3] . The three sub-sectors of the fisheries sector in Indonesia are capture fisheries, aquaculture, and fish processing [4] . The capture fisheries sub-sector is one of the mainstay sub-sectors that has an impact on the national economy [5] . In addition to the national economy, the Indonesian capture fisheries sub-sector plays a major role in world capture fisheries production [6] . The Food and Agriculture Organization (FAO) report in 2020 stated that Indonesian capture fisheries are among the five highest contributors to capture fisheries production, namely as much as 8% of the total world fisheries production. Statistically, Indonesia is ranked second after China with a contribution of 15% [7] . Cirebon City is located on the North Coast, in the eastern part of West Java Province with a coastal area of ± 7 km [8] . The location of this area is strategic for transportation and communication aspects because it is a transportation node from the Jakarta area to the eastern part of the provinces of West Java and Central Java via the northern cross-coastal route (Pantura) [9] . The coastal area of Cirebon City is relatively narrow because it is only located in two sub-districts, namely Lemahwungkuk and Kejaksan Districts with a total area of 8.56 km2 [10] . The Cirebon coast consists of beaches with sandy and muddy characteristics [11] . The existence of coastal areas in Cirebon City influences the existence of fishing communities in it [12] . Fishing communities are defined as a group of individuals who live in coastal areas and make their main livelihoods by utilizing the natural resources available in the sea [13] . There are four points of fishing villages in Cirebon City, namely Cangkol Village, Samadikun Village, Pesisir Village, and Kejawanan Village [14] . Cangkol Village is part of the Lemahwungkuk District with a fishing community that is considered more developed than fishing communities in other villages in terms of its productivity as a fishing community that actively makes its FADs, is active in joint business groups, and can open marine tourism in its area [9] . Even though it is said to be more developed, this does not guarantee the welfare of the people in it because the fishing community in Cirebon City still lives in a state of concern seen from their slum living environment and unprosperous economic conditions [15] . This indicates the uneven development carried out in the coastal area of Cirebon City [16] . A description of the condition of capture fisheries in the Kampung Cangkol area needs to be known as a tool for related parties in monitoring the condition of the capture fisheries sub-sector in the area under which it is managed [17] . --- Method The research was carried out in Cangkol Village, Lemahwungkuk District, Cirebon City, West Java Province in April-June 2023. The research location map is shown in Figure 1. The data collected is in the form of primary data and secondary data. The primary data in this research is the result of interviews and direct observation in the fishing community of Cangkol Village. Secondary data in this research is in the form of statistical data from the Department of Food Security, Agriculture and Fisheries (Dinas Ketahanan Pangan Pertanian dan Perikanan /DKP3) Cirebon City and the results of literature studies. Secondary data obtained includes data on an overview of Cangkol Village, the livelihoods of Cangkol Village residents, facilities and infrastructure supporting the activities of Cangkol Village residents, the development of the number of fishermen in Cangkol Village, and the catch production of Cangkol Village fishermen. The statistical data presented is in the form of 5-year time series data, 2018-2022. --- Result 3.1. Geographical Conditions and Population of Kampung Cangkol Cangkol Village is located at an altitude of 5 m above sea level with an average rainfall of 1,351 mm/year and 86 days of rainy days. The average temperature in Cangkol is 22.3°C, with an average maximum temperature of 33.0°C. The state of groundwater is affected by seawater intrusion so the need for water for drinking purposes is fulfilled by the water supply from the Regional Drinking Water Company (Perusahaan Daerah Air Minum/PDAM) of Cirebon City, which originates from Kuningan Regency. Other water needs are obtained from wells with a depth of 2-6 m [18] . Demographically, the population of Kampung Cangkol is divided into female and male residents. The residents of Cangkol Village consist of residents of RW 04 Kampung Cangkol Utara, RW 05 Kampung Cangkol Tengah, and RW 06 Kampung Cangkol Selatan. There are a total of 26 RTs in the three RWs with a distribution of 9 RTs in RW 04, 8 RTs in RW 05, and 9 RTs in RW 06 [18] . The male population is 0.8% more than the female population. Data on the population of Cangkol Village by gender are shown in Table 1. --- Livelihoods of Cangkol Village Residents The residents of Kampung Cangkol consist of residents whose livelihoods are fishermen, civil servants, traders, laborers, employees, and some who are unemployed or otherwise. It is shown in Table 2 that 4,245 residents are unemployed. Livelihood as a fisherman is the least livelihood for the residents of Kampung Cangkol, which is only 0.9% or as many as 60 people [19] . --- Facilities and Infrastructure in Cangkol Village The residents of Cangkol Village need various facilities and infrastructure as supporting facilities in carrying out various activities [20] . Facilities and infrastructure in Cangkol Village were built with various functions, namely the functions of worship, sports, health, and education. The results of interviews with respondents indicated that of all the existing religious infrastructure, residents of Cangkol Village tended to concentrate on religious activities. The residents of Cangkol Village, especially the children, actively utilize sports facilities and infrastructure as a place to play in the afternoon. To support the health conditions of the residents of Cangkol Village, the Kampung Cangkol Community Health Center is available as the main health infrastructure. The closest formal education infrastructure for the residents of Kampung Cangkol is only at the elementary school level so that children in Kampung Cangkol continue their education in the vicinity of the Lemahwungkuk District. As a tourism facility, fishing tourism was created by the fishing community in Cangkol Village. --- Supporting facilities and infrastructure for fishermen Cangkol Village is one of the four fishing villages in Cirebon City [19] . Fishing communities run fishing businesses to fulfill their daily needs [21] . Therefore there are various facilities to support fishing activities in Cangkol Village. Based on the results of interviews and observations, it is known that the administrative office of the Cangkol Fish Auction Place (TPI) by the fishing community functions as a central secretariat and storage for fishing units belonging to the business group with fishermen. The fish marketing area by the fishermen of Kampung Cangkol is used as a place to sort fish after being caught or a place for fishermen to gather and have meetings when needed. Jetty is the way to the ship and where the ship is anchored [22] . Banking is used by fishermen as a place to save. Joint Business Group (KUB) is a management facility formed as a forum for fishermen to improve the quality of fishing businesses [23] . --- The Development of Fishermen in Cangkol Village The types of fishing businesses in Cangkol Village consist of skipper fishermen (owners), boat crew (ABK/workers), and seasonal fishermen. The skipper fisherman is the owner of the ship as well as the captain when the fishing effort is carried out [24] . Ship's crew (ABK) or labor fishermen offer services or have certain attachments to skipper fishermen when fishing operations are carried out [25] . Seasonal fishermen are fishermen who offer services at certain times, depending on the fish harvest season [26] . An overview of the development of the number of fishermen in Cangkol Village is shown in Figure 2. The trend in Figure 2 shows that the number of fishermen in Cangkol Village tends to decrease. In the last five years, the largest number of fishermen will be in 2020 and 2021 with 80 people. The least number of fishermen will be in 2022 as many as 71 people. Based on the results of interviews with the chairman of the Nelayan Association, Mr. Suparman, he stated that the fishing community in Cangkol Village was entirely residents without the presence of immigrants in it so the number of fishermen in Cangkol Village tended to continue to decline [27] . Another causal factor is that there are fishermen who are looking for other opportunities and moving to other coastal areas, especially Jakarta. --- Number of fisherman effort (Trips) in Cangkol Village There are 27 boats belonging to the fishing community of Cangkol Village [19] . These vessels are 3 GT vessels with outboard motor engines. Fishermen who own boats usually go out to sea with one crew member. The development of the number of fishing trips in Cangkol Village is shown in Figure 3. The figure shows that the number of fishing trips in Cangkol Village tends to increase. There was a decrease in activity in 2019 and 2020 due to restrictions on the activities of fishing communities during the COVID-19 pandemic [28] . Re-arrest activity will increase in 2021 as restrictions on community activities have been relaxed [29] . Based on the results of the interviews conducted, the average fishermen in Cangkol Village make 10-12 trips in one month with a distance of FADs 40-60 km from the coast. --- Cangkol Village Fisherman Capture Fisheries Production The fishing effort of Cangkol Village fishermen is carried out using hand-line fishing gear with assistive devices in the form of FADs. FADs are operated by sinking them to the bottom of the water so that fish gather around them making it easier for fishermen to catch fish [30] . The development of caught fish production in Cangkol Village is shown in Figure 4. Based on Figure 4, the trend of caught fish production in Cangkol Village tends to increase. The highest production was in 2019, amounting to 612,945 kg. The lowest catch will be in 2021, amounting to 134,049 tons. Following the picture of catch production, the trend of fish catch production value in Kampung Cangkol also tends to increase. The highest catch production value was found in 2019, amounting to IDR 29,350,803,000.00. The lowest fish catch production value is in 2021 of IDR 5,695,938,851.00. The development of the production value of caught fish in Cangkol Village is shown in Figure 5. --- Conclusion The population of Kampung Cangkol makes a living as fishermen as much as 0.9%. Within 5 years (2018-2022), the number of fishermen from Cangkol Village tends to decrease. Even so, the number of trips, production, and production value of catches from Kampung Cangkol fishermen tends to increase. All three aspects showed a decline in 2019 and 2020 due to restrictions on community activities due to the COVID-19 pandemic.

An overview of the condition of capture fisheries in an area is a tool for regional management parties in maintaining the sustainability of fishery resources in it. This research is focused on describing in general the area and conditions of capture fisheries in Kampung Cangkol, Cirebon. Residents in the Cangkol Village area have livelihoods as fishermen as much as 0.9% of the population. Within 5 years (2018-2022), the number of fishermen in Cangkol Village has tended to decrease. Nonetheless, the trend in numbers and production value of the catch of Cangkol Village fishermen tend to increase with the catch of demersal fish by the characteristics of sandy and muddy waters.

Introduction Since May 6, 2022, a monkeypox outbreak has spread to or been detected in more than 100 countries. Shortly after media coverage of the outbreak, misinformation about monkeypox was reported. 1 The World Health Organization advised "detecting public sentiment…[to] address possible rumours and misinformation." 2 This qualitative study used real-time data from TikTok, a social media app allowing users to create and share short videos, to proactively identify monkeypox conspiracy theories for public health to debunk before their potential viral spread. --- Methods To identify emergent conspiracy theories about monkeypox, content and metadata under #monkeypox (864 videos) on the app's desktop version were collected using the DataMiner website scraper tool and manual retrieval of videos on May 21, 2022. We chose the app owing to its high monthly use (>1 billion users). We reviewed each English-language video for the presence of a conspiracy theory or theme related to the emerging monkeypox outbreak. We classified theories into a typology and reported their viewership and engagement metrics. M.Z. coded the videos; T.C. audited coding decisions. Ethical approval and informed consent were not needed because videos were publicly available and posted without expectation of privacy. Data were analyzed using Microsoft Excel, version 2208. --- Results We identified 153 videos with a monkeypox conspiracy theory or theme. The estimated mean time since posting was 30.2 hours. In total, videos received 1 485 911 views (median, 2872; IQR, 1691-6697), 74 328 likes (median, 192; IQR, 93-386), 7890 comments (median, 26; IQR, 12-53), and 13 783 shares (median, 21; IQR, 8-58). Our analysis sorted conspiracy theories into 11 types (Table ). The most prominent were assertions that monkeypox was a planned pandemic introduced for power, control, or money or to instill fear (71 videos [46.4%]); content alleged that monkeypox was a purposeful repeating of COVID-19, intentionally released, or associated with COVID-19 and conspiracy theories such as "the great reset" and "one world order." Fifty-one videos (33.3%) were related to vaccines and asserted monkeypox was an excuse to administer or mandate vaccines worldwide. Vaccine manufacturers and governments were accused of knowing of an upcoming outbreak or having a role in creating the outbreak. Content alleged that government approval or orders of smallpox vaccines were proof of involvement. Five videos (3.3%) alleged that COVID-19 vaccines were the reason for or contributed to the outbreak. The World Health Organization was accused of involvement in the outbreak as an excuse to pass the May 2022 global pandemic treaty (27 [17.6%]) and erode the sovereignty of countries, override national laws, and seek broader power. The commentary of Bill Gates predicting or addressing the need to prepare for the next pandemic was taken as evidence of his involvement (28 videos [18.3%]). Specifically, Gates' comments about a possible bioterror attack or laboratory-created pandemic were cited, with some allegations of Russian government involvement (22 [14.4%]). Simulated pandemic preparation exercises were also taken as evidence of a preplanned pandemic (16 [10.5%]). Several conspiracy theories tied unrelated news events to the cause and/or cover-up of the monkeypox outbreak. An escape of monkeys in the US, as covered in a news story, was cited as potentially leading to the monkeypox outbreak (22 videos [14.4%]). Lost and found vials of smallpox had similar allegations (6 [3.9%]). Other videos suggested monkeypox was a symptom of an upcoming religious rapture (7 [4.6%]) or was introduced for political purposes (5 [3.3%]). --- Discussion Our results demonstrated the potential use of real-time social media data to identify and understand conspiracy theories before their viral spread. This is particularly important during the informationgathering phase of infectious outbreaks. 3 The COVID-19 pandemic has shown the challenges of viral misinformation 4,5 and the need to proactively deter it. 6 A limitation was that we included only videos in English under 1 hashtag; there are likely videos with conspiracy theories in other languages or different hashtags. Public health experts may consider greater attention to and investment in monitoring the online environment. --- Mr Zenone and Prof Caulfield 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 funders 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 "There is no chance for the welfare of the world unless the condition of women is improved. It is not possible for a bird to fly on only one wing." -Swami Vivekananda. Education is the basic necessity of every human being beside food shelter safety etc. Education helps in self-confidence and courage to overcome the problem they face in their daily life. The female literacy of tribes in West Bengal is only 47.7% compare to male literacy 68.2% and that there is a significant gap between rural and urban area. In Purulia district have four major tribal community, they are Santal, Kheriar, Sabar and Birhor. In this community, female education are mostly backward under privileged and deprived in term of literacy. Education is an important tool to improve human development and social economic development too. To increase the literacy rate of women probable solution are required. After independence, the State and the Central Government prepared scheme for women empowerment and for the implementation of the scheme, motivation as well as animation is required with the help of various NGOs and social workers. --- Study Area The study area consists of Purulia district of West Bengal. Purulia district is located in the western part of West Bengal, the latitudinal extension are from 22°42'35 N to 23 °42.00 N and longitudinal extent is from 85 °44'25E to 86 °54'37 E, respectively and the total area is 6.259 square kilometers as per the 2011 census. In West Bengal, Tribal population is 52, 96, 963 as per Census 2011, which is about 5.8% of the total population of the State. The literacy rates among tribal population in West Bengal and Purulia district are 57.92% and 53.86% respectively, both the data are comparatively low than the average total literacy rate of India (Census of West Bengal 2011). In West Bengal female literacy of tribes is only 47.7%. --- Objectives The basic objective of the study are as follows 1. To find out the educational status of tribal women. 2. To observe the literacy rate of tribal women of Purulia district in West Bengal. ~ 16 ~ 3. To identify the common barriers of tribal women for quitting their studies 4. To find out the solution that help their educational development. 5. To study about the various schemes adopted by central and state government to reduce illiteracy rate and help the educational development of tribal women. --- Methodology To complete the present study, secondary data have been used. Before entering into the study, a large of literature have been reviewed. Data are used collecting from secondary sources like -handbook on social welfare statistics and different journal articles and ebook based on women education and its status in West Bengal, most of the data from census 2011 and educational policies and schemes etc. The purpose of the study was educational status of tribal women at Purulia district in West Bengal. Purulia district has 20 blocks, some blocks are Urban and some blocks are rural. For data collection some blocks were selected where the population of tribal people are more. --- Analysis Education is the most important elements in the development of any community literacy rate is the one of the most significant determinates to measure the percentage of literate among the people. --- Probable Solution The probable solution for elimination of women's illiteracy are as follows -1. A mass programme must be taken up to strengthen the efforts for elimination of illiteracy. --- Implementation of vocational education freel of cost for women would support women financially and becomes self-reliant. --- Implementation of vocational education fee of cost for women would support women financially and become self-dependent. --- Conducting educational awareness camp in the rural areas would also be one of the probable solution. 5. Setup community base learning centre in rural area which can provide safe and inclusive space for women to learn. --- Schemes implemented by the Govt The following schemes have been implemented by the State as well as the Central Govt. 1. Kasturba Gandhi Balika Vidyalaya: The Kasturba Gandhi Balika established by the Govt of Indian for the girls belonging to the weaker section which is a residential secondary school. 2. Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (Sabla): It is a Central Government programme initiated in 2012 mainly for the benefit of adolescent girls, providing nutrition, education and helping young women self-reliant by providing vocational training. 3. Beti Bachao, Beti Padhao: This is a campaign of Govt of India to Save and Educate girl child since January 2015. 4. Uddan: A scheme that provides girl child education, mainly for students poor socio-economic background. 5. Mid -Day Meal Scheme: This Scheme in India provides mid-day meal in the schools to improve the nutritional levels of the students and to improve and attrack enrollment in schools and reduced dropouts. 6. Sukanya Samridhi Yojana: This is a saving account scheme which can be open at any India post office or branch of authorised commercial bank encouraging parents to buid funds for the feature education of their girl child. 7. Kanyashree Prakalpa: This Schemes helps to improve the condition and status of girls belonging to economically backward families. This Schemes has two components -8. K1 which provides Annual incentive of Rs 750/-to be paid annually to the girls of age group 13 to 18 years. 9. K2 is a One Time Grant of Rs. 25,000/-, to be psid as soon as a girl complete 18 years, provided that she is engaged in studies or some training and is unmarried. --- Conclusion The study of the status of tribal women of Purulia district of West Bengal with reference to education reveals that these women face multiple challenges and disadvantages in accessing and completing their education. The study shows that the tribal women of this region have low levels of literacy, enrolment and that there are significant disparities across communities, villages and urban-rural areas. The study also identifies the various factors that affect the educational status of these women such as poverty, hunger, lack of infrastructure, social discrimination and cultural barriers. The study suggests that there is a need for more research and intervention to improve the educational opportunities and outcomes for these marginalized groups. The study also highlights the importance of education as a tool for the empowerment and development of tribal women. The study suggested some strategies for improving the female education among the tribal communities such as enhancing awareness, motivation and participation of the parents and community leaders; providing incentives, scholarships, and free textbooks to the female students; ensuring adequate infrastructure, teachers and curriculum in the schools promoting vocational training and skill development programmes for the tribal women and creating a conducive environment for the preservation and promotion of the tribal identity and culture. The study concluded that education is a vital tool for the sustainable development of the tribal women in Purulia district, as it can enhance their self-reliance, dignity, and social status. The study also highlighted the need for more research and intervention on this issue, as well as the collaboration of various stakeholders such as government agencies, NGOs, civil society groups, and academic institutions.

Education is a key factor for the empowerment and development of any community, especially the marginalised and vulnerable ones. Tribal women in India face multiple challenges and disadvantages due to their socio-economic, cultural, and geographical conditions. According to the census of India (2011) tribal population share about 8.6% of total population in this country and their literacy rate is about 58.96%. West Bengal being one of the popular tribal concentrated states in India having almost 5.79% tribal people of the total population (Census 2011). The study was exploring the educational status of tribal women of Purulia district of West Bengal, one of the most backward and tribal populated districts in the country. Tribal women in India are often considered as the most deprived and discriminated section of the society. This paper would like to particularly focus on three major tribal communities: Santal, Kheria Sabar, and Birhor, who have distinct and diverse characteristics and needs. Primary and secondary data sources are used to analyses the levels of literacy, enrolment, attainment, and dropout among these tribal women. The present study also examines the factors that influence their educational participation and outcomes, such as poverty, gender roles, cultural norms, access to schools, quality of education, etc. This study will provide useful information and suggestions for improving the educational status and empowerment of tribal women in Purulia district.