Motorcycle accidents can impede sustainable development due to the high fatality rate associated with motorcycle riders, particularly in developing countries. Although there has been extensive research conducted on motorcycle accidents on highways, there is a limited understanding of the factors contributing to accidents involving the most commonly used motorcycles on local roads. This study aimed to identify the root causes of fatal motorcycle accidents on local roads. The contributing factors consist of four groups: rider characteristics, maneuvers prior to the crash, temporal and environmental characteristics, and road characteristics. The study employed random parameters logit models with unobserved heterogeneity in means and variances while also incorporating the temporal instability principle. The results revealed that the data related to motorcycle accidents on local roads between 2018 and 2020 exhibited temporal variation. Numerous variables were discovered to influence the means and variances of the unobserved factors that were identified as random parameters. Male riders, riders over 50 years old, foreign riders, and accidents that occurred at night with inadequate lighting were identified as the primary factors that increased the risk of fatalities. This paper presents a clear policy recommendation aimed at organizations and identifies the relevant stakeholders, including the Department of Land Transport, traffic police, local government organizations, and academic groups. Thailand has the highest rate of road accident fatalities in ASEAN and ranks ninth globally, with an estimated death rate of 32.7 per 100,000 people, as per the projections made by the World Health Organization ,5. NumerThere are three main road types in Thailand. First, arterial and highway roads refer to roads that connect provinces or districts. These usually consist of a large number of lanes focused on mobility, and they have heavy traffic volumes. In Thailand, these roads are maintained by the Department of Highways. Second, collector and distributor roads focus on connecting the highway to the district or to connecting districts with 2–4 traffic lanes and a low number of cars . This grConsidering only motorcycle-related crashes classified by road type in Most studies on road accidents utilize crash data and typically employ an analytical method based on the dependent variable’s characteristics, such as the severity of injuries sustained. As a result, a logit model is often utilized as the statistical model . In estiThe objective of this study was to examine the risk factors that have an impact on the fatality rate in motorcycle accidents on local roads. Additionally, because motorcycle crash severity may also exhibit temporal variations, this study additionally considered the concept of temporal instability. By shedding light on the underlying factors contributing to motorcycle accidents, this study can aid in developing effective policies and recommendations to reduce the severity of such accidents on local roads. The relevant agencies responsible for constructing and maintaining the roads, as well as those in charge of road safety, can use the results of this study to implement appropriate measures and recommendations.The present research article is divided into several sections. The first component is a review of factors that may influence the severity of motorcycle crashes. This is followed by a discussion of the analytical methods and of model development. The subsequent section details the dataset and its preparation for analysis. The next section is called the Temporal Stability Test, which was used to evaluate the model’s suitability for each year and over a three-year period. The results section provides an overview of the preliminary analysis findings. The discussion section provides a comprehensive argument supporting the model’s validity and explaining the various crash factors, such as rider characteristics, maneuvers prior to the crash, and temporal and environmental factors. The final section summarizes the study results and offers policy recommendations based on the model’s findings, along with application guidelines.According to previous research, the rider is consistently identified as the primary factor contributing to accidents. This is determined by various variables that can be grouped into different dimensions. For instance, differences in collision speeds caused by different genders can lead to varying levels of injury severity . YoungerThis group of factors is considered to be the underlying causes of crashes and encompasses several factors, such as exceeding the speed limit. This variable is present in crashes that occur at high speeds where the vehicle is thereby unable to brake in time, especially when colliding with fixed objects such as light poles, kilometer markers, and semis. Such crashes often result in more severe collisions . AnotherThis group of factors pertains to the temporal and environmental factors that may affect traffic volume and road user characteristics. The duration of a festival that coincides with a long holiday has an influence on crash characteristics. As a result, there are many intoxicated motorcyclists on local roads who drive at high speeds with delayed reaction times, potentially increasing the severity of crashes . During The rider’s ability to perceive and make decisions to reduce speed and prevent crashes is impacted by their visibility. This group of factors includes the time of day, such as daytime or nighttime. During the day, visibility is generally good, but the severity of daytime crashes may be higher than those at night due to higher speeds used by motorcyclists . AnotherThe readiness and physical characteristics of the road surface can have a significant impact on driving speed and, ultimately, the severity of crashes. This category of factors includes various examples such as road maintenance, where closed traffic lanes can cause sudden braking and result in a potential collision . Anotherm sustaining injury j, m sustaining an injury severity j,The main objective of this study was to establish the relationships between the independent variables and the dependent variables that contribute to the death of a motorcycle rider. Injury severity was categorized into two groups: fatal and non-fatal. To analyze the data, the study employed a statistical modeling approach using the concept of random parameters that account for heterogeneity in both means and variances. The parameter estimation first introduces a function that assesses the severity of the crashk is the number of estimated parameters [The McFadden cal data  as follonts only . Althougnts only . With rarameters . Furtherrameters .To develop a random parameter logit model that takes into account unobserved heterogeneity in means and variance, the researchers utilized Nlogit version 6. The Halton sequence of draws was selected for the model’s development, as it provides speed gains without adversely affecting simulation performance . In thisThis study analyzed data from accidents that took place on Thai local roads maintained by the Royal Irrigation Department, local government organizations, municipalities, or Bangkok Metropolitan from 2018 to 2020. Crashes that occurred on highways and rural roads were not included in the dataset. Prior to the analysis, a binary code was employed to prepare the data in which 1 indicates a certain value, and 0 indicates all other values. The definitions of the variables can be found in The outcome variable, which pertains to the number of fatalities resulting from motorcycle crashes, was scaled down to a single rider, where a value of 1 signifies death and 0 indicates other injury levels, including severe or minor injuries . The ind2 and using data subset m1 at the same time. The tests were also reversed for each pair. This process was repeated six times until six pairs were completed. The null hypothesis for the likelihood ratio tests was that the impact of various factors on injury levels over two years was not different (or was the same). The level of confidence was determined using the The Temporal Stability Test gauged the dissimilarity between crash datasets for each year using the likelihood ratio test principle, which was employed to compare two distinct years as follows :(6)χ2=−2rameters .Another assessment involved determining whether a model was more fitting when partitioned into yearly intervals as opposed to model development utilizing the entire dataset . The lik2ρ and Adjusted McFadden 2ρ of the random parameter logit model were more favorable than those of the traditional logit model. The random parameter model, which incorporated unobserved heterogeneity in means and variance, showed McFadden 2ρ values ranging from 0.133 to 0.141. Among the three models, the 2018 model exhibited the highest value, followed by 2020 and 2019. The adjusted McFadden 2ρ values ranged from 0.125 to 0.137, which falls within an acceptable range for interpreting the results and making policy recommendations for road safety [After evaluating the goodness of fit for the three models, as displayed in d safety .In general, a number of parameter estimates were found to be significant. The results of the 2018 analysis are presented in To examine the heterogeneity in the mean of the random parameters, it was found that licensed riders decreased the mean of crashes during festivals, resulting in a lower chance of fatal crashes. On the other hand, drunk riders and dry road surfaces decreased the mean of the gender variable, whereas licensed riders increased it. The mean of the local address variable was increased by the dry road surface variable, indicating a higher likelihood of fatal crashes. In addition, the afternoon peak hour was found to increase the variance of the random parameter of the local address variable.Several factors were found to be affected by other factors in terms of the effect of heterogeneity on the means of the random parameters. Wet road crashes reduced the mean of the festival duration variable , whereas the helmet variable and daytime collisions increased its mean . The mean of the variable for crashes on dry surfaces was affected by several factors, including drunk rider, helmet, license, daytime, and age. The drunk rider variable reduced the mean of foreigner involvement in crashes. In terms of heterogeneity in the variance of the random parameters, the variable for riders under 30 reduced the variance of crashes on dry roads. In terms of heterogeneity in the means of the random parameters, the mean of the festival duration variable was reduced by the indicator for licensed riders, whereas it was increased by the smoke indicator. The mean of the drunk rider random parameter was increased by the daytime and wet road variables, whereas the indicator for crashes that occurred in the rain decreased the mean of drunk riders. The indicators for mobile phone use and rain decreased the mean of the helmet random parameter, whereas those of the curve and license parameters increased its mean. The license parameter also increased the mean value for the gender random parameter. The variance of the helmet variable was affected by the local address and darkness parameters (which increased the variance) as well as the afternoon peak hour (which decreased the variance).In this section, the parameter estimation results are presented, highlighting the parameters’ effects’ instability over time. The effects of factors are compared using the ME and presented in Throughout the three studied years, the data consistently indicated that male riders were more likely to suffer fatalities in the event of a crash. This is likely due to the fact that men tend to drive more aggressively than women, particularly on local roads where policing and law enforcement are minimal. This finding is consistent with previous research by Abrari Vajari, et al. . HoweverThe age factor of riders is comprises two variables: those under 30 years old and those over 50 years old. Young riders had a consistently low chance of fatality each year, whereas older riders had a high chance of death. Despite the fact that young riders tend to drive more aggressively, older individuals are more likely to sustain injuries during crashes, and these injuries can be more difficult to treat . NeitherIn terms of rider experience and familiarity with the area, the results showed that riders who were from the same district as the crash location had a lower chance of being killed in that crash compared to those from outside the area. This could be due to their familiarity with the roads and traffic, which could help in making quick decisions, thereby reducing the risk of injury. Across time periods, the values were close to each other . Foreign riders had a high probability of dying in crashes, which may be attributed to their limited knowledge of traffic rules and signs as well as their unfamiliarity with common road behaviors. Additionally, the collisions that occur as a result of sudden cutting in front of foreign riders are more likely to be fatal . In termThe law-related variables include wearing a helmet and possessing a rider’s license. The analysis results revealed that having a rider’s license was insignificant, indicating that it does not ensure a decrease or increase in the chance of death from a crash, perhaps due to the ease of obtaining a motorcycle rider’s license in Thailand. However, it does help in reducing the frequency of crashes. On the other hand, for the helmet variable, the 2018 and 2020 results were conflicting, and both produced significant random parameters. In 2018, the majority of people wearing helmets had a higher risk of death (ME = 0.0154). The probable reason for this is that helmet wearers tended to be more confident or drive at higher speeds. Additionally, as there are various types of helmets available, local road riders do not prioritize standard and costly helmets, and instead, they purchase non-standard helmets. Therefore, in the event of a crash, the risk of death would be still high. However, the 2020 data demonstrated that the use of helmets reduced the likelihood of death (ME = −0.0756), which is understandable considering the improvement in the quality of riders’ helmets and the intense efforts of helmet-related agencies to spread awareness to the public .The crash characteristics refer to the factors that contribute to the occurrence of the crash. Exceeding the speed limit was found to have a high risk of resulting in fatalities, which is consistent with the findings of Se, et al. . This isNext, the variables for crashes that were caused by traffic signal violations include disregarding no-overtaking signs or lines, not yielding at intersections, and running red lights. These variables were found to have a significant positive correlation with the risk of fatal crashes. This may be due to these violations causing collisions with high impacts, such as those occurring at intersections involving different types of vehicles. Regarding wrong-direction driving, there was a higher risk of associated fatalities, which contradicts the findings of Chung, et al. , who didCrashes resulting from mobile phone use had a lower probability of fatalities and were only significant in 2019. The probable explanation for this is that when motorcyclists use their mobile phones while driving, they realize that they cannot effectively control their vehicle, which typically leads them to drive at slower speeds. As a result, the occurrence of crashes may be due to sudden braking or falling over, and the level of severity is typically minor. This is consistent with the findings of Islam , who fouThe likelihood of fatalities resulting from falling asleep while driving was only significant in 2018, indicating that motorcyclists rarely fell asleep while riding in the following years. Sudden cutting is another contributing factor to the high frequency of motorcycle crashes due to the motorcycle’s high mobility and the carelessness of riders on local roads. However, this study determined that this factor was unlikely to cause fatalities . This can be attributed to the fact that most motorcycle riders would likely notice sudden cutting and apply their brakes in time, resulting in less severe crashes. Interestingly, intoxicated riders were discovered to have a reduced likelihood of fatalities in the event of a crash. This outcome contradicts findings from several studies . A possiThe overall variables in this group were found to go in the same direction over the three years studied. Motorcycle crashes were less likely to result in death during a festival period, a variable with a relatively negative ME . This may be due to the relatively high traffic volume and strict traffic discipline during the festivals, making riders on local roads aware of their speed [The subsequent variable was the timing of crashes. The morning rush hours in 2018 and 2019 were significantly correlated with a high likelihood of fatalities, indicating that crashes occurring between 7 and 8 am had a higher probability of being fatal. This could be due to people being in a hurry to get to work or school and having reduced awareness. Furthermore, accidents involving vulnerable road users (VRUs), such as motorcyclists, would almost certainly result in fatalities during this time of day . HoweverRegarding the time of day, the analysis results indicated that daytime crashes had a lower likelihood of fatalities and were only significant in 2018. This finding is consistent with the study conducted by Li, et al. , which sIn terms of variables associated with a crash scene on a road undergoing construction or maintenance, it was discovered that the chance of fatalities was significantly high in 2020 with an extremely high ME value (ME = 0.3518) second only to illegal overtaking maneuvers. This suggests that roads under maintenance pose significant danger. The probable explanation is that local roads are not regularly maintained, causing riders to be unfamiliar with the road and receive insufficient warning before reaching the construction site . With reRegarding curved road sections, they were associated with a greater risk of fatalities, but it was only significant for 2018 and 2019, suggesting that road safety campaigns and inspections were minimal during those years. Many curved roads remain unrepaired, but in 2020, there may be several agencies in charge of handling crashes by checking and improving hazardous areas. Thus, this variable became insignificant in 2020. In terms of the dry and wet road surface variables, the analysis results revealed that dry road surfaces have a high likelihood of causing fatalities, particularly in 2020, potentially because riders in that year were likely to ride at high speeds. This is consistent with the analysis results of the “exceeding the speed limit” variable, which found that if a crash occurred due to this reason, the crashes would be more severe in the 2020 model. These results also align with the findings of various studies, including that of Se, et al. , who fouRoad crash research has predominantly concentrated on roads with high mobility, such as highways and arterial roads, due to their classifications of accessibility and mobility. However, local roads, which emphasize accessibility, also contribute significantly to fatalities resulting from road crashes. This study aims to examine the factors that influence fatal motorcycle crashes on local roads to improve our understanding of road crashes. The outcomes of this study can be utilized to develop policy recommendations by relevant agencies such as local government organizations, the road safety center, and the Ministry of Public Health to improve motorcycle safety.This study employed four categories of variables, namely rider characteristics, maneuvers prior to the crash, temporal and environmental characteristics, and road characteristics. To conduct the statistical analysis, a model that took into account the heterogeneity in means and variances of random parameters along with the principle of temporal instability was utilized in the study.The summaries of the key findings are as follows. The study found that motorcycle-involved crash data on local roads from 2018 to 2020 varied by year. Many variables in each year were found to be statistically significant random parameters, and their means and variances were affected by other considered risk factors. In terms of rider characteristics, male riders had a tendency to increase their risk of being fatally injured over time compared to the female rider counterparts. Riders over 50 and foreign riders were significant variables in 2018 and 2020 that tended to also increase the chance of fatalities. Numerous cause-related factors were found to be positively associated with fatal crashes, including exceeding the speed limit, disobeying traffic signs, illegal overtaking maneuvers, and driving in the wrong direction. These factors may constitute rather worrisome variables, as they were significant in all three-year models with a higher chance of death. On the contrary, some factors from this variable group were associated with a decrease in injury severity levels, including crashes due to sudden cutting in front and mobile phone use while driving. Regarding the time of the crashes, the morning peak hours produced a higher likelihood of fatal crashes, whereas crashes during the afternoon peak hours and during festival occasions were less likely to cause fatal injuries. Regarding environmental factors, most models discovered that low-light conditions or poor visibility would increase the likelihood of a fatal crash . Finally, regarding roadway attributes, curved roads and areas under maintenance or construction were also found to have a higher risk of causing fatal crashes.To develop policy recommendations, factors that had significant effects or had high and sustained marginal effects over several years were considered. The variable of rider gender showed that male riders were more prone to aggressive behavior than female riders. An actionable policy recommendation could be to present statistical data on gender and the likelihood of death to increase rider awareness of the danger, and to promote awareness of the probability of death while driving on local roads by relevant agencies such as the Department of Land Transport, which is responsible for driver’s license training. For elderly riders, public relations posters or notices should be created to help them understand that their physical attributes are not as robust as those of teenagers, which increases their risk of death in the event of a crash. This could be promoted by relevant agencies such as the Thai Health Promotion Foundation  through media such as television. To educate foreign riders, it is essential to provide knowledge before allowing them to rent a vehicle, such as information on Thai people’s driving behavior, the meaning of warning signs, and the basic traffic rules, such as speed limits. Additionally, related agencies, including the Ministry of Tourism and Sports and the Traffic Police, could take necessary action.During the morning rush hour, there was a heightened risk of fatalities. It is imperative that a public awareness sign be displayed to emphasize the need for extra caution between 7:00 a.m. and 8:00 a.m. Raising riders’ awareness of the dangers of excessive speed during the morning rush hour is crucial and can be promoted through various sources such as government centers, schools, universities, and other places of activity. The high speeds of motorcycles during the morning rush hour pose a significant risk and should be addressed in training for students and parents. The relevant government agency responsible for road management should also consider implementing measures to control speed during the morning rush hour. These countermeasures should specifically target rushing riders, such as by posting speed limit signs near schools and other high-traffic areas. Despite the fact that a cohort of helmet-wearing riders had a higher probability of fatal crashes in 2018, it lowered the chance of fatal injury in 2020. As a result, a consistent campaign for helmet-wearing should be implemented, both in the form of public relations in schools and villages and through various online media.Excessive speed continues to be a prevalent cause of accidents, posing a significant danger of fatalities. As a result, ongoing efforts to instill a sense of discipline in terms of traffic speed are essential to raising riders’ awareness of the severity of potential injuries. This can be achieved through multimedia campaigns that illustrate the correlation between speed and impact force. Agencies such as the Thai Health Promotion Foundation can leverage various media channels or websites to disseminate this information. In terms of traffic engineering, it is recommended to consider implementing road markings that promote lower speeds, such as those that say, for example, “Reduce speed in horizontal curves.” In areas with high traffic volumes, such as urban areas, traffic calming measures may be necessary . ThroughThe study found that crashes during nighttime hours, regardless of the presence of lighting, resulted in significantly higher crash severity due to the limited budget allocated to local roads. This results in inadequate lighting compared to larger roads prioritizing mobility. To address this issue, it is important to identify areas where crashes are likely to occur at night and to install appropriate lighting there. The local government organization is best suited to undertake this task and can collaborate with educational agencies or academic institutions to determine the most hazardous areas. In addition, relevant agencies should consider installing highly visible line markings and pavement markings on roads to enhance road safety.The road characteristics variables revealed that roads undergoing construction or maintenance pose a high risk of death. Thus, it is recommended that public relations efforts be made to inform individuals in the area of the risks associated with such construction sites, and standardized signs should be placed in accordance with engineering principles. Moreover, a contracting agency should conduct regular inspections based on road safety audit principles. As for curved areas, the risk was only significant in 2018 and 2019. However, it is important that responsible organizations regularly assess the suitability of curves, including factors such as visibility, the speed when entering curves, and curve warning signs.This study is a preliminary study of motorcycle crashes on local roads, which included those in both urban and rural areas. Therefore, there are some issues that require further study, such as the comparison of motorcycle crash severity in urban and rural areas. Determining an appropriate budget for road safety promotion requires considering economic aspects , as highlighted in previous studies . For loc


Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. Materials and methods: We conducted a literature search for scientific articles published from 2012 to 2022  with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. Results: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE , whereas the CAM , CAM-ICU  and RASS  were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. Conclusions: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team. Delirium and dementia are two of the most common causes of cognitive impairment in older people. Delirium is a clinical syndrome characterized by disturbances in consciousness, cognitive function or perception, with acute onset and course that develops over a short period of time and tends to fluctuate . It is aTo date, pharmacological treatments have shown to be ineffective for delirium prevention and treatment . MoreoveThe aim of this review is to explore the literature regarding the methods used to assess the cognitive, functional status and quality of life and to describe the rehabilitative interventions adopted in the studies involving occupational therapy (OT) and physical therapy (PT) for the prevention and treatment of older patients with delirium, dementia and DSD across various settings of care.For this scoping review, we focused on the studies that examined the role of OT and PT in preventing and treating delirium and DSD in older adults. The following research questions were asked: 1. Which assessment tools were used to screen for delirium and dementia? 2. Which tools were used to assess the functional status and the quality of life of both the persons with delirium and dementia and their caregivers (outcomes)? 3. Which kind of interventions were performed during OT and PT during the rehabilitative sessions?We searched in the scientific database PubMed and the database CINAHL, MEDLINE and AMED (using the EBSCO search mask) using a combination of keywords: physiotherapy OR physical therapist OR pt AND delirium AND dementia; delirium AND prevention OR intervention OR treatment OR program AND physiotherapy OR physical therapist OR pt; occupational therapy OR occupational therapist AND delirium AND dementia; delirium AND prevention OR intervention OR treatment OR program AND occupational therapy OR occupational therapist OR ot.Studies were included if they were experimental , exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical case studies) and if the mean age of subjects was ≥65 years. Articles that did not include specific OT or PT classifiable interventions and reviews were excluded. In addition, articles not written in English and published in nonpeer-reviewed journals were excluded.We decided to limit our literature search only to the studies published in the last decade (from January 2012 to July 2022) since these publications accounted for the majority (58.45%) of all those published on this topic from the beginning up to the present. Below is The original search yielded a total of 326 articles, which, after applying the exclusion criteria, were finally reduced to 9 studies. The global number of patients enrolled across studies was 887, ranging from a minimum of 6 to a maximum of 370 individuals, depending on the study. Two studies were conducted in an orthogeriatric unit ,11, two Several tools were used to assess delirium and dementia. Four studies ,11,12,13The Barthel Index (BI)  was the Qualitative interviews with caregivers and staff were used in two studies ,16 whereThe rehabilitation interventions were heterogeneous. Most studies in PT reported either the early mobilization or motoric exercises as the core elements of the interventions ,11,12,13By looking at the studies that included an OT intervention, Alvarez et al. reported the use of polysensorial stimulations  and specific activities that were perceived as meaningful by the patient . A similThe lack of control groups and randomization do not allow conclusions to be drawn on the generalization of efficacy of the interventions in most studies. However, physiotherapy and occupational therapy for the older people with delirium or delirium superimposed on dementia (DSD) can be assumed:-Person-tailored exercises at a moderate intensity can improve motor performance, autonomy, cognitive functions and quality of life, but not delirium incidence .-Early mobilization can reduce 30-day readmission, falls, pressure sores and respiratory adverse events in ICU patients. Moreover, these interventions can improve independence in activity of daily living but cannot shorten the length of stay .-OT intervention is feasible ,15,16,17This review aimed at exploring the literature regarding the methods used to assess cognitive and functional status and quality of life and the types of physiotherapy and occupational interventions carried out for the prevention and treatment of patients with delirium, dementia and DSD across various settings of care.An important insight is that we only found 9 studies that addressed these issues. Although our literature search was limited to the articles published during the last 10 years in the commonly used databases and did not start from their inception, we found very few such studies. The role of both PT and OT is universally acknowledged as crucial to prevent and manage delirium, dementia and DSD, but, in fact, it is still undervalued, suggesting that obstacles in delirium care provision have a cultural basis . ScientiA finding of our review is the great heterogeneity in the patients’ characteristics across studies and in the methods used to assess cognition, function and outcome measures. Only a few studies explicitly enrolled patients because they had delirium and/or dementia as the main diagnosis ,15,16,17The interventions described in the selected articles were also markedly heterogeneous: early mobilization seemed to have been used in most studies in PT as well as in training of activities of daily living (ADL) as a generic approach in OT. It is of interest that both studies with an RCT design found functional improvement at the end of the trial while only one found a decrease of delirium incidence. A possible explanation is that in the study by Alvarez et al., the reduction of delirium incidence was the main outcome measure, while it was a secondary outcome measure in the study by Martinez Velilla. It should also be considered that in the study by Alvarez et al., the enrolled patients received standard strategies of delirium prevention plus occupational therapy, while in the study by Martinez Velilla et al. the patients received only physiotherapy and underwent active exercises, but no delirium prevention strategies. Furthermore, the patients enrolled in the study by Alvarez et al. were critically ill, while they were relatively stable in the study by Martinez Velilla.Other studies found a reduction of behavioral disorders or agitation by providing a person-centered approach , modifications of the environment and the active involvement of caregivers in rehabilitation sessions . One of Some studies supported the active involvement of the caregiver in the PT and OT sessions, assuming that this could facilitate the patient’s functional and occupational performance. However, the studies did not describe in detail when and how caregivers were involved. There is evidence that caregivers can be successfully integrated in the programs for the management of people with dementia at home in occupational therapy ,45, whilWe acknowledge some limitations of our scoping review. We followed most of the recommendations for scoping reviews of the PRISMA-ScR checklist . HoweverIn conclusion, this review contributes to raising awareness of the medical and non-medical community of how to appropriately manage these conditions and could trigger research in this field. Both professions have emerging roles in the prevention and treatment of delirium. Already existing knowledge about specific occupational and physical therapy interventions should be clearly described and tested in future trials. Occupational therapy and physiotherapy interventions might have great potential in the rehabilitation and treatment of both people with dementia and of people with delirium superimposed on dementia. Yet, in this respect, additional research is needed. It appears to be promising to focus rehabilitation interventions through a person-centered approach , encourage environmental modifications and pursue active involvement of caregivers in rehabilitation sessions to reduce behavioral disorders or agitation. Thus, it would be important to investigate whether already established and effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia ,48 are a


In this era of evidence-based medicine, the randomized controlled trial (RCT) has become the gold standard in determining whether a new intervention has beneficial effects. Although in recent years the RCT has given way to more flexible approaches, the strong reliance on this type of decisive study design in evidence production has had unintended consequences . An examIn the current debate about prevention, there is a strong plea for a shift in content and mode of delivery of prevention, specifically targeting the environments in which disadvantaged groups live and work . While tThere is compelling evidence that psychosocial work factors may introduce health effects . A recenScandinavian Journal of Work Environment and Health, Aust and colleagues (In this issue of the lleagues  have undThis editorial is not the place to summarize the evidence of a meta-review, which itself summarizes the evidence of 52 reviews. Read the article yourself and be surprised by the quality and density of information on the evidence of organizational-level interventions. However, the meta-review shows some findings that should challenge the research community.First, 28 out of 52 reviews focus on the healthcare sector. Healthcare organizations are apparently easily accessible and reachable, and have plenty of study participants. The feasibility of a research project seems more important than scientific or societal considerations. Hence, the available evidence is extremely biased towards the specifics of work environments in healthcare with low generalizability to other workplaces. We must ask ourselves the question whether our research priorities reflect sufficiently societal needs.Second, the synthesis of evidence presented in the 52 reviews seldom demonstrates that improvements in the psychosocial work environment are causally linked to improvements in workers’ health. In line with the terminology of the authors, it remains to be seen in many interventions whether proximal effects are associated with distal ones. The noticeable exceptions were : interveThird, linked to the discussion about the appropriate study design for evaluating effectiveness of interventions in occupational health, in most reviews the majority of original studies had some type of control group, but the use of an RCT design was low. This illustrates the intrinsic difficulty of randomization of workplaces for many different reasons . The disThe meta-review of Aust and colleagues is not only of interest because of its specific content, it also raises important considerations for intervention research. I propose the following five guiding principles for intervention research on the psychosocial work environment:1.In primary prevention strategies, the essential choice is between selective or universal prevention . An orga2.In intervention studies with a short follow-up period, it is sensible to focus on proximal endpoints, ie, changes in the psychosocial work environment, rather than distal endpoints such as sickness absence or workers’ health.3.When the proportion of workers’ health attributed to the risk factor of interest is modest then the reduction in the risk factor due to the intervention must be large to have a discernable impact on workers’ health. Remember that most workers are quite healthy, thus, large effects in universal interventions cannot be expected.4.We often lack insight into whether an organizational intervention introduces improvements in the psychosocial work environment, and, consequently, that through these improvements the beneficial effects on workers’ health are achieved. Without insight into the pathway of effectiveness, interventions will remain a black box.5.It is a misconception that the effectiveness of an intervention is primarily determined by its content and quality of delivery. The implementation and specific context in the organization are equally as important. New analytical evaluation methods may be required, acknowledging that individual behavior and circumstances, specific working conditions, and higher-level contextual factors interact continuously.


The COVID-19 pandemic generated unprecedented challenges for social and organizational life. We set out to explore how empowering leadership and leadership support were affected as a result of the team-based organization starting to implement flexible and remote work practices after the outbreak of the COVID-19 pandemic. We collected data in a cross-lagged design and used the two-condition MEMORE mediation procedure to analyze data on work satisfaction and team effectiveness obtained just before and immediately after the COVID-19 outbreak in 34 organizational teams. Our results show that the COVID-19 outbreak did not significantly impact perceptions of empowering leadership or perceived leadership support. However, teams that experienced changes in empowering leadership also reported proportional changes in work satisfaction and effectiveness. Finally, we show that the association between empowering leadership and leadership support, on the one hand, and work satisfaction in teams, on the other hand, is moderated by team size, such that the strength of the association is higher in small rather than large organizational teams. We conclude by arguing that the team-based organization absorbed well the impact and disruptions associated with the COVID-19 outbreak. We also stress the role of empowering leadership as a driver of work satisfaction and the effectiveness of organizational teams. As the COVID-19 outbreak spread across the world, many organizations had to implement flexible and remote work practices almost instantly and on a large scale. In this respect, the pandemic imposed increased pressure on employees working in organizations and teams, suddenly having to work at home full-time  with an average age of 45.87 years filled in the survey during the first wave, and 125 participants (22 women) with an average age of 48.22 years filled in the survey during the second wave. Participation was voluntary and anonymous, and participants could withdraw from the study at any moment if they wished so. As the study documented the implications of team-based reorganization, all employees who were organized in teams across the different value streams in scope were invited to fill in the survey. Data on work satisfaction, empowering leadership, and leadership support were collected from the team members, while data on team effectiveness was collected from the team leaders . The scores obtained from team members were aggregated to obtain a team-level score, which we have used for further analyses of the teams for which we had evaluations at both time points. Team size was extracted from the company records. In short, we collected data from multiple sources for the variables included in the model, and all analyses were conducted at the group level.Work satisfaction was evaluated by asking team members to answer two items: “All things considered, how satisfied are you with your work in general” (1–7) and “How happy are you feeling in your job in general” (0–10). Cronbach's alpha for this scale was 0.77 at time 1 and 0.78 at time 2. Given the fact that the items were evaluated using different Likert scales, we have used the dominant Bartlett factor score as an accurate indicator of the underlying work satisfaction component rated with the two items  to empowering leadership (7 = gives autonomy and space to decide on how to perform your work). Therefore, a high score reflects empowering leadership.Leadership support was evaluated with two items that capture instrumental and emotional support, presented in the study by Muntean et al.  or team effectiveness ; therefore, hypotheses 1 and 2 were not supported by the data. Furthermore, the results also reveal that the COVID-19 outbreak did not significantly decrease teams' perceptions of empowering leadership  or leadership support . We can therefore conclude that the detrimental effects expected due to the COVID-19 outbreak did not emerge as hypothesized.The results of the repeated measures mediation analysis reveal that the COVID-19 outbreak did not significantly reduce work satisfaction . This direct effect reveals that when empowering leadership increases, so does the work satisfaction reported in the teams. In other words, even though the COVID-19 outbreak did not have a systematic effect on change in empowering leadership, the teams that experienced such a change (due to other factors and circumstances) also reported a proportional change in work satisfaction.Furthermore, our results revealed a positive and significant effect of change in empowering leadership on change in work satisfaction , as well as between leadership support and team size . The significant interaction effect between change in empowering leadership and team size reveals that the effect of empowering leadership change is positive and significant for small  and medium-sized teams , while the effect is negative but not significant for larger teams , it is positive but not significant for average-sized teams , and it is negative and marginally significant for large teams , and none of the interaction effects are significant. The overall results of this moderated mediation analysis with repeated measures are presented in The moderated mediation results for team effectiveness as a dependent variable reveal a similar pattern of results, with the COVID-19 outbreak having no significant effect on any of the changes in the variables included in the model. The only significant effect is the positive association between the change in empowering leadership and the change in team effectiveness , the mediating effects hypothesized in the third and fourth hypotheses were not supported by the data. Furthermore, as the moderating effects of team size in the relationship between change in empowering leadership and leadership support, on the one hand, and team effectiveness, on the other hand, were not supported see , we can This study aimed to capture the potential deleterious consequences of the COVID-19 outbreak on work satisfaction and team effectiveness as triggered by diminished empowering leadership and leadership support. We have used data collected before the COVID-19 outbreak and right after the outbreak in an organization that started using multiteam systems as a way of organizing teams. The analysis and results showed three relevant insights.First, contrary to our expectations, the results of our study showed that in this organization, for the teams in scope, the COVID-19 outbreak did not significantly decrease work satisfaction or team effectiveness. Our understanding is that, in this regard, this organization and its teams seemed to have absorbed the shock of the COVID-19 outbreak quite well. The organization implemented an organizational setup based on delegating responsibilities to self-managing teams combined with more empowering leadership approaches to foster ownership and autonomous work. With teams established as a core and versatile unit for organizing work, this organization proceeded by introducing organizational constructs to aggregate multiple teams. The main reason for this organizational design was the pursuit of agility . Surveys were translated in Dutch and participants gave their informed consent for participating in the study.EEC and PLC: study design, data analysis, first draft, and revisions. EEC: data collection. All authors contributed to the article and approved the submitted version.


Mineral nutrients are the food of plants. The absorption and utilization efficiency of nutrients are crucial for improving the yield and quality of tea. Tea plant is an economically important leaf crop. Long-term harvesting and pruning can lead to a significant deficiency of nutrients, causing a decline in tea plant vigor and a severe decrease in tea yield and quality. Furthermore, tea plants adapt to acid soil, in which the nutrients are easily to be lost. In order to pursue higher tea yields, a large amount of fertilizer is usually used in tea plantation, leading to a series of environmental problems such as soil compaction. However, current research is mainly focused on the quality of tea processing in the field of tea, with little attention paid to mineral nutrients. This special issue mainly studies the influence of mineral nutrients on tea yield and quality, and includes four research articles covering soil nutrient characteristics, the impact of mineral nutrients on tea yield and metabolites, and the effect of pruning on the distribution of mineral nutrients.Malakar et al. found that more than half of the pH values of tea plantation soils in the region were between 4.5-5.5, which is suitable for the growth of tea plants. Nitrogen is an important macronutrient for plants, especially for tea, which requires a large amount of nitrogen due to frequent harvesting and pruning. The autophagy process of plants can improve the utilization efficiency of mineral nutrients. Huang et al. screened CsATG101 gene in tea trees, and found that the expression level of this gene in most mature leaves was higher than that in young leaves among 24 tea tree varieties. This suggests that the autophagy process is stronger in mature leaves. This gene might be used as a candidate gene to increase the yield of fresh leaves under different nitrogen levels. In addition, tea plants prefer ammonium nitrogen, but its regulation mechanism for tea tree growth is unknown. Wang et al. treated tea trees with ammonium nitrogen deficiency and recovery, and found that ammonium nitrogen may act as a signaling molecule affecting catechins and thus affecting growth. However, there is also a concentration range of ammonium nitrogen, otherwise, tea plants will be stressed under high ammonium conditions. Pruning is an important strategy to improve the yield of fresh leaves in tea garden management. Liu et al. compared tea leaves from 1962 pruned and 1188 unpruned tea plants, and found that pruning significantly reduced the concentration of easily mobile elements such as nitrogen, phosphorus, potassium, and magnesium, while significantly increased the concentration of immovable elements such as calcium and aluminum. Additionally, calcium and magnesium contributed the most to the differences in metabolites, providing a management improvement measure to improve the quality of tea.The growth of tea plant adapts to acidic soil. Through physical and chemical analysis of 7300 soil samples from 115 tea gardens in India, In conclusion, the research in this topic highlights the importance of mineral nutrients and their impact on tea production and quality. The findings suggest that improving mineral nutrient management in tea cultivation can lead to better tea quality and production.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


This article analyses the support and self-care strategies of artists from Turkey who have left their country from considerable risk regarding their country’s political and economic instability since 2013 and have relocated to Germany. It maps the support networks, programs and institutions as well as consider questions of sustainability and risk (self-) assessment. The study is based on interviews with Turkish and Kurdish artists in Germany and an analysis of the activities by the Maxim Gorki Theater, Apartment Projekt, bi’bak, Hafiza Merkezi Berlin, as well as support systems like artistic research fellowships, art residencies, artist networks and supportive theatres. The guiding questions of this study examine the longer-term orientation of the support of artists at risk. The findings show three deficiencies. Despite the variety of available support systems, artists who left Turkey experience difficulties integrating in the artistic labour market. The output-oriented, meritocratic basis on which programs select candidates often fail to help artists in a holistic way. The intergenerational disparity in the migrant communities create the infrastructures, solidarity discourses and networks for newly arriving artists, but also creates ideological tensions which limits inter-communitarian solidarity. Specific self-organized programs extend the solidarity to artists from other affected regions, which limits chances to support artists at risk from Turkey. There are generational disadvantages of newcomers in an overburdened, professionalized independent art scene that has struggled to break free from the social work and socio-cultural stigmas. The latter masks artists with a non-German background from positive discrimination initiatives. The study proposes improvement in support systems through a coordinated effort, encourages to relieve programs from a need for identity representation as an expectation or requirement, and advises a shift in support systems from output orientation towards enhancement of individuals through self-care, for greater autonomy and self-development in their art practices and new life. This analysis looks critically at the existing opportunities for artists at risk from Turkey in Germany, focusing on the independent art scene in Berlin. It offers an overview of the most relevant support networks, programs and institutions until the summer of 2022. It also determines common deficiencies and possible solutions as recommendations to improve the existing support mechanisms towards more sustainability. This article aims to help, thereby, circulating the information around existing programs and residencies, as well as to help newly arriving artists at risk in harnessing self-care. starting from the period after the Gezi protests in the summer of 2013 and, more progressively, after the July 15 coup attempt in 2016, there has been a silent but constant exodus of artists from Turkey emigrating to Germany. Reasons for their relocation are: socially, the curbing of freedoms like the freedom of association, assembly, and expression; politically, a steady decline of democracy and civil society towards authoritarianism, the constant erosion of reproductive rights, the withdrawal of the Istanbul Convention in 2021 (protecting women against violence), increasing hate crimes against other, subaltern identities like the Kurdish and LGBTQ+ identities; and economically, the macro-financial instability with occasional drops of the Turkish lira with a record low of nearly TRY 15 to USD 1 in December 2021 . The protestors’ demands for a more participatory democracy by occupying public spaces were met with increased repression.Turkey’s democratic backsliding is caused by a domestic agenda of the government relying on repression based on short-term political calculations. This trend has been set in motion since the heavy-weight crackdown on protestors during the Gezi Park uprising between 28 May and mid-July 2013, which constituted a major challenge in the 19 years of rule of Recep Tayyip Erdoğan’s conservative Justice and Development Party  co-chair Selahattin Demirtaş on unsubstantiated terrorism-related charges since November 2016, in spite of two binding rulings in favour of his release by the European Court of Human Rights; as well as the latest trial of 16 citizens who allegedly organized and financed the Gezi protests, including Turkish businessman, human rights defender and philanthropist Osman Kavala who has been in detention since his arrest (without indictment) in 2017. On 25 April 2022, Kavala was sentenced to life in prison without parole on charges of attempting to overthrow the government, and seven co-defendants were sentenced to 18 years on charges of aiding and abetting. In both cases, Human Rights Watch reported gross miscarriages of justice censorship practices, a growing number of artists from Turkey who identify with a ‘new wave’ have relocated to Germany. This also had significant impact on the financial support mechanisms for those who have left Turkey due to political prosecution and cannot simply return. New displaced peoples, like the Ukrainians, are now prioritized. Yet those who have fled from Turkey or other countries earlier cannot be expected to be integrated into the German job market so quickly, given the historical and linguistic disadvantages most experience care and solidarity, not just through their artistic practice but also their presence in the society. The previously established post-migration discourseNevertheless, the support mechanisms are strained, limited and at risk themselves, particularly after the COVID-19 pandemic. It is of vital importance to map and strengthen the existing support mechanisms in pursuit of helping displaced artists to adapt to the living and working conditions of Germany.The current research is based on a mixed-method approach combining ethnographic research (in-depth interviews) with comparative policy analysis, insights from migration studies and sociology of theatre for context. Semi-structured interviews were conducted between 1 May 2021 and 1 June 2022 with artists and cultural workers from Turkey, residing in Germany, the Netherlands and the UK at the time of the interviews.Due to considerable risk, all interviews were anonymized with a key as part of the method for processing sensitive qualitative data so that any risk to the individuals resulting from the study will be minimized. Freely given, informed consent is obtained from the participants, by means of a consent form (kept on record) and an information sheet, outlining clearly the study’s key objectives and ethical principles, to guarantee trust and minimize the risks associated with research involving natural, human beings. Extra anonymization in the publication of results was also offered as an option in the consent form.Secondary data include information available on publicly accessible platforms . Sources were selected on the basis of the input of the participants in the interviews and a comprehensive literature search on all the relevant support schemes available in Germany to newly arriving artists in (self-)exile and/or at risk. The only exclusion criterion concerned those schemes that do not prioritize those artists.Interviewees were approached and interviewed both online and face-to-face, following national COVID-19 restrictions. The study totals 30 adult participants of a wide age range, who have come to Germany, the Netherlands and the UK in the last 10 years. The questions asked about the routes and reasons to leave Turkey, the supportive institutions and networks, the sense of new subjectivities in the receiving country or city, the possibilities and limitations of artist production, and the vision of the near or distant future . Upon reFor the research on the support programs, residencies, institutions and networks, websites as well as flyers of the relevant institutions and organizations were consulted.versus concern were identified from the literature in advance of the data and formed a special focus for the analysis of this study. The context of post-migration discourse was also studied in previous research, prior to the current study. Other themes, such as sustainability and fragmentarization of the existing support programs, were derived from the interviews. The study made use ofMaxQDA Plus 2020 software to process policy texts and programs in conjunction with interview transcripts on the basis of tags creating automatic codes to improve and accelerate comparison through the campus license of the Freie Universität Berlin (until September 2023). End user agreements with VERBI GmbH are in place. The study could be replicated with freely available or open-source data analysis alternatives, likeQualCoder,Taguette,RQDA,CATMA andWired-Marker.Themes such as (self-)care and solidarityEthical approval was obtained by the Central Ethics Committee of the Freie Universität Berlin (ZEA-Nr. 2020-012). Freely given, written informed consent is obtained from the participants, by means of a consent form (kept on record) and an information sheet , before conducting any interviews, to guarantee trust and minimize the risks associated with research involving natural, human beings.Bundesamt für Migration und Flüchtlinge .Germany’s current policy infrastructure largely splits topics related to Turkey into two separate policy areas that do not interfere with each other: socio-political and developmental issues are treated by the Ministry for International Cooperation as well as the Foreign Offices as a foreign policy topic, whereas labour and visa issues regarding incoming migrants fall under domestic policy by the Ministry of the Interior, theMartin Roth-Initiative (MRI), which is a joint project by IFA (Institut für Auslandsbeziehungen) and the Goethe-Institut, Germany’s cultural institute of the Federal Republic of Germany with a global orientation. MRI supports artists who are committed in their home countries to the freedom of art, democracy and human rights and who are persecuted because of that. They offer temporary residence in Germany or in third countries, but Turkey is not regarded as a high risk. The number of artists they support is very limited and their current orientation is more on Africa and Latin America.Besides regulating social insurance for artists and indirect support through the funding of cultural institutions, the Federal Government’s support limits itself to the funding of stays abroad for artists living in Germany. Funded by the Federal Foreign Office of Germany, there is theS+T+ARTS  initiative under Horizon2020 to support collaboration between artists, scientists, researchers and engineers, with its ownresidencies program. Such programs are, however, highly specialized, restricted, competitive, and thus hard to obtain.Moreover, the migration policy of Germany is rather intended to manage, control and limit the immigration of foreigners. This makes interconnected issues and local partnerships on a micro-level between the two countries hard to support. On a more macro-level, the European framework does also hardly support individual artists with a special need to leave their countries of origin. Mobility falls largely under the Creative Europe programme and related to that, the European Commission also launched theKulturstiftung der Länder) actively supports diversity and the social relevance of art, it is tasked to support institutions (museums and archives), project executing organisations, networks and interest groups on a larger scale. It does offer a limited number of international artist fellowships in combination with residencies, but they are targeting German artists to work abroad . Due to this lack for newcomers, the city has become increasingly a critical actor in this type of support. There are also a few private non-profit support programs that help to strengthen the bilateral dependency and the civil societies within a framework for change.As mentioned in the introduction, Germany and Turkey’s societies are interconnected, which binds them in solidarity and politics. There is no support for artists on a state level due to a cultural policy climate that is divided between the federal states. Although the Cultural Foundation of the German Federal State  which was designed to professionally integrate people working in art, media and culture who intend or are being forced to leave their home countries. The grant (a monthly sum of up to EUR 2500) is for a maximum period of a year and is targeted to finance project-related costs to secure independent artistic or creative work in collaboration with a cultural sector stakeholder. This means that the artist who applies needs to be already somehow embedded through their network in the cultural sector in Berlin in order for the application to be successful.In Berlin, most central is the fellowship programAcademy in Exile, under the thematic rubric ‘Fixing What’s Broken’, from 2021 onwards. Founded in 2017, particularly as a result of the exodus of academics from Turkey, Academy in Exile is a consortium of the Duisburg-Essen University, the Institute for Advanced Study in the Humanities (KWI) in Essen, the Berlin-based Forum Transregionale Studien, and the Free University Berlin. The consortium provides normally fellowships for academics that are threatened or delegitimized in their home countries. Yet it now offers also 3 three-month residency fellowships in Berlin (a monthly stipend of EUR 2500 plus travel expenses), funded by the Allianz Kulturstiftung, to artists and cultural producers who advocated human rights, democracy, free expression and/or who have been displaced because of their work.Another Berlin-based fellowship program open to artists has recently been initiated byAid A – Aid for Artists in Exile, supports artists around the world who have been threatened in their home countries particularly for defending artistic freedom, democracy, and human rights and who are, therefore, prevented from continuing their work. Similarly, there is since 2013 the non-profit network,Artists at Risk (AR), that recently also partnered with Germany’s cultural institute of the Federal Republic of Germany, theGoethe-Institut to coordinate a German network of hosting institutions that support persecuted art practitioners , facilitating their safe passage from their countries of origin, hosting them at residencies, and curating related projects. Since the demand is high, the residencies scattered over Europe and the priorities of who to support change more quickly depending on global dynamics, such non-profit organizations and networks cannot offer sustainable solutions to many artists for a longer period of time, yet they do create awareness, constantly map the need and provide networks of care and solidarity. One such network that contributes to awareness isKopuntu, a solidarity network focusing on the new generation diaspora.More Germany-wide, the non-profit, originally French organization,Allianz Kulturstiftung collaborates actively with the European framework to support contemporary art, new music, literature and translation, and European development. It supports a residency program with annual stipends for four up to eight months (up to EUR 2500 per month) to foster exchange at theTarabya Cultural Academy in Istanbul, either for individuals from Germany or for tandem-partners with one partner from Germany, one based in Turkey. This partnership favours ‘exceptionally qualified artists and cultural professionals’ and is more targeted towards exchange than support for artists who are in real danger. For the latter, the Allianz Kulturstiftung has a very small program since 2018,Torschreiber am Pariser Platz’‘, which only supports one writer in exile per year up to six months. Since 2020, Esra Kücük assumed the role as Chief Executive Officer. She previously worked at the Gorki Theater in the GORKI FORUMS particularly on the topic of exile. This may be hopeful for the widening of the ArtistAs a private initative since 2000 funded by the Allianz insurance group, thePEN International’s Writers in Exile program with offices in Istanbul (PEN Turkey Centre) and Darmstadt (German Centre). The latter’s support is based on the priority and severity of the risk, which they also constantly monitor . PEN International is an organisation funded by donations and differentpartners; the German branch is supported by the Minister of State for Culture and Media at the Bundesregierung.For threatened authors, academics and journalists, there is alsoWhile most support programs and residencies offer immediate financial relief for the early days of the relocation and some even help to embed artists at risk also in the civic, cultural and social ecologies of the new home, they are limited and not sustainable in the long run. Most newcomers do not speak German and adapting to the new living situation, sometimes with a family, in a new cultural and linguistic environment requires much more time and energy than that the support program can help with. Artists who left Turkey are also at different risk levels, which often excludes them from the support programs. Some lack the support networks for getting institutional support, others are more focused on educating themselves further or coming temporarily for exchange, which complicates a longer stay. They are also generally different to economic migrants as their mobility was often not as planned or coordinated towards a job.For a non-exhaustive list of supportive institutions and organizations in Germany together with their modes of support, please seeDespite the many programs, residencies, networks and institutions that have supported newly immigrating, often vulnerable artists who have left Turkey for diverse reasons, in-depth interviews show that artists still face many problems.1. A most common problem is that the existing support is temporary, mostly focusing on project-based labour and thus output-oriented, meritocratic, and limited in responding to all the specific needs of the artist who is trying to find their way in the new living situation, the associated bureaucracy as well as the art industry and job market in Germany. The Maxim Gorki Theater is overstrained with the demand for support, and often it takes more time for artists to be redirected to other opportunities as the information is scattered. Support programs and residencies also usually do not offer space and time for learning the language and culture . Neither do such means of support focusing on carrying on jobs always help to solve any psychological effects of the loss of identity and the looming financial  precarity in a context of living in ongoing short-term protection. Some carry on by moving from one support system to another, with periods of severe precarity, others are resourceful in producing on their own with partial support of coproductions. But there is always a sense that the support will come to an end one day, as public and political interest for the silent exodus from Turkey is waning and other exiles and refugees from other countries are arriving.2. DIDF-Jugend, the previous migration centre Allmende, or the theatre for the first-generation Turkish migrants,Tiyatrom in Berlin).A second problem is the disparity between the generations of Turkish immigrants and citizens with a Turkish migration background in Germany. Historically and legally, the new wave benefits from the presence of the older generations, but they do not necessarily stand on their shoulders. In spirit and perhaps ideology, they have closest affinity with leftist artists, intellectuals and journalists who fled Turkey after the 1980 military coup and its subsequent conflicts in the Kurdish region in the 1990s, yet there is a great legal difference as a big portion of these migrants in the 1980s arrived as political refugees and asylum seekers, whereas the new wave after 2013 has been arriving with more privileges. The latter are also defined in the press as Turkey’s ‘brain drain’  that would undermine the artistic qualities and opportunities to professionally exchange know-how. This is an acquired step forward, no doubt, yet it complicates the support of vulnerable artists under the German Act on Equal Treatment as their precarious labour situation should also be seen as part of anti-discrimination laws and support for excluded groups. This creates new inequalities in a scene that has been already overburdened in its struggle against institutionalized inequality, only highlighting more the generational disadvantage that newcomers suffer from.The public debates on special support for migrant artists or those with a migration background in the post-migrant scene have also created a clear break from any support mechanisms forThe specific treatment of artists in exile and/or at risk necessitates also the widening of the public debate and support as they take part of larger waves of ongoing migration affecting diversity issues in society. Most commonly, artists at risk actively engage in awareness and support for other exilic groups in Europe  and the complexity of precarity. Their precarity  is part of their new identity formation, and their specific stories metonymically help to uncover bigger issues in our modern culture and society. Yet the necessary widening of the scope of support complicates the specificity of the needs of every newly arriving community, and it adds extra risk and vulnerability to those who are trying to find sustainable means and solutions to stay in Germany.1. a more coordinated effort by building relationships and communication channels with the specialized networks that enhance diversity and awareness regarding migrants, like the International Cities of Refuge Network (ICORN). Information and collaboration are key.A first point for improvement concerns the current fragmentation of the existing support mechanisms. Though in the early days after the attempted coup in Turkey, there seemed political good will to strategize the support for the incoming flow of artists from Turkey, just like the academics and journalists, a strategy document that would coordinate targeted themes and existing support structures which could be implemented by theatres and cultural institutions has been lacking. The result is that many support programs work on an ad-hoc basis depending on priorities and risk levels that are often politically defined and motivated, as well as very differentiated from one to another. In order to respond to more sustainable needs of very diversified communities, targeted support could benefit from2. need for representation. On the one hand, as the postmigrant theatre scene has struggled for, it is vital to have representatives of exiled artists at risk on decision making boards. On the other hand, the theatre stage as well as the use of digital technologies have the ability to empower voices, strengthen identities and enhance visibility for migrants’ precarity and political concerns care. The latter should not only be understood in entrepreneurial terms but also broader, in the sustainable support of personal growth by means of listening, understanding, responding, and potentially rethinking our attitudes (practice” (Fonds Darstellende Künste (fonds-daku) during the COVID19-pandemic to support artists through their support programs #TakeCare and #TakeHeart, in collaboration with NEUSTART KULTUR, are promising in this regard as they are more focused on research, development, and restart of cultural life after the pandemic than on output. Yet, besides a call for artists from Ukraine in their special #TakeAStand residence program, artists at risk do not generally benefit from these funds.A third, most prevailing proposition to improve the life situation of the artist at risk is totitudes . Care shactice” : 90. TheThrough Germany’s support systems, we should avoid alienating or traumatizing those who have fled a politically volatile situation in their home country twice over, not by giving them preferential treatment as rules of exception, but by fully including them as equal partners in the receiving society, its cultural industry and job markets, as a requirement to fulfill this inclusive vision of relational (self)care in the future. Special programs are important to target specific needs in situations of risk, yet a two-tier support system that separates artists in terms of privilege or origin should be prevented.Based on a mapping of support mechanisms as well as interviews concerning artists at risk from Turkey in Germany and Europe, the report proposes the following recommendations:1. a more integrated, strategic approach that combines better coordination, collaboration and information exchange involving the different actors, institutions, networks, support services and residencies of individual theatres and cultural centres;2. more coordinated support in helping artists and cultural professionals from Turkey to entering the German/European cultural market;3. affirmative action in favour of inclusivity, diversity and representation of artists at risk, including participation of representatives of disadvantaged groups in boards and commissions;4. a shift in focus from immediate concern to more sustainable (self-)care in the scaffolding of support programs and strengthening of existing networks, in favour of an inclusive society.Ethical approval was obtained by the Central Ethics Committee of the Freie Universität Berlin (ZEA-Nr. 2020-012). Freely given, written informed consent is obtained from the participants, by means of a consent form (kept on record) and an information sheet , before  strict sensu with a strong theoretical grounding, but a policy-oriented paper, questions about the originality of the argument are not relevant. Overall, the report leaves the reader much better informed about the problems and the possible solutions of artists at risk from Turkey. This paper gives a concise and well-researched synopsis of the care and self-care mechanisms available for artists at risk from Turkey. There is an insightful discussion of the different networks, initiatives and institutions, their activities, and the limitations of their work. As this is not an academic article  My limited criticism would aim at the policy recommendations which struck me as slightly too general. I believe that these recommendations would be stronger, if they included concrete suggestions for the trajectories and choices for existing actors, networks, and programs that address the durability of such programs. Alternatively, the author could de-emphasize the policy recommendations and conclude on a more theoretically grounded note, reflecting on the necessity and sensibility of such ad-hoc support programs  and their efficacy .If any, are all the source data and materials underlying the results available?YesIs the work original in terms of material and argument?YesIs the work clearly and cogently presented?YesIs the argument persuasive and supported by evidence?YesDoes the research article contribute to the cultural, historical, social understanding of the field?YesDoes it sufficiently engage with relevant methodologies and secondary literature on the topic?YesReviewer Expertise:Turkish Studies, Politics, Autocratization and democratisationI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. This article fills a very important gap in the field of research centered on the new wave of intellectual immigration from Turkey that took place in the 2010s. In particular, the fact that this research does not focus on the experiences of one or a few individuals, but rather attempts to capture a sense of the field that the immigrant artist from Turkey in particular is trying to integrate by analyzing and comparing in-depth interviews with policy reports, marks the research as a unique contribution to the field. It is also interesting and innovative to document the inter-community tensions between Turkish-speaking groups in Germany, and the class and education-based differences between earlier generations of immigrants and the post-2010s immigrants. The notes I mention below do not need to be integrated into the current form of the article, since this peer-review document is currently paired with the article. Please consider them as notes for readers and future researchers. Özgül Akinci (2018) Performing Academia in Public Space in Turkey, Performance Research, 23:2, 44-48, DOI: 10.1080/13528165.2018.1464753 The second point that I think could be improved is a brief overview of the history of Turkish migrant theater in Germany and the reasons for its discontinuity up until now by citing some sources on the topic. Two sources that immediately come to mind are:Ela E. Gezen. Brecht, Turkish Theater, and Turkish-German Literature: Reception, Adaptation, and Innovation after 1960. Rochester, NY: Camden House, 2018.Erol M. Boran. Die Geschichte des türkisch-deutschen Theaters und Kabaretts - Vier Jahrzehnte Migrantenbühne in der Bundesrepublik (1961-2004). Transcript-verlag, 2022.  In addition, a minor point is that on page 7 of the pdf version of the document, the paragraph that begins with “As a private initative since 2000 funded by the Allianz insurance group” ends with an unfinished sentence that cuts off the sentence as follows: "This may be hopeful for the widening of the Artist”. There are two points I would like to note about this research that I think can be improved, both of which are about adding some important nuances to the background of the phenomenon being researched here. The first is to perhaps briefly mention the cancellation of the peace negotiations between the Turkish state and the Kurdish movement that took place between 2012 and 2015, since this political rupture also affected the aftermath of the 2016 military coup attempt, which significantly contributed to the wave of dissident intellectuals who were forced to leave Turkey. In order to strengthen the article on this front , I can recommend briefly quoting this article at a relevant point: Despite these two brief points, which are preliminary information to better ground the research in its two contexts (in Turkey and in Germany), I think the research is a very important contribution to the literature on the intellectual exodus from Turkey in the 2010s.If any, are all the source data and materials underlying the results available?PartlyIs the work original in terms of material and argument?YesIs the work clearly and cogently presented?YesIs the argument persuasive and supported by evidence?YesDoes the research article contribute to the cultural, historical, social understanding of the field?YesDoes it sufficiently engage with relevant methodologies and secondary literature on the topic?YesReviewer Expertise:Turkish contemporary theatre, performative politics, public sphere studies, puppetryI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. The research article “Exiled lives on the stage: Support networks and programs for artists at risk from Turkey in Germany” critically explores the institutions, networks, and programs that aim to support displaced artists and to facilitate their integration into the artistic labor market, based on a study of the case of artists who recently left Turkey mainly due to political repression and settled in Germany.  As well as extensively mapping the existing support systems, the article uncovers their deficiencies that put artists in precarious positions and negatively affect their artistic careers and individual well-being. Furthermore, the author offers valuable suggestions to improve the functioning and the sustainability of the support systems. Such a constructive critical approach to the support mechanisms is vital in the wake of growing number of artists and academics who are fleeing their countries due to political oppression, turmoil and violence, as well as flourishing support programs that face some challenges. This study delves into significant questions and represents great potential to contribute to the policies of support systems.      Yet, the article lacks theoretical and conceptual framework since it does not engage with the existing literature sufficiently. For this reason, the work serves more as a policy paper or a project report than a research article in its current form and cannot realize its full potential to contribute to the scholarly understanding of the field. In the analysis section, it is mentioned that the themes of (self-)care and solidarity and the context of post-migration discourse were previously studied through the relevant literature. I would suggest the author to theoretically engage with these concepts and debates in this article too. The short discussion of (self-)care vs. concern in the conclusion could be expanded and moved to the beginning of the article. What does self-care mean in “entrepreneurial terms”? How do the forms of care suggested in this study differ from neoliberal discourses and industries of self-care? I think that the article can substantially contribute to the growing scholarly interest on care practices and discourses, if the project findings are discussed through the theoretical frameworks. I would also be interested in reading more about the support programs #TakeCare and #TakeHeart. In addition, the article often mentions “post-migration discourse” but does not discuss what it is. A theoretical discussion of the concepts of postmigration and postmigrant society could support the article’s arguments. Lastly, I would recommend a brief discussion of the literature on the topics of precarity in migration contexts and the general precarity in artistic labor markets. The argument on the generational disparity among people who migrated from Turkey at different times and its impact on the possibilities of solidarity is quite intriguing. I was wondering if the author could further elaborate on this. The argument could be enhanced by describing the disparity in worldview and political perspective in more detail and discussing the relations of newcomers with the cultural centers established by older generations. For example, are there some forms of solidarity and collaboration between different generations in the art scene?    Since in-depth interviews have been employed to detect deficiencies of supports systems, I would be interested in reading more input from the interviews conducted. Also, since the methodology has been described as ethnographic research, I was wondering if there has been participant observation involved in the field study. Some input from the artistic and cultural events in which the author participated, if any, could enhance the overall article.   The introduction presents a well-written review of the recent political situation in Turkey that causes the exodus of artists, as well as the historical connections between Germany and Turkey that have been shaped by multiple migrations. However, it does not explain aims, scope and the conceptual framework of the article. These could be addressed in the introduction and the detailed discussion of the background of displacement from Turkey can be possibly made into a separate section. In addition, recommendations to improve the support systems that are discussed in the conclusion can be made into a separate section. And, the conclusion can rather restate and wrap the main findings and arguments of the study.If any, are all the source data and materials underlying the results available?YesIs the work original in terms of material and argument?YesIs the work clearly and cogently presented?YesIs the argument persuasive and supported by evidence?YesDoes the research article contribute to the cultural, historical, social understanding of the field?YesDoes it sufficiently engage with relevant methodologies and secondary literature on the topic?PartlyReviewer Expertise:Migration studies, media studies and ethnography; research expertise on the recent displacement from Turkey.I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.


There are 200 million girls and women alive worldwide that have undergone the practice of Female Genital Mutilation/Cutting (FGM/C) and 4 million girls are at risk of undergoing the practice each year. FGM/C provides no known health benefits, while puts a plethora of medical, psychological, and sexual health risks into perspective. One of the countries where the prevalence of FGM/C is the highest in the World, even though local authorities legally banned the practice in 2008, is Egypt. Within the Egyptian context, there are several complex socioeconomic, religious, and cultural drivers that influence the familial decision making of the daughters being cut. Female attitudes hold great significance in the process, because mothers and female family members are typically the prime decision makers at the daughter's circumcision. However, whilst FGM/C is often performed to enhance marriageability and address male preferences, in practicing communities there is little to no open communication between men and women about the practice, making women rely on their perceptions on FGM/C related expectations of men. Even though the connection between female and perceived male attitudes toward the discontinuation was established almost 20 years ago, since then to our knowledge little is known about the further characteristics of this association. Therefore, this study aims to explore the association between female and perceived male attitudes within families of a younger cohort and moreover attempts to provide a more layered picture of it within different levels of education.To explore the relation between female and perceived male attitudes toward the discontinuation of FGM/C we conducted a 3-step binary logistic regression model.Our results show that women are significantly less likely to favor a continuation of FGM/C if they think men are disapproving of the practice, compared to women that think men want it to continue. The strength of this association partially varies between the different levels of education as it is less pronounced at the level of secondary education, compared to the reference group.In alignment with previous findings in the literature, women were more likely to support the discontinuation of FGM/C if they believed that men want the practice to discontinue as well and vice versa. At a higher level of secondary education however this association is less pronounced. This result concludes that the role of perceived male attitudes should be an important factor associated with female ones and studied further, and underlines the importance of education in women empowerment. Female Genital Mutilation/Cutting (FGM/C) refers to the partial or total removal of the female external genitalia or other ways of harmfully altering the female reproductive organs for non-medical reasons . The overall percentage of the practice however remained high within the Egyptian population  were mostly associated with a higher level of education, urban residence and being uncut . Closely connected to this assumption, we also expect that this difference holds when controlling to such sociodemographic and socioeconomic factors that partially explain it (H2). And finally, we expect that this difference will be more pronounced within lower educated women (H3).The Demographic Health Survey (DHS) Program, funded by the U.S. Agency for International Development (USAID) aims to assist institutions with collecting and analyzing health data from all over the world . The don't know and depends answers (together making up around 11% of the responses) were coded as missing value, creating a dichotomous variable for the binary logistic regression model.To measure the dependent variable, female attitudes toward the discontinuation of FGM/C, this study used the question whether Female Thinking that men want circumcision to continue or to stop, which was introduced in the regression model as an independent variable. The original 3 values of the variable, continued, stopped and don't know were altered, coding the don't know answers as missing values to simplify the regression model.To represent perceived male attitudes by our sample , this study used the variable The control variables applied in the regression model were chosen from a selection of demographic and social indicators already associated with female attitudes toward the discontinuation of FGM/C in the literature. A variable to represent knowledge on the negative health effects of FGM/C, which has proven to be associated with female attitudes was also included. To test the 3 hypothesis introduced earlier, a 3 step binary logistic regression model was conducted. First, a binary logistic regression model was established to test the first hypothesis and explore whether there is an association between female attitudes and perceived male attitudes toward the discontinuation of FGM/C. Secondly, this regression model was expanded with the control variables . Thirdly, an interaction term between perceived male attitudes and highest level of education was added to the model . Almost 60% of these women had a rural residency, and 52% of them finished secondary education. The number of women that received no education at all was 23% of the sample, while 10% finished primary, and 14% finished higher education. Household wealth clusters (from poorest to richest) were represented in a balanced way within the sample, while 84% of the respondents was currently unemployed. A prominent majority, 96% of participants reported to be of Muslim faith. Coming to the specific questions regarding FGM/C, almost 90% of the sample was circumcised, and 64% of the respondents answered that FGM/C should continue. At the same time 64% thought that men want circumcision to continue, while 53% agreed with the statement that circumcision can lead to a girl's death.p < 0.001). This effect holds when the results are adjusted by the controls variables, with only a small reduction in the effect size . Women with secondary  or higher education  also held less favorable attitudes toward the continuation of the practice compared to women with no education. Findings of this model additionally show that older women are significantly more likely to support the continuation of FGM/C , while the type of residency  was not associated with a significant difference. At the same time women from the poorest households were significantly more likely to support the continuation of the practice  compared to women from middle wealth households, while women from richer  and the richest  households were significantly more likely to support the discontinuation of the practice compared to the reference category. Women who currently did not work, compared to those who did were significantly more likely to support the continuation . Looking at the role of religion, Christian women were significantly less likely to have positive attitudes toward the continuation  compared to those of Muslim faith.p < 0.001), while disagreement with the fact that FGM/C can lead to fatal consequences significantly raised the likelihood of positive attitudes toward the continuation of the practice , compared to the opposite belief. Additionally, even those women who articulated an uncertain opinion were more likely to support the continuation of FGM/C than those who believed that it can lead to death .Coming to the questions relating to the practice itself, uncut women were significantly less likely to support the discontinuation than circumcised women .The result of the first logistic regression model confirms our first hypothesis and reveals that in alignment with previous findings from the early 2000s . Secondly, the interview situation in which the data was collected might have pressured the respondents to provide socially conform answers, and the questions do not leave room to reflect on ambivalent feelings . ZZ took the lead, while NV, SV, and KM guided her throughout the process. Several discussions were carried out about the research aim, methodology, and interpretation of the results. ZZ carried out the literature review, participated in the study design, accessed, and processed the data, contributed to the statistical analysis, and drafted the manuscript. KM coordinated the research project, participated in the study design, and was consulted about the results of the study. SV participated in the study design, data management, interpretation of the results, carried out the statistical analysis, and provided supervision of the manuscript. NV participated in the study design, the data process, statistical analysis, the interpretation of the results, and provided constant supervision and support at drafting the manuscript. All authors have read and approved the final document.