Individual Consideration Research Articles

Environmental Exposures and Risks During Pregnancy.

The Women in Wilderness Medicine Research Committee of the Wilderness Medical Society conducted a narrative review to address considerations for pregnant individuals in wilderness environments. There is limited evidence behind many opinion-based recommendations on the safety of various environmental exposures in pregnancy. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolation from physiological data, as well as evaluating expert consensus statements. The benefits of exposure to natural environments include better pregnancy outcomes and improved maternal mental and physical health. Risks are similar to nonpregnant individuals with the added risks associated with maternal-fetal physiology in wilderness environments and difficulties of evacuation. This narrative review discusses pregnancy-specific concerns in extreme environments, including high altitude, hypothermia, hyperthermia, lightning strikes, envenomations, and common outdoor exposures.

An Investigation into the Relationship between Transformational Leadership Style and Organizational Commitment in a College of Administration and Economics: An Empirical Research

The current research aims to demonstrate the relationship and impact between transformational leadership and its dimensions (Idealized Influence Behaviour, Idealized Influence Attributed, Intellectual Stimulation, Inspiring Motivation, and Individual Consideration) on organizational commitment and its dimensions (continuous organizational commitment, emotional organizational commitment, and normative organizational commitment) at the College of Administration and Economics. Descriptive-analytical approach used to achieve the core object of the research.  The research adopted the questionnaire as the core tool for this purpose. A research sample included various administrative levels (director, chief inspector, supervisor, and assistant supervisor). The questionnaire distributed randomly, and 70 valid questionnaires collected for statistical analysis. The research adapted a set of statistical methods such as arithmetic mean, coefficient of variation, standard deviation, and simple regression coefficient by the statistical program (SPSS V26) to analyze data and test hypotheses. The research reached a set of essential results, the most important of which was that transformational leadership is the main factor for building an organization's culture to achieve growth and success and motivate individuals.   Paper type: Research paper

Guilt and Shame in Patients with Obsessive-Compulsive Disorders

Introduction: Obsessive-compulsive disorder (OCD) is a tremendous psychiatric illness with a variety of severe symptoms. Feelings of shame and guilt are universal social emotions that fundamentally shape the way people interact with each other. Mental illness is therefore often related to pronounced feelings of shame and guilt in a maladaptive form. Methods: A total of 62 participants (38 women and 24 men) were clinically and psychometrically investigated. Results: The OCD patients (n = 31) showed a maladaptive guilt and shame profile, characterized by increased interpersonal feelings of guilt accompanied by a stronger tendency to self-criticism and increased punitive sense of guilt with a simultaneous prevailing tendency to perfectionism, as well as an increased concern for the suffering of others. The proneness to profuse shame in OCD patients seems to be in the context of the violation of inner values and a negative self-image with persistent self-criticism. Conclusion: Although there are limitations with a small sample size in this monocentric approach, our study underlines the importance of an individual consideration of the leading obsessive-compulsive symptomatology, especially in the context of very personal feelings of guilt and shame. Further multidimensional studies on guilt and shame could contribute to their implementation more strongly in individualized psychotherapy.

Review article: Abdominal pain and diabetes mellitus in the emergency department.

This manuscript seeks to describe diagnostic considerations in individuals with diabetes mellitus presenting to the ED with abdominal pain. It highlights the importance of early investigation with computerised tomography to differentiate aetiologies that compel early surgical intervention from those which may be treated conservatively.

GROWTH AND YIELD RESPONSES OF RED AMARANTH TO LOCALLY SOURCED LIQUID MANURE

The experiment was conducted at Horticultural farm, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh during the period of September to November 2023. The experiment was laid out with single factor experiment using a completely randomized design with three replications to study the Growth and Yield responses of Red Amaranth (Amaranthus cruentus L) to liquid manure. The treatments under this study were; T1: Control (Only Water), T2: Vermi Tea; T3: SAU- MLM, T4: SAU-NLM, T5: SAU-PLM. Significant variation of growth and yield parameters were found among the treatments. Among the treatments. The tallest plant (44.3 cm), maximum root length was (13.3cm), maximum leaf area (38.2 sq. cm), maximum leaf number (14.0), maximum fresh weight per plant (22.1g), highest weight of plants per 506.25 sq. cm (274.9 g) and highest yield per ha (54.3 ton) was found in T5 while shortest plant (25.1 cm, minimum root length (4.8cm), minimum leaf area (16.4 sq. cm), minimum leaf number (8.6), minimum weight of plants/506.25 sq.cm. (77.5 g) and the lowest yield per ha (15.6 t) was found in T1 at final harvest (30 days after showing). Considering the overall analysis, it becomes evident that T5 consistently exhibits superior outcomes when compared to the other treatments. The superior performance of T5 suggests that it could be the optimal choice for maximizing agricultural productivity while maintaining a focus on human well-being and environmental sustainability. This treatment option not only results in higher yields, indicating potential economic benefits, but it also contributes to the overall safety and health considerations for individuals involved in the agricultural processes.

Bridging Gaps: Pre-Service Mathematics Teachers’ Handling the Difficulties in Posing Real-World Mathematical Problems

Real-world mathematical problem (RWMP) solving and posing are important aspects of teaching and learning mathematical modelling, as well as developing a mathematization disposition for both teachers and students. Several researchers have explored blockages or difficulties in such modelling processes and in problem posing. However, prior research has identified difficulties that the pre-service mathematics teachers (PSMTs) encountered when they tried to pose a modelling problem by choosing the general topic themselves, as there is little known about possible obstacles that PSMTs can encounter when trying to pose a real-world problem relevant to a given mathematical topic. The current study explored the difficulties encountered by PSMTs in a RWMP-posing activity. The target group was 23 PSMTs with prior experience in mathematical modelling and mathematical problem posing. The findings showed that the PSMTs struggled with: (a) task organization, which involved selecting and understanding mathematical knowledge; (b) specialized content knowledge, which included a lack of real-world knowledge and difficulty in connecting mathematical concepts to real-world contexts; and (c) individual considerations of aptness, which encompassed authenticity, interest, complexity, language, and relevance to task organization. The PSMTs applied various strategies to complete the posing task, such as using problem-posing and solving heuristics, adapting existing problems, sharing and discussing with friends, and considering the perspective of a typical student. The implications of these findings should help in developing preparatory instructional practices for mathematics teachers.

Perspectives on AI-based recommendations for mask-wearing and COVID-19 vaccination for transplant recipients in the post-COVID-19 era

In the aftermath of the COVID-19 pandemic, the ongoing necessity for preventive measures such as mask-wearing and vaccination remains particularly critical for organ transplant recipients, a group highly susceptible to infections due to immunosuppressive therapy. Given that many individuals nowadays increasingly utilize Artificial Intelligence (AI), understanding AI perspectives is important. Thus, this study utilizes AI, specifically ChatGPT 4.0, to assess its perspectives in offering precise health recommendations for mask-wearing and COVID-19 vaccination tailored to this vulnerable population. Through a series of scenarios reflecting diverse environmental settings and health statuses in December 2023, we evaluated the AI’s responses to gauge its precision, adaptability, and potential biases in advising high-risk patient groups. Our findings reveal that ChatGPT 4.0 consistently recommends mask-wearing in crowded and indoor environments for transplant recipients, underscoring their elevated risk. In contrast, for settings with fewer transmission risks, such as outdoor areas where social distancing is possible, the AI suggests that mask-wearing might be less imperative. Regarding vaccination guidance, the AI strongly advocates for the COVID-19 vaccine across most scenarios for kidney transplant recipients. However, it recommends a personalized consultation with healthcare providers in cases where patients express concerns about vaccine-related side effects, demonstrating an ability to adapt recommendations based on individual health considerations. While this study provides valuable insights into the current AI perspective on these important topics, it is crucial to note that the findings do not directly reflect or influence health policy. Nevertheless, given the increasing utilization of AI in various domains, understanding AI’s viewpoints on such critical matters is essential for informed decision-making and future research.

Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network.

Postoperative length of stay (LOS) significantly contributes to healthcare costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for degenerative conditions of the cervical spine. The secondary objectives were to examine the variability in LOS and institutional practices used to decrease LOS. This was a multicenter observational retrospective cohort study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective anterior cervical discectomy and fusion (ACDF) (1-3 levels) or posterior cervical fusion (PCF) (between C2 and T2) with/without decompression for degenerative conditions of the cervical spine. Prolonged LOS was defined as LOS greater than the median for the ACDF and PCF populations. The principal investigators at each participating CSORN healthcare institution completed a survey to capture institutional practices implemented to reduce postoperative LOS. In total, 1228 patients were included (729 ACDF and 499 PCF patients). The median (IQR) LOS for ACDF and PCF were 1.0 (1.0) day and 5.0 (4.0) days, respectively. Predictors of prolonged LOS after ACDF were female sex, myelopathy diagnosis, lower baseline SF-12 mental component summary score, multilevel ACDF, and perioperative adverse events (AEs) (p < 0.05). Predictors of prolonged LOS after PCF were nonsmoking status, education less than high school, lower baseline numeric rating scale score for neck pain and EQ5D score, higher baseline Neck Disability Index score, and perioperative AEs (p < 0.05). Myelopathy did not significantly predict prolonged LOS within the PCF cohort after multivariate analysis. Of the 8 institutions (57.1%) with an enhanced recovery after surgery (ERAS) protocol or standardized protocol, only 3 reported using an ERAS protocol specific to patients undergoing ACDF or PCF. Patient and clinical factors predictive of prolonged LOS after ACDF and PCF are highly variable, warranting individual consideration for possible mitigation. Perioperative AEs remained a consistent independent predictor of prolonged LOS in both cohorts, highlighting the importance of preventing intra- and postoperative complications.

INTERNATIONAL LEGAL STATUS OF THE WORLD TRADE ORGANISATION IN THE CONTEXT OF ECONOMIC GLOBALISATION

The subject of the study is the conceptual, theoretical, empirical, methodological and applied foundations of the international legal status of the WTO in the context of economic globalisation. Methodology. General scientific and specific legal methods were used in the research process. With the help of the analysis the quantitative and qualitative characteristics of international trade are determined as a prerequisite for the determination of the international legal status of the WTO in the conditions of economic globalisation. The synthesis ensured the formation of characteristic features of the legal status of the WTO as an international organisation. The comparative legal method allowed to identify the common and distinctive features of international organisations in this area, as well as to clarify the defining aspects of the legal personality of the WTO in the modern international legal field. The formal-legal method created the conditions for formulating conclusions on the effectiveness of the implementation of the legal personality of the WTO in the sphere of ensuring the rules of international trade in the conditions of economic globalisation. The purpose of this article is to identify the characteristics of the international legal status of the WTO under the conditions of economic globalisation. The results of the study showed that the international legal status of the WTO in the conditions of economic globalisation is based on the basic principles of legal regulation of international trade and is mediated by the purpose of activity, legal personality, the order of formation and powers of the governing bodies, principles and procedural aspects of the functioning of this organisation. Conclusion. The international legal status of the WTO in the conditions of economic globalisation is considered from the standpoint of a dichotomous approach to this category from the standpoint of economics and law. Economic preconditions for the introduction of international trade rules in the form of GATT, 1947 and WTO research through the analysis of primarily statistical data of the periods 1947-1948 and 2017-2022, reflected in the consolidated information data of the WTO, as well as the study of individual theoretical considerations of scientists. Statistical indicators show clear signs of globalisation of the world economy, which is mediated by international trade operations, as a result of which the creation of transparent mechanisms for the circulation of goods within the framework of trade activities as a kind of existence of the world community through various static and dynamic legal constructions, among which WOT occupies almost the most significant importance along with other international organisations. The above is demonstrated by the example of the impact of COVID-2019 on international trade, the corresponding reaction to which was the revitalisation of trade processes, primarily in the field of pharmaceutical industry products. The above has covered the main principles of international legal regulation of trade relations at the formal and substantive level, which is carried out at the universal international legal, regional international legal and national levels. In connection with the differentiation of the components of the legal personality of the WTO, the definition of international legal capacity is given as the ability of a subject of international activity to acquire appropriate rights for itself by its own actions and to exercise them independently, as well as to create corresponding obligations for itself by its actions, to fulfil them independently and to bear responsibility in case of their non-fulfilment. In terms of the nature of this organisation, its place among other similar international organisations, in particular those operating within the framework of the UN, was invented by the field of activity, where attention is paid to the predominance of the latter in order to maintain international peace and security. The purpose of the activities of the WTO is to create and ensure international, multilateral, open, based on fair competition and other features inherent to trade in modern society, where the quasi-procedural moment, based on the replacement of a number of bilateral and multilateral agreements, is an external manifestation of such activity. It characterises the original and derivative legal instruments of the WTO's operation, defines the socio-economic and legal purpose of its activities, defines the structure and powers of the WTO's governing bodies, and focuses the organisation's legal personality on the procedural aspect of its activities, in particular through the implementation of relevant principles, among which the principle of maximum contribution plays a leading role.

A Smart Leader in VUCA World: Presenting Key Components of Strategic Leadership Using SLR Method

The current study compiles and summarizes the key findings of the researches conducted on strategic leadership to meet VUCA world’s demand for organizational excellence, sustainable growth, competitive advantages and people centric approach using SPAR-4-SLR protocol technique. Reputed international journals of ABDC A*, A &amp; B ranking are referred to extract corresponding findings of quality research articles on strategic intents of progressive and transformational leadership. Using SLR method the study tries to collate relevant evidences based upon ‘systematic procedures and rationales’ disclosing key parameters of smart leadership required in today’s dynamic business world. Here, ‘smart’ word refers to a ‘learnt leader through experience’ than ‘a trained leader in a business school’. With the help of ‘Systematic Literature Review (SLR)’ technique, the study finds ‘idealized influence (4 component), intellectual stimulation (2 factors), individual consideration (4 factors) and inspirational motivation (4 factors) are identified as the key components of a strategic leadership in today’s VUCA world. The research also presents four elements of a smart leader viz. social intelligence, emotional intelligence, professional wisdom and spiritual intelligence.

Elterliches Belastungserleben, Unaufmerksamkeits‑/Hyperaktivitätssymptome und elternberichtete ADHS bei Kindern und Jugendlichen: Ergebnisse aus der KiGGS-Studie

ZusammenfassungHintergrundEine Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) bei Kindern und Jugendlichen geht mit elterlichen Belastungen einher. Umgekehrt sind psychosoziale Belastungen der Eltern mit dem Auftreten von Unaufmerksamkeits‑/Hyperaktivitätssymptomen (UHS) bei den Kindern assoziiert. In diesem Beitrag wird der Zusammenhang verschiedener Arten und des Umfangs elterlicher Belastungen mit UHS und einer elternberichteten ADHS-Diagnose der Kinder analysiert.MethodikAuf Grundlage der Daten von n = 4596 Teilnehmenden der KiGGS-Kohorte (Welle 2: 2014–2017) wurden in einer querschnittlichen Analyse elterliche Belastungen in Zusammenhang mit UHS sowie einer elternberichteten ADHS-Diagnose der Kinder gebracht. Berichtet werden Häufigkeiten, Mittelwerte sowie für Geschlecht, Alter, sozioökonomischen Status und Migrationshintergrund adjustierte Beta-Koeffizienten und Odds Ratios.ErgebnisseEinzeln betrachtet waren mehr elterliche Belastungsarten mit UHS assoziiert als mit einer ADHS-Diagnose. Multivariat betrachtet erwiesen sich finanzielle Sorgen und Erziehungsprobleme/Konflikte mit den Kindern als signifikante Prädiktoren sowohl für UHS als auch für eine ADHS-Diagnose des Kindes. 4 oder mehr elterliche Belastungen gingen zudem mit einer höheren Wahrscheinlichkeit sowohl für UHS als auch für eine ADHS-Diagnose einher.DiskussionFinanzielle Belastungen und Erziehungsprobleme stellen relevante Belastungen der Eltern von Kindern mit UHS oder ADHS-Diagnose dar. Wechselbeziehungen zwischen elterlichen Belastungen und der ADHS eines Kindes sind anzunehmen. Maßnahmen zur familiären Entlastung können entweder auf eine Verbesserung der familiären Lage (Verhältnisprävention) oder des familiären Umgangs mit dem von ADHS betroffenen Kind (Verhaltensprävention) zielen.

KEPEMIMPINAN DALAM ORGANISASI DI ERA DUNIA VIRTUAL

Pandemic has resulted many changes, Virtual world had become massively growing. Every aspects of life become more virtual and less physical. Most of organizations and company are having no different in phasing virtual era, they have to be moved their working space from the office to from home or even from everywhere. A team coordination and leadership inside it, is also shifted to be more challenging because of less physical meeting. The authors try to elaborates about leadership in virtual world era, when every physical meeting is limited. Is there any different from the previous era? And is there any certain expectations of the employees about their leader. Qualitative method through several times deep interview towards five interviewees is being used by the writers to get a picture towards the specific issue related on leadership in virtual era. After collecting the data, the writer will give an explanative description about the interview results. In this article, the author found transformational theories aspect such as idealist influence, motivational inspiration, intellectual stimulation and individual consideration are needed for some employees to enhance their quality of work.

Features of calculating the strength of gantry and ship cranes gear units in the probabilistic aspect

The performed study is the result of collecting statistical data on failures of port transshipment and floating cranes. It is found that many accidents of components and parts of crane mechanisms can be associated with an erroneous determination of design loads. In order to increase the strength reliability, numerous field tests were carried out in river and sea ports under various modes of transshipment for different types of cargo. Tests have shown that operational loads are random in nature, and their laws of distribution over time of individual crane mechanisms can be approximated by truncated normal Gauss laws, accounting for which at the stage of new design developments, as shown by the practice of performing strength fatigue calculations, is not possible. In the article, in order to use the obtained laws at the design stage, it is proposed to replace the representation of operational loads with initial moments that are common to the entire crane mechanism, and transfer individual characteristics consideration such as stress concentration coefficients, fatigue curve parameters, operating time or test base, to subsequent stages of machine components development. For practical testing of the operational loads representation by the normal Gauss laws, a critical analysis of their initial moments, which makes it possible to identify inconsistencies in the representations of variable loads proposed for strength calculation, is given. For the corrected truncated normal load distribution law, the initial moments, the value of the order of which corresponds to the formulas structure used in calculating fatigue resistance at variable load amplitudes (in particular, under alternating loading modes), are determined. The presentation of corrected normal distribution laws with initial moments complements the normative documents used in practice when performing strength calculations under variable loading conditions, significantly simplifies calculations and makes it possible to take it into account at the stage of new design developments in accordance with the formulas established in the current normative documents.

Public Opinion Through Art: Exploring Chinese University Students' Perspectives on COVID-19 Mass Nucleic Acid Testing.

In the context of the global COVID-19 pandemic, this study focuses on Chinese university students, employing graphic elicitation as a qualitative research method to analyze their hand-drawn paintings and related descriptions. Augmented by A/r/tography and metacognitive methods, the research aims to unveil the participants' collective memory, as well as the perspectives and responses of these students to policies related to the pandemic. By specifically examining this particular demographic, the study incorporates Fairclough's ethical theory, applying deontological ethics, consequentialist ethics, and virtue ethics to establish a comprehensive framework for evaluating adjustments to pandemic response policies. This research not only enhances our understanding of how these university students perceive and adapt to COVID-19 policies but also provides valuable insights for decision-makers. The particular methodology, combining graphic elicitation and metacognitive research, contributes to policy assessment and ethical analysis, offering a nuanced perspective on the interplay between individual perceptions, policy responses, and ethical considerations amid the complexities of a public health crisis.

Shifting Paradigms

Photo ID 117847165© Mohamad Faizal Ramli|Dreamstime.com INTRODUCTION In our cosmic narrative, for centuries we believed the Earth held the universe's center, a belief that shifted with evidence and transformed our understanding of our cosmic place. Correspondingly, paradigms surrounding autism have been shaped by medical assumptions that label it a condition, a disorder, or even a tragedy. Just as our understanding of celestial perceptions evolved, that Earth was not at the center of the universe, it is time for a seismic shift in how we perceive and address autism. ANALYSIS Venturing into autism research, we see the prevailing medical paradigm that defines Autism Spectrum Disorder (ASD) as a developmental disability caused by neurological differences.[1] Social communication, repetitive behaviors, language, movement skills, cognitive abilities, and emotional reactions—all cast as deficits.1 This narrative, embraced by researchers, medical professionals, and society, serves as the foundation of our current understanding. Yet, delving deeper unveils a counter-narrative—one not etched by researchers but articulated by those living with autism. This narrative introduces us to the neurodiversity paradigm, a revolutionary lens that sees autism as a part of the rich tapestry of human neurological development, fostering a stable cognitive landscape.[2] It posits that there is no singular "healthy" brain; and no definitive way of neurocognitive functioning.2 Shockingly, although this perspective is more inclusive, portraying autistic people as crucial contributors to humanity, it remains the more controversial model in society. Contrasting with the classical medical view that treats autism as a disease to be eradicated, the neurodiversity paradigm challenges the notion of normalizing society and underscores the importance of recognizing autism as an advancement. Without it, we would lose invaluable perspectives, strengths in attention to detail, visual perception, creative and artistic talents, mathematical and technical abilities, and expertise in ‘niche’ areas.[3] Asserting that every form of neurological development holds equal validity, deserving of respect and human rights, the neurodiversity paradigm counters the deficit mindset perpetuated by the traditional medical view. The repercussions of our medical-centric assumptions extend beyond perception; they infiltrate the very fabric of societal structures. Autism is labeled a disability. But is it autism that disables individuals, or is it the societal environment that excludes and alienates cognitive diversity? The traditional medical model points fingers at individuals, placing the onus on the differently abled person, not the disabling environments. For example, our societal perspective on disability is largely framed by the medical model, which views disability as an individual problem. According to this model, the disability is located within the person experiencing it—within individuals like me.[4] For instance, I often find myself becoming excessively overstimulated in places like department stores. The bustling environment—loud, brightly lit, unpredictable, and crowded—is a sensory challenge. Following the medical model attributes my struggle in department stores to a perceived problem with the way my brain processes sensory inputs, attributing it to my autism. The consequences of the medical model are far-reaching and profound, particularly in shaping our understanding of autism. This perspective places undue blame on those with autism and directs the focus of research toward "curing" autism rather than addressing societal structures that contribute to exclusion and alienation. One glaring example of this misguided approach is the predominant focus of autism research on finding a cure, as seen in 2020 with a major research theme centered around gene therapies aimed at altering the genetic factors associated with autism-related conditions.[5] Even influential organizations like Autism Speaks, until 2016, subscribed to the notion of seeking a cure.[6] Their evolution, acknowledging the need to listen to the lived experiences of autistic individuals, led to a shift in their mission—from searching for a cure to promoting advocacy, support, understanding, and acceptance.6 This shift highlights the importance of moving away from the medical model. Instead, we should adopt more inclusive models like the neurodiversity or social model of disability, which are rooted in the idea that neurological differences, including autism, are natural variations of the human brain. Listening to the voices of those with autism and embracing the social model of disability allows us to recognize that disabling factors often reside in societal structures, not within the individuals themselves. This paradigm shift is crucial for fostering an inclusive society that values and accommodates cognitive diversity. For instance, when we enter the social model of disability—an alternative lens that shifts the blame from the individual to the environment, it views disability not as a characteristic but as an action done to individuals by society4. In this model, going to a department store is not a struggle for me because there is something inherently wrong with me, but it is a struggle because the environment around me does not cater to my diverse needs. Imagine if our world, including department stores, were designed with neurodiversity in mind—quiet, dimly lit, predictable, and spacious. Neurodivergent individuals would still be cognitively different, but their surroundings would not disable them. Adopting the social model of disability would catalyze shifts in research and attitudes toward autism, reflecting the transformative changes observed in the department store examples. Rather than focusing on changing autistic individuals to fit societal norms, the emphasis would shift to enhancing the lives of neurodivergent people by advocating for structural changes in society. This shift aims to foster inclusivity while preserving individuals' authenticity and embracing their unique differences. Autistic individuals are not seeking a cure for autism because our neurodivergent way of thinking is integral to our identity. Yet, the considerable funding directed toward researching autism's causes for prevention or a "cure" underscores a lack of consideration for our voices in deciding how research funds are utilized. The emphasis on normalization, a cornerstone of the medical model's view of autism, prioritizes societal desires over the well-being of autistic individuals already part of our society. It is imperative to recognize this flaw in research that aims to cure autism, as it risks genetic research for eugenic purposes, necessitating regulation by the autistic community.[7] Redirecting resources from the pursuit of an unwanted cure to research supporting and empowering autistic people to lead fulfilling lives is essential. This redirection involves investing in communication research, offering tools such as communication boards, picture exchange communication systems, speech-generating devices, or sign language for nonverbal or speech-challenged autistic individuals, giving them a voice in our society.[8] Community living research, centered on community inclusion programs, not only provides services but also educates and reinforces accommodations for daily activities such as in schools, workplaces, or even in department stores as stated in the example.[9] Attention to support services for autistic individuals and their families, including residential and day support programs, respite, recreation, and transportation, is crucial.[10] A commitment to promoting lifelong support for autistic individuals necessitates advocating for caregiver support, home and community-based services, financial planning resources, and more.10 Additionally, research aiming to identify qualitative results of adaptation and modification strategies to support inclusive education for autistic students is paramount at school and classroom levels.[11] Research to improve healthcare quality and the healthcare system for autistic individuals is also essential, as they face shorter lifespans and worse health than non-autistics.[12] All these research initiatives align with the principles of the social model of disability. However, as a society that does not follow the social model; the bulk of our understanding of autism is rooted in research driven by medical assumptions and paradigms. In 2022, the United States allocated $306 million to autism research[13]. However, a considerable portion of this research approaches autism as a problem to be solved. An examination of a comprehensive study focused on the allocation of NIH autism research funding from 2008 to 2018 reveals a striking trend. In this distribution, 49.7% of the total funds were allocated to treatment development and evaluation, which represented 53.6% of all projects.[14] This statistic underscores a predominant emphasis on genetic and biological research. However, the goal of such research is not only to understand the underlying reasons for autism so we can cure it. But this research also explores ways of prevention or management of autism through pharmacological treatment or behavioral therapies like intervention or Applied Behavioral Analysis, both of which are intervention models focused on changing the external behaviors of autistic individuals, with the goal of making an autistic person look and act non-autistic.14,[15] Contrastingly, only a minimal fraction of NIH funding—9.1%, approximately $225 million out of nearly $2.5 billion dedicated to ASD research—was channeled towards services-related research.14 This includes critical areas such as improving accessibility and quality of services in the community, characterizing understudied groups, policy development, dissemination, and implementation.14 This glaring discrepancy highlights a diminished emphasis on services research in funding decisions, revealing an imbalanced focus on biological and risk factor research, aiming to eliminate differences rather than seeking ways to integrate accommodations that allow autistic individuals to authentically express themselves within societal structures. The consequence of this skewed prioritization is evident in distressing statistics. Autism affects about 1 in 100 children worldwide, and yet 85% of college-educated adults on the autism spectrum face unemployment—twice the rate of their non-autistic peers.[16],[17] 7 out of 10 autistic individuals wrestle with mental health conditions, including anxiety, depression, ADHD, or OCD.[18] Alarmingly, the suicide rate among autistic individuals is three times higher than the general population.[19] Similarly, individuals with autism have an average life expectancy of 54 years, a staggering 16 years less than the average age of mortality for the general population.[20] And we deserve better. These disheartening realities underscore the urgent need for a paradigm shift in our approach to autism within society. It is crucial to recognize that masking autistic traits is not the optimal outcome for individuals with autism. In fact, hiding autistic traits has been linked to worse mental health outcomes and increased suicidality in autistic adults.15 Services and support systems are required to enable autistic individuals to lead long, happy, and fulfilling lives while respecting their right to be authentically autistic. Embracing neurodiversity is not only a matter of ethical consideration and benefit for autistic individuals but also cultivates progress, acceptance, and overall societal growth for all. CONCLUSION The call for change is clear—we need research initiatives led by autistic individuals, addressing the questions that matter most to the community. We need more autistic individuals in the medical profession to advocate for improvements in the medical perspective. Having only 1% of autistic individuals in the medical profession is no longer enough.[21] Just as the sun is not the center of our universe, individuals with autism are not a tragedy. They deserve a future built on understanding, inclusion, and support. - [1] “Signs and Symptoms of Autism Spectrum Disorders.” Centers for Disease Control and Prevention. Last modified, 28 Mar. 2022, www.cdc.gov/ncbddd/autism/signs.html#:~:text=Autism%20spectrum%20disorder%20(ASD)%20is,%2C%20moving%2C%20or%20paying%20attention. [2] Robinson, John Elder. “What Is Neurodiversity?” Psychology Today, Sussex Publishers, 7 Oct. 2013, www.psychologytoday.com/us/blog/my-life-aspergers/201310/what-is-neurodiversity. [3] “Focus on Strengths as Well as Challenges.” Autistica, 17 Oct. 2019, www.autistica.org.uk/news/focus-on-strengths-and-challenges. [4] “Office of Developmental Primary Care.” Medical and Social Models of Disability | Office of Developmental Primary Care. Accessed 26 Oct. 2023, https://odpc.ucsf.edu/clinical/patient-centered-care/medical-and-social-models-of-disability. [5] “Hot Topics in Autism Research, 2020.” Spectrum, 3 Mar. 2023, www.spectrumnews.org/features/hot-topics-in-autism-research-2020/#:~:text=Gene%20scene,be%20administered%20early%20in%20life. [6] “Questions and Answers.” Autism Speaks. Accessed 26 Oct. 2023, www.autismspeaks.org/autism-speaks-questions-answers-facts#:~:text=It%20was%20the%20right%20decision,research%20for%20the%20autistic%20community. [7] “Research.” Autistic Self Advocacy Network, 31 Aug. 2023, autisticadvocacy.org/research. [8] “7 Autism Behavior and Communication Strategies.” National University, 23 Sept. 2021, www.nu.edu/blog/7-autism-behavior-and-communication-strategies/#:~:text=Strategy%20%231%3A%20Using%20Communication%20Boards,photographs%2C%20illustrations%2C%20or%20symbols. [9] “Inclusion: Ensuring Access for Everyone.” Autism Speaks. Accessed 26 Oct. 2023, www.autismspeaks.org/tool-kit-excerpt/inclusion-ensuring-access-everyone. [10] “Support for Family Members.” Autism Speaks. Accessed 26 Oct. 2023, www.autismspeaks.org/autism-support-family-help#:~:text=People%20with%20autism%20and%20the,%2C%20recreation%2C%20transportation%20and%20others. [11] Petersson-Bloom, Linda, and Mona Holmqvist. “Strategies in Supporting Inclusive Education for Autistic Students-A Systematic Review of Qualitative Research Results.” Autism &amp; Developmental Language Impairments, U.S. National Library of Medicine, 21 Sept. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9620685/. [12] Weir, Elizabeth, et al. “Autistic Adults Have Poorer Quality Healthcare and Worse Health Based on Self-Report Data - Molecular Autism.” BioMed Central, BioMed Central, 26 May 2022, molecularautism.biomedcentral.com/articles/10.1186/s13229-022-00501-w. 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Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study.

The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.

Decision Considerations in Labor Market Flexibility under the Phenomenon of “Valley Circle”

The “Valley Circle” refers to a group of enthusiasts passionate about derivative products related to characters from fiction, animation, and games. This phenomenon has, to some extent, reshaped the consumer market and also impacted the labor market. Under the influence of the “Valley Circle” phenomenon, individual decision-making considerations in the labor market have become more complex. The phenomenon has enhanced labor market flexibility. With the development of internet technology, many professions related to “Valley Circle” have emerged, such as character designers, illustrators, and game developers. These professions often emphasize individual creativity and skills rather than geographical location, offering more opportunities for remote work. This flexibility not only helps individuals better balance work and life but also provides a wider geographical choice when choosing a job. Therefore, in decision-making considerations, individuals should fully assess their interests, skills, and long-term career planning, weighing the pros and cons comprehensively to make the most suitable choice for themselves.

Adapting the Multiple Sclerosis Functional Composite for Telehealth Administration Using Videoconference Delivery: Methodological Considerations and Interrater Reliability

ObjectiveTo describe the adaptations made and to examine interrater reliability and feasibility of administering a telehealth version of the Multiple Sclerosis Functional Composite (tele-MSFC). DesignThe Multiple Sclerosis Functional Composite (MSFC) is a commonly used, in-person clinical outcome assessment. It is composed of the timed 25-Foot Walk Test (T25FWT), Nine-Hole Peg Test (NHPT), and Paced Auditory Serial Addition Test (PASAT). The MSFC was adapted for videoconference administration as part of a larger clinical trial. One of the adaptations included administering a timed 12.5-Foot Walk Test (T12.5FWT) for participants who did not have adequate space in their homes for the T25FWT. Participants, examiners, and raters completed surveys online about their satisfaction and experience with tele-MSFC. SettingParticipants underwent the tele-MSFC in their homes using a laptop or smartphone while examiners scored the tele-MSFC in real-time at a remote location. ParticipantsAdults (n=61) with mild-to-moderate multiple sclerosis (MS) symptoms. InterventionsNot applicable. Main Outcome MeasureTele-MSFC. ResultsIntraclass correlation coefficients (ICC) assessed interrater reliability between the examiner and 2 independent raters who later scored a recording of the tele-MSFC. Interrater reliability was excellent (ICC>0.90) for all tests, including the T12.5FWT. Participants were highly satisfied with tele-MSFC. However, challenges included adequate space for T25FWT, technical difficulties, and safety and privacy considerations of individuals with moderate impairments who were requested to have their caregivers present during testing. ConclusionThe tele-MSFC is reliable and feasible to administer with adaptations for adults with mild to moderate MS symptoms. Further validation of T12.5FWT is needed.

Transformational Leadership Influence on Employee Performance: A Proposed Study Among Palestinian Central Municipalities Employees

This research investigates the impact of transformational leadership on employee performance within Palestinian municipalities. As a vital cog in the management wheel, transformational leaders inspire and motivate employees, encouraging innovation and promoting excellence. Using a quantitative research approach, this study collected data from administrative staff in ten central Palestinian municipalities, leveraging questionnaires and statistical analysis. Our findings reveal the significant positive impact of transformational leadership behaviours, including inspirational motivation, intellectual stimulation, idealized influence, and individual consideration, on employee performance. The research also underscores the role of goal setting, as emphasized by Fischer (2016), in driving individual commitment and motivation. Further, this study discusses how transformational leadership contributes to successful teamwork and fosters a culture of creativity and problem-solving. It presents a set of recommendations for implementing transformational leadership in Palestinian municipalities, including leadership training, employee empowerment, communication of a compelling vision, and fostering a culture of innovation, among others. By adhering to these strategies, Palestinian municipalities can enhance employee performance and improve public service provision.

Exploring caring collaborations in academia through feminist reflexive dialogues

AbstractThis study challenges the prevailing collaboration norms within academia, which predominantly adhere to meritocratic principles favoring masculine and individualistic values. These principles often result in a productivity paradigm centered on publications and high research performance. We contend that such collaboration norms perpetuate exclusionary practices, limiting the participation of women and individuals who do not neatly conform to the criteria of high productivity. Drawing inspiration from Long and colleagues' work in 2020, and guided by relational care ethics, we developed the notion that collaboration as a feminist strategy represents a transformative process of reflexive becoming and co‐learning, emphasizing connectedness and generativity through care. Our findings highlight that through the lens of care, we transcended differing viewpoints, transitioning from self‐centeredness to an other‐oriented approach characterized by empathy, mutual understanding, and acceptance. Emotions emerged as embodied forms of knowledge, enriching the process of co‐learning and co‐becoming. Based on this, we propose a new constellation of Feminist Caring Collaboration in the academy, emphasizing the inclusivity of diverse participants and their varied skills and competencies, with full consideration of individuals' needs and future growth opportunities. Furthermore, we advocate for a broader acknowledgment of emotions such as satisfaction, joy, friendship, and pleasure in the knowledge production process, recognizing their significance in individuals' fulfillment in work and various life circumstances.