Indicators of selenium in the placenta.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Payan-Carreira",dateSubmitted:"April 21st 2020",dateReviewed:"September 10th 2020",datePrePublished:"October 8th 2020",datePublished:"January 20th 2021",book:{id:"8545",title:"Animal Reproduction in Veterinary Medicine",subtitle:null,fullTitle:"Animal Reproduction in Veterinary Medicine",slug:"animal-reproduction-in-veterinary-medicine",publishedDate:"January 20th 2021",bookSignature:"Faruk Aral, Rita Payan-Carreira and Miguel Quaresma",coverURL:"https://cdn.intechopen.com/books/images_new/8545.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"25600",title:"Prof.",name:"Faruk",middleName:null,surname:"Aral",slug:"faruk-aral",fullName:"Faruk Aral"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"38652",title:"Dr.",name:"Rita",middleName:null,surname:"Payan-Carreira",fullName:"Rita Payan-Carreira",slug:"rita-payan-carreira",email:"rtpayan@gmail.com",position:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",fullName:"Miguel Quaresma",slug:"miguel-quaresma",email:"miguelq@utad.pt",position:null,institution:{name:"University of Trás-os-Montes and Alto Douro",institutionURL:null,country:{name:"Portugal"}}}]},book:{id:"8545",title:"Animal Reproduction in Veterinary Medicine",subtitle:null,fullTitle:"Animal Reproduction in Veterinary Medicine",slug:"animal-reproduction-in-veterinary-medicine",publishedDate:"January 20th 2021",bookSignature:"Faruk Aral, Rita Payan-Carreira and Miguel Quaresma",coverURL:"https://cdn.intechopen.com/books/images_new/8545.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"25600",title:"Prof.",name:"Faruk",middleName:null,surname:"Aral",slug:"faruk-aral",fullName:"Faruk Aral"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},ofsBook:{item:{type:"book",id:"10300",leadTitle:null,title:"Breast Cancer",subtitle:null,reviewType:"peer-reviewed",abstract:"
\r\n\tWorldwide, breast cancer is the most frequent invasive cancer among women, impacting over two million women each year, and also causes the maximum number of cancer-related deaths among women. The incidence of breast cancer varies greatly around the world. While breast cancer rates are higher among women in more developed regions, rates are increasing in nearly every region globally. Researchers and clinicians around the world are working to find better ways to prevent, detect, and treat breast cancer, and to improve the quality of life of patients and survivors. In recent years, there is substantial amount of development in the area of breast cancer research and its clinical applications, for instance breast cancer biology and genomics; epidemiology and prevention; early detection and screening; as well as diagnosis and treatment. In addition, since the advent of various emerging technologies, such as stem cell technology, genome editing technology, bionanotechnology, as well as tissue engineering and regenerative medicine-and the knowledge gained from such studies not only enhanced our understanding of breast cancer but also produced novel insights that could lead to the development and deployment of newer clinical/therapeutic interventions.
\r\n\r\n\tTherefore, the purpose of this book is to consolidate the recent advances in area of breast cancer biology/therapeutics covering a broad-spectrum of interrelated topics in a timely fashion, and to disseminate that knowledge in a comprehensible way to a great scientific and clinical audience.
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Valarmathi",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10300.jpg",keywords:"Breast Cancer Pathophysiology, Metastatic Breast Cancers, Breast Cancer Stem Cells, Breast Cancer Cells Proliferation, Breast Cancer Signalling Pathways, Breast Cancer Epithelial to Mesenchymal Transformation, Breast Cancer Genomics, Breast Cancer Proteomics, Breast Cancer Immunology, Breast Cancer Immunotherapy, Nanomedicine of Breast Cancer, Bioengineering Models of Breast Cancer",numberOfDownloads:6,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 26th 2020",dateEndSecondStepPublish:"November 23rd 2020",dateEndThirdStepPublish:"January 22nd 2021",dateEndFourthStepPublish:"April 12th 2021",dateEndFifthStepPublish:"June 11th 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Mani T. Valarmathi has had extensive experience in research on various types of stem cells. He is a member of the Society for Stem Cell Research, American Association for Cancer Research, American Society for Investigative Pathology, American Chemical Society, European Society of Cardiology, American Society of Gene & Cell Therapy, American Heart Association.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",slug:"mani-t.-valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",biography:"Mani T. Valarmathi is presently an assistant professor at the University of Alabama at Birmingham, USA. He began his scientific career as a cancer geneticist, but soon became captivated with the emerging and translational fields of stem cell biology, tissue engineering, and regenerative medicine. After completing his Bachelor’s degree in Chemistry at the University of Madras, he received his MBBS in Medicine and Surgery and MD in Pathology from the University of Madras, as well as his PhD in Medical Biotechnology from All-India Institute of Medical Sciences, New Delhi, India. For over 15 years, he has had extensive experience in research on various types of stem cells, including adult, embryonic (pluripotent), and induced pluripotent stem cells. Currently, his research work focuses on generating three-dimensional vascularized tissues and/or organs for implantation purposes. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"68863",title:"The Importance of Selenium in Children’s Health and Reproduction",doi:"10.5772/intechopen.88864",slug:"the-importance-of-selenium-in-children-s-health-and-reproduction",body:'Pregnancy is a period of important conditional physiological changes, when the fetus requires a regular and balanced diet provided by the mother’s food and its physiological reserves. The intrauterine period, infancy, and early age are considered to be a critical period in terms of the impact of nutrition on subsequent development [1].
For the growth and development of the fetus, normal pregnancy requires a constant consumption of sufficient amounts of nutrients, at least 40 of them are essential for pregnant and lactating women. Nutritional status of pregnant and lactating women is of great importance for the health of the child, as the development of the body is most actively carried out up to 18 months of life.
Adequate provision of selenium for pregnant women, premature infants, children of different ages, and adolescents living in environmentally unfavorable conditions and constituting a risk group for selenium deficiency is particularly relevant [2, 3, 4, 5, 6, 7].
Nefedova et al. [8] believe that the fact of selenodetic in healthy women in Western Siberia is associated with the possible formation of “anomalous biogeochemical province” endemic selenium. In pregnancy, even with the physiological course, this deficit is exacerbated, which is an understandable increased expenditure of trace elements [9, 10, 11]. In women at risk of termination of pregnancy, selenium deficiency is most pronounced, with pregnancy ending in miscarriage at different stages [12, 13, 14, 15].
The level of selenium (serum, erythrocytes, urine, and hair) in healthy adult blood donors, residents of Khabarovsk in the preconception (indicator group), at the end of physiological pregnancy (group “healthy pregnant”) and breast milk on the 7–10 day after birth in mothers of healthy newborns and preterm infants was established.
There were no differences in the content of selenium in the serum of young healthy nonpregnant women, donor volunteers (residents of Khabarovsk, examined by random sampling), healthy pregnant women at the end of physiological pregnancy, and healthy puerperas. The provision in these groups was found to be average (82–85 μg/l), which is approximately 80% of the optimal level, since the interval of normal serum concentrations of selenium is on average 115 μg/l. At the end of physiological pregnancy and normal childbirth, the level of selenium in the blood serum was determined within 85.4 + 4.8 μg/l and 82.6 + 6.1, respectively, which is lower than optimal for pregnant women. In premature births, serum levels of selenium were significantly lower—58.2 μg/l, which is about half of the optimum. There are no significant differences in the content of selenium in the blood inversion in smoking and nonsmoking women in the indicator group (82.8 + 16.2 and 83.1 + 15.9 μg/l) or in the group of healthy pregnant women (84.7 + 15.8 and 85.8 + 16.1 μg/l), in the presence of significant differences in the hair of smoking and nonsmoking pregnant women (383.0 + 24.4 and 436.6 + 28.2 μg/l, respectively, p < 0.01).
During pregnancy, there is a significant reduction in the excretion of selenium in the urine, which ensures the maximum possible provision of the fetus with a trace element [16]. Excretion of selenium in urine is constant and is normally 40–50% of intake [17]. Losses of selenium with urine in the group of healthy pregnant women in Khabarovsk ranged from 12.6 to 40.8 μg/l, on average 23, 68 μg/l, which differs with a high degree of reliability from the standards described in the literature.
A direct relationship of average strength between the level of selenium in the hair and urine of pregnant women indicate unidirectional changes in the concentration of selenium in the hair and urine of pregnant women.
Also in the process of gestation, there is a change in the content of selenium in serum and in hair, and there is a highly reliable feedback of average strength between the content of selenium in serum and hair of pregnant women.
In young healthy nonpregnant women, the existence of a direct relationship of moderate strength (r = 0.4804) is established between selenium content in blood plasma and urine, and there is a highly significant direct strong correlation between selenium in serum and erythrocytes (r = 0.9552), direct medium strength correlation between selenium in urine and selenium in erythrocytes (r = 0.4348). At the same time, during the physiological course of the gestational process in healthy mothers, serum selenium levels and urine selenium values have a direct relationship of average strength.
The loss of selenium in urine was significantly lower (p < 0.05) in women with a long labor period (18.6 + 0.76 μg/l) and higher in mothers with planned operative labor (24.9 + 1.3 μg/l), and there was no dependence on the gestation period. Probably, the detected changes are associated with the development of oxidant stress; since the intensive physical activity (childbirth) determines the acceleration of metabolic processes, leading to significant oxidant stress of the body, a specific mechanism is included that ensures the preservation of selenium by reducing its excretion in the urine [18].
On the territory of the Khabarovsk, there is a shortage of selenium, because in the food diet of the inhabitants of the region, local products prevail, including from household plots, which, in conditions of natural low maintenance, contain little of this element. The problem is also aggravated by the fact that our study of the diet of young children showed a significant deficit in the consumption of the surveyed residents of Khabarovsk products—sources of selenium, which undoubtedly exacerbates the population deficit.
In the epidemiological study of the provision of selenium in children permanently living in Khabarovsk, we have established a significant variability in the provision of selenium in different age groups of children with maximum security in adolescents 12–17 years; the minimum level of selenium was detected in children aged 2 years of life, due to the peculiarities of nutrition and food preferences of children of different ages. In general, selenium deficiency was observed in 18% of the surveyed children; only 28% of children found trace element content at the lower limit of the norm. The data obtained by us on the provision of selenium for children and residents of Khabarovsk are comparable with the data obtained by us from the adult population [19].
The placenta is a unique, complex organ composed of the maternal and fetal parts. It is a full component of the system and performs numerous functions, the violation of which leads to a wide range of pregnancy complications [20]. The placenta has a wide range of functions that go in both ways; directly from maternal body to placenta; from placenta to fetus, and vice versa, from the fetus to the mother and placenta [21, 22, 23]. Placental dysfunction is a threat to the development and life of the fetus, and subsequently the newborn. In physiological pregnancy, the mother’s body retains its homeostasis and provides the fetus with everything necessary for normal development [24, 25]. Studies in recent years [3, 26] show that the inability of the system of “mother-placenta-fetus” to maintain adequate exchanges between mother and fetus (feto-placental insufficiency) leads to violation of fetal development and homeostasis of the mother. The value of the placenta is as an indicator of fetal selenium content [20, 21, 22, 27].
It is known that the mass of the newborn is largely determined by serum selenium [21, 28]; however, the unknown is the correlation between the content of selenium level with the mass of the placenta and fetus. During the multivariate correlation analysis, it was found that there is an average strength positive correlation (R = 0.53; p = 0.002) between the body weight of premature infants born at gestation 28–36 weeks, and the content of selenium in the placenta.
Therefore, the higher the level of selenium in the placenta, the greater the body weight of the newborn. The same relationship was established in the group of children with psrp (R = 0.57; p = 0.03). The obtained results do not confirm the data of Zadrozna et al. [27], which did not reveal this dependence. A negative correlation between the placental-fetal coefficient and the content of selenium in the placenta (R = −0.55; p = 0.002) was established [29].
In the study of the accumulation of selenium in the placenta, depending on the duration of pregnancy, it was found that the minimum content was observed at the gestation period of 28–33 weeks and significantly different from the indicators in other groups [29]. The content of selenium in the placenta of women in countries such as Russia, Ukraine, Poland, Spain, and Turkey is in the range of 0.15–1.65 mg/kg [21, 22, 23, 30, 31], which is significantly higher.
There is a positive correlation between the average strength between the levels of selenium in the placenta and the evaluation of the newborn on the Apgar scale both at the first (R = 0.45; p = 0.02) and fifth minute (R = 0.36; p = 0.005), which indicates a better tolerability of labor stress in newborns with a greater reserve of this microelements antioxidant properties in the placenta.
Clinical and diagnostic parallels were made to assess the role of trace element imbalance in the placenta in the formation of pathological conditions of newborns in the early neonatal period by calculating the relative risk (RR) with 95% confidence interval.
It was found that the deficiency of selenium significantly and statistically significantly affects the low score on the Apgar scale in the first minute in newborns—more often 2.5 times (OR with CI 1.1–2.5) for selenium. A low content of selenium in the placenta in newborns significantly increases the risk of neutrophilia with OR—1.6 (CI 1.1–3.0). The above parallels occur reliably in all study groups. In the pathogenesis of RDS, selenium deficiency probably plays a significant role because its deficiency not only in the hair of the mother and newborn, but also in the placenta at gestation 28–33 weeks forms the risk of RDS and is 1.9 CI 1.06–4.3.
It was found that the most pronounced imbalance of trace elements in the groups of premature infants with a gestation period of 28–33 weeks and in newborns with intrauterine growth retardation syndrome, which is a manifestation of immaturity in the first and decompensation of the function of passive transport systems in the second case. Clinically, this will be manifested by a violation of acute neonatal adaptation with a low Apgar score, severe general condition, and the presence of markers of inflammatory response.
In serum and placenta, selenium to some extent mimics the behavior of zinc and behaves opposite to copper [32]. It is interesting to note that active smoking gave higher levels of selenium and zinc in the placenta [32]. Both elements play an important role in protecting against oxidant stress: selenium in glutathione peroxidase and zinc in superoxide dismutase. Smoking causes severe chemical stress to the placenta, so a higher concentration of zinc and selenium in the placenta in smokers may reflect the activation of protective mechanisms.
When smoking, the transfer of selenium from the blood to the placenta is increased, so that the level of selenium in the blood decreases; while the level of selenium in the placenta of smoking women is much higher than in nonsmokers. In general, the results suggest that in women smokers, selenium transport appears to be part of a protective mechanism against chemical stress.
Selenium concentrations during pregnancy are reduced in serum and placenta by the end of pregnancy and increased in the placenta of smokers. Since selenium status negatively affects the level of zinc in breast milk [33, 34], the concentration of selenium can affect the level of zinc in the placenta and serum by changing the distribution of zinc. Low concentrations of serum selenium and low copper concentrations in the placenta are associated with higher weight of newborn, which reflects the correlation between serum selenium and copper of the placenta. A strong positive correlation in serum between selenium and copper correspond to such in milk [34], although the reason for this is not clear. An inverse correlation between the activity of aromatase and placenta selenium was revealed, which indicates the protective effect of selenium by acting on the activity of the enzyme to transfer nutrients to the fruit. The authors conclude that it is essential to identify the relationship between selenium, zinc, and copper. Thus, the protective role is established selenium during pregnancy, especially in smokers (Table 1).
Indicator | Level | Region |
---|---|---|
Se placentae | 810 ± 20 μg/kg | Spain* |
Se umbilical cord blood | 74 ± 7 μg/kg (51–104) | |
Se mothers blood | 90 ± 15 (57–118) | |
Se mothers hair | 600 ± 370 (220–1500) | |
Se newborn hair | 1040 ± 480 (400–2530 μg/kg) | |
Placentae | 200 μg/kg raw weight | Austria** |
Placentae | Italy*** | |
Placentae (normal pregnancy) (36) | 150 ± 30 (100–240 мкг/кг) | Croatia**** (significant differences with the norm P < 0.05) |
Placentae intrauterine growth restriction cases (49) | 140 ± 20 (100–200 мкг/кг) |
It is shown that Cd and Pb placenta have an inverse correlation with the body weight of the newborn [25, 36], and these elements are selenium antagonists which reduce their toxic effect [36, 37, 38].
In Croatia, Alexiou et al., [35], indicated that Se in the placenta predicts birth of a child of normal weight, not intrauterine growth restriction. In this work, a significant positive relationship between placental Se and neonatal weight in a subgroup of pregnant women with body weight appropriate for this gestational age was established. This is consistent with a number of important functions that can be used to influence fetal development. On the other hand, the lack of communication in the IWRM group may mean that the element is not causally related to the condition and further research is needed on this issue. In studies Alexiou et al. [35] studied trace elements (zinc, cobalt, selenium, rubidium, bromine, gold) in the human placenta and in the liver of the newborn at birth, the authors note that the average concentration of essential trace elements (zinc, cobalt and selenium) were significantly higher in the liver than in the placenta, while interchangeable trace elements (rubidium, bromine, gold) were found in significantly higher concentrations in the placenta than in liver tissue.
Since the decrease in serum selenium level during pregnancy occurs monotonously, it is possible to calculate the optimal concentration of selenium in the serum of pregnant women: by the end of the first trimester—104 to 109 μg/l, the second—98 to 103 μg/l, to the third trimester—95 to 100 μg/l [39], these indicators can be used to assess the normal selenium status during pregnancy.
There is evidence of a connection with selenium deficiency weak labor activity, a significantly greater number of complications during delivery and lower development indicators of newborn [40]. The risk group for selenium deficiency is also pregnant women living in ecologically unfavorable regions and women with cardiovascular diseases [30]. In several case studies, the authors attributed the poor pregnancy outcome and reproductive failure, including recurrent pregnancy loss, with abnormal concentrations of selenium [12]. Other authors [13, 41, 42] also found a positive correlation between the increased risk of miscarriage in women with low selenium concentrations. Selenium reduction is a predictor of preterm birth and low birth weight, and correction of selenium deficiency during pregnancy eliminates the risk of low birth weight [28].
The concentration of selenium in the placenta at different periods of gestation was studied in children—residents of the Khabarovsk territory [43]. Estimating the central values of the studied microelements, the norm was understood as variants within one standard deviation; the boundaries of the norm were the values between the 25th and 75th centiles or (M + 2δ), and the pathological values beyond these limits were considered. To calculate the extreme limits of normal values, the method of standard deviations was used—the lower limit—5 SD corresponds to 5 percentiles; the upper limit +5 SD—95 percentiles. Based on this, for all cases with values below 5 percentile, we consider a sign of a significant decrease in the parameter, and with values more than 95 percentile—it is stated as an increase (Table 2).
Group | n | Average | m | Deviation interval |
---|---|---|---|---|
28–33 gw | 14 | 0.217*,**,*** | 0.01 | 0.160–0.278 |
34–36 gw | 17 | 0.341* | 0.03 | 0.176–0.588 |
Fetal growth Retardation | 14 | 0.271** | 0.01 | 0.196–0.343 |
Control group | 20 | 0.370*** | 0.04 | 0.233–0.626 |
Selenium concentration (mg/kg) in the placenta at different gestational ages.
Significant difference between 28 and 33 weeks and 34 and 36 weeks (p = 0.0017).
Significant difference between 28 and 33 weeks and DLD don (p = 0.0013).
Significant difference between 28 and 33 weeks and full term (p = 0.00003).
It is interesting to note that with the increase in gestation period, there is a more significant variability of selenium content, which does not occur in the group of children with intrauterine growth retardation syndrome.
Our findings suggest that passive transport through the placenta of selenium has insufficiently mature mechanisms of its regulation in the early stages of embryogenesis.
The study revealed that the level of selenium in the placenta has a dynamics similar to that in the hair of the mother and the newborn and in breast milk [29, 44].
The placenta is an organ that reflects the features of the course of the intrauterine period, the environmental situation, and the infectious background, and it is also an indicator of the content of vital for the normal carrying of the newborn trace elements.
The only natural vitamin and mineral complex is breast milk; it contains all the necessary bioelements and is most adapted to the assimilation of the child. However, the composition of breast milk, both qualitatively and quantitatively, depends on the time of onset of labor, significantly different from normal indicators for premature termination of pregnancy and fetal growth retardation syndrome. Of particular importance for solving the problem of nutrition of small children [45] is a detailed explanation of the properties of breast milk and determining the value of each of its components [46].
Given that the child in the first months of life receives selenium exclusively from mother’s milk and baby food does not always contain it in sufficient quantities, of particular importance is the provision of this micronutrient women, both during pregnancy and during lactation. The estimated need for selenium in premature infants is 20–25 μg/l in breast milk or infant formula (15 μg/l for full-term infants) [47, 48]. The main source of selenium for a child is breast milk, but many children, especially those receiving long-term inpatient treatment, are artificially fed and have lower values of selenium content [49]. In addition, the presence of selenium deficiency in the mother is a common cause of element deficiency in the newborn [50, 51]. The content of selenium in breast milk varies widely [9, 50, 52]. Thus, in the study of selenium in breast milk of women living in the United States, it was determined that the average selenium content is 18 μg/l, and the maximum level reached 60 μg/l [52]; a direct correlation was found between the level of selenium in milk and serum. In premature births, the milk of women living in New Zealand contains an average of 20 μg/l selenium [53]. The question of the needs of newborns in selenium is not finally resolved, but most researchers recommend enriching the mixture for children with selenium in an amount corresponding to its content in breast milk. But the supply of children with selenium in an amount equal to its content in breast milk is not equivalent, because in breast milk, mixtures contain different chemical forms of selenium with different levels of bioavailability and toxicity. Currently, baby foods mainly use selenite, which easily interacts with the ascorbic acid contained therein, forming an inactive elemental selenium; as a result, such products are inert against selenium [54]. Therefore, it seems natural to normalize the level of selenium in the mother feeding a newborn baby breast milk.
The content of selenium in breast milk during normal pregnancy and physiological childbirth by a conditionally healthy fetus and at low birth weight (Table 3) was determined in Khabarovsk [55].
Trace elements | Control group, n = 20 | 28–33 weeks of gestation, n = 20 | 34–36 weeks of gestation, n = 20 | Fetal growth retardation, n = 19 | Literature data |
---|---|---|---|---|---|
Se | 0.02 ± 0.007 | 0.01 ± 0.004** | 0.009 ± 0.002* | 0.001 ± 0.0002** | 0.019 ± 0.001 |
Content of Se (mg/kg) in milk (M + m).
Significance of differences between the control group and childbirth at 34–36 weeks, p < 0.05.
Significance of differences between the control group, 28–33 weeks of labor, 34–36 weeks of labor, and fetal growth retardation syndrome, p < 0.05.
When compared with the data of the WHO/MAGATE collaborative study [56], there were significant differences in the content of selenium in the milk of healthy women living in Khabarovsk (Table 3). The most pronounced deficiency of selenium in breast milk is preterm labor and fetal growth retardation syndrome; its level is 2 and 20 times lower than optimal, respectively, and from the first days of life of a small child, its insufficiency is formed with a significant (p < 0.05) maximum decrease in premature infants with a gestation period of 34–36 weeks and children with fetal growth retardation syndrome.
Selenium supply in newborns in the control group is optimal (Table 4).
Groups | n | Se |
---|---|---|
The norm of physiological needs* | 0.01 | |
Childbirth 28–33 w | n = 20 | 0.003 |
Childbirth 34–36 w | n = 20 | 0.003 |
Childbirth a delay syndrome fetal growth retardation | n = 19 | 0.0003 |
Control group | n = 20 | 0.013 |
Actual consumption of bioelements (mg/day).
Norms of physiological needs for energy and nutrients for different groups of the population of the Russian Federation were approved on December 18, 2008 (Mr 2.3.1.2432–08).
At low weight, the actual provision of newborn children with selenium did not meet the standards of physiological needs of the body. The extremely low figures for the actual supply of selenium in natural feeding are detected in underweight children with the syndrome of fetal growth retardation and prematurity. Low level of selenium from the first days of life of a small child forms its negative balance. Given that the need for selenium at low weight is higher, and breast milk [55], as the only source of selenium for the newborn, contains less than optimal selenium, such a child is provided with the necessary trace element only 25–30% in premature birth and only 3% of the need for the birth of a child with delayed fetal development syndrome.
In the study of selenium content (Table 5) in the hair of 20 healthy women who gave birth to healthy children, a few months after birth, and an average of 13.05 + 0.54 months after birth (variability from 10 to 18 months) there were significant differences in the content of selenium in women’s hair 13 months after birth depending on the duration of lactation. At the time of the study, seven women continued to feed their children with breast milk, the rest of the lactation ended 6 months or more ago [3].
Indicators | All subjects 13 months after delivery, n = 20 | Lactation, 13 months after birth, n = 7 | No lactation, 13 months after delivery, n = 13 | Immediately after birth |
---|---|---|---|---|
Se | 359.9 ± 18.9* | 314.6 ± 20.2* | 388.7 ± 25.1 | 524.6 ± 55.0* |
Selenium content (μg/kg) in women’s hair after childbirth (M + m).
Significant differences (<0.05) between groups.
In women with preserved lactation function by 13 months after birth, the level of selenium is significantly lower than in women who breastfed children for a shorter time.
Regardless of the presence of lactation, all subjects had significantly lower levels of selenium than immediately after birth. Thus, in the above observations, there is no recovery of selenium concentration after childbirth, typical for the content of selenium in blood serum. There were no significant differences in the content of selenium in the hair of women a year after childbirth with or without the use of vitamin complexes during lactation (368.9 + 22.13 and 336.4 + 38.7 μg/kg, respectively).
Premature infants with low selenium levels have a higher rate of early neonatal morbidity [57]. The risk group for selenium deficiency includes children receiving long-term hemodialysis [18], with respiratory distress syndrome [58]; and children born in a state of chronic intrauterine hypoxia [59], with bronchopulmonary dysplasia [60]. In premature infants, selenium deficiency is associated with hypoxia and respiratory diseases [61]. In all these cases, the appointment of selenium is accompanied by a positive therapeutic effect. Confirmation of the diagnosis of chronic intrauterine hypoxia in the fetus can be a decrease in the content of selenium in the blood less than 25 μg/l [62]. Based on a multicenter randomized trial conducted by Darlow et al. in 2003, including a meta-analysis of other studies in this area, the additional use of selenium in the diet of preterm infants contributed to a reduction in the incidence of septic complications, which allowed the authors to recommend the use of selenium in the diet of preterm infants [53].
However, the optimal selenium supply of a newborn child is not currently determined; in the literature, there are different indicators of the norm from 65–75 μg/l [63] to 191 μg/l [64] in whole umbilical cord blood. In a study by Anya et al. [65] in the reference group of healthy newborns normal level of selenium was established in children younger than 1 month of life within the median 64 μg/L. Parfenova and Reshetnik [66] in the whole blood of preterm infants 27–32 weeks of gestation the level of selenium equal to 112.4 + 5.3 μg/l was determined.
The concentration of selenium in serum is reduced in children with intraventricular hemorrhage [67], diseases of the respiratory system [68], and diseases of the gastrointestinal tract [69]. However, first of all, premature children are a risk group for selenium deficiency, aggravated by living in environmentally unfavorable conditions [3, 61, 70]. Many of them, especially those receiving long-term inpatient treatment, are artificially fed, and baby foods contain predominantly sodium selenite—an inorganic compound of selenium with high toxicity, low bioavailability and not always in sufficient quantities. Selenium obtained from mother’s milk is better absorbed than selenium nutrient mixtures [71]. It is recommended to add selenium to the nutrition of mothers, as well as cows whose milk is used for the preparation of nutrient mixtures [63].
The mass of the newborn is largely determined by serum selenium and is inversely correlated. This also confirms the assumption that selenium is actively transported to the fetus in the quantities required by the embryo (Table 6).
Group | 28–33 gw | 34–36 gw | Fetal growth retardation | Control |
---|---|---|---|---|
n | 23 | 34 | 21 | 20 |
Mother | 0.3 ± 0.04* 0.02–0.7 | 0.4 ± 0.06* 0.02–1.4 | 0.4 ± 0.07* 0.02–0.8 | 0.6 ± 0.05 0.4–1.1 |
Children | 0.5 ± 0.07* 0.04–0.9 | 0.6 ± 0.05* 0.08–1.01 | 0.2 ± 0.04*,** 0.01–0.6 | 0.8 ± 0.05 0.2–0.96 |
Selenium content (mg/kg) in the hair of mother-newborn pairs in prematurity and delay syndrome fetal growth retardation (M ± m, min-max).
Significant difference (p < 0.05) between study and control groups.
Significant difference (p < 0.05) when comparing the indicators of the fetal growth retardation group with the groups of 28–33 weeks and 34–36 weeks.
Selenium levels in the hair of low-weight newborns and their mothers are statistically significantly different from the levels of selenium in the hair in the control group, with the highest degree of confidence established in the group with fetal growth retardation.
The deeper the immaturity and the lower the gestation period, the lower the level of selenium in the hair of premature infants and their mothers; the level of selenium in the hair of the group with fetal growth retardation decreased more than four times and was significantly lower than in the group of premature infants with the deepest immaturity.
Reduction of selenium in the hair of newborns increases the chance of oppression syndrome, muscle dystonia, and neutrophilia. RDS is often formed when selenium deficiency in the pair “mother-newborn” in prematurity.
Direct dependence of the average strength between the level of selenium in the hair and urine of pregnant women indicates unidirectional changes in the concentration of selenium.
Also in the process of gestation, there is a change in the content of selenium in serum and hair and a highly reliable feedback of average strength (r = 0.538) between the content of selenium in serum and hair of pregnant women.
Selenium deficiency in pregnant women can lead to an increase in the frequency and severity of early and late gestosis, fetal hypotrophy, and hypoxia, and has an impact on the duration of pregnancy and the rate of growth of fetal body weight. Selenium deficiency in pregnant women can lead to an increase in the frequency and severity of early and late gestosis, fetal hypotrophy and hypoxia, and also affects the duration of pregnancy and the rate of growth of fetal body weight, the formation of a deficiency in the fetus and newborn [15].
The study found a deficiency of selenium in women in preterm labor and is due not only to the lack of an element in the diet and the environment, but also an excess of selenium antagonists—Mn, Cd, Pb, and Fe.
The provision of selenium depends on the degree of maturity and physical development of newborns, decreases with fetal development syndrome, prematurity, artificial feeding, and hypoxia. The content of selenium in breast milk of prematurely born women provides only 25–30% of the needs of the element in premature infants. Breast milk of prematurely born women contains selenium three times less than in normal childbirth, which contributes to a high risk of developing alimentary-dependent conditions in premature infants [72].
In autumn of 2017, two faculty and 13 undergraduate students from Dickinson College—located in Carlisle, Pennsylvania, US—traveled to Panchkahl Municipality of Kavrepalanchok District, Nepal, to engage in 3 weeks of field research. Fieldwork consisted of numerous interviews conducted in four different wards of Panchkahl. When they returned to the US, each team completed a 50-page research paper that focused upon the ability of the respective community members to handle risks to their human security stemming from shortages of fresh water resources. In spring of 2018, the authors studied the four reports to distill high-level themes. As well, they constructed a basic yet original systems model to frame the relationships emerging in the reports.
\nVia that inductive process, this chapter offers the following thesis. Although the availability of fresh water was scarce and access to fresh water was constrained: (1) a successful collaboration among the community members and nongovernmental organizations had enhanced the capabilities relevant to adaptability and resilience, and thus, human security; and (2) future progress was contingent on the additional empowerment of women as well as the ability of the government to become a more trusted collaboration partner.
\nThe students and faculty who conducted the field research were participants in a semester long Dickinson Global Mosaic Program [1], “Climate Change and Human Security in Nepal [2].” The program was 2 years in the making. As part of the building process, the Dickinson professor who initiated the program traveled to Nepal on two occasions and established a relationship with the Institute for Crisis Management Studies (ICMS), a master’s program affiliated with Kathmandu-based Tribhuvan University. The director of the ICMS designated a project coordinator for the initiative.
\nThe professor and the project coordinator negotiated the activities, locations, and logistics. The Coordinator suggested four wards as the research sites: Hokse, Kharelthok, Koshidekha, and Sathighar Bhagawati. The wards, located to the east of Kathmandu, were part of Panchkhal Municipality of Kavrepalanchok District, located in Province 3 of Nepal. As well, the Coordinator agreed to recruit ICMS graduate students who would provide general assistance to the Dickinson students and serve as guides and translators during the field-research.
\nFourteen students enrolled in the program. It consisted of three phases. Phase one included 9 weeks of study in Carlisle that incorporated three courses each taught by a different professor1 plus one team-taught qualitative research methods course.2 Furthermore, in phase one, the students were assigned to one of four teams.
\nPhase two consisted of 3 weeks of field research in Nepal that lasted from late October to mid-November. The advantage of the four-course structure was that there were no scheduling issues when faculty and students traveled to Nepal.3\n
\nDuring phase three, which lasted for 4 weeks, each team generated a 50-page research report that summarized their findings. Those four written reports provided the qualitative data for this chapter.
\nThe United Nations Development Programme [3] offered the first generally accepted description of the term human security. Many alternatives have since been proposed. One schema, designed with Nepal in mind, illustrates interconnections among ecosystems and climate security; water and energy security; food and health security; environmental security; and nuclear and biological security ([4], p. 3).
\nMany definitions have also been proposed for resilience. Nevertheless, a description offered by Twigg [5] is helpful. Community resilience includes the capacities to: “anticipate, minimize and absorb potential stresses or destructive forces through adaptation or resistance”; “manage or maintain certain basic functions and structures during disastrous events”; and “recover or ‘bounce back’ after an event ([5], pp. 8-9).” A caveat he offers ([5], p. 10) is relevant to this chapter.
\nIndividuals can be members of several communities at the same time, linked to each by different factors such as location, occupation, economic status, gender, religion or recreational interests. Communities are dynamic: people may join together for common goals and separate again once these have been achieved.
\nIn recent decades, the environments confronting citizens and professionals in all domestic and global settings have exhibited rapid change and increasing complexity [6]. Those developments have made collaboration among organizations an increasingly relevant way to achieve objectives beyond the reach of any single entity. For example, Goal 17 of Sustainable Development Goals [7] views multi-stakeholder partnerships as an “important vehicle” for making progress toward “the achievement of the sustainable development goals in all countries, particularly developing countries.”
\nIn 2010, Nepal’s Ministry of Environment released the National Adaptation Programme of Action (NAPA) to Climate Change [8]. The report reflected the results of a 2-year, multi-stakeholder effort. After the Dickinson Mosaic Program had concluded, a Ministry of Forests and Environment report [9] also pointed to the need for collaboration. At the outset, the latter described the NAPA as an ongoing process that “will leave no one behind”; included numerous functionally based working groups; and recognized the need for engagement by multiple types of stakeholders ranging from local to national levels.
\nMeadows [10] explains that a human system has three essential components: elements; interconnections; and a purpose. Elements may be either physical items or intangible items. Interconnections are the relationships that hold the elements together: for human systems, they include customs, rules, or laws. The purpose of the system reflects intended outcomes. Since systems can be nested within systems, purposes can be nested inside other purposes.
\nShe also explains that systems have three important attributes: self-organization, hierarchy, and resilience. Self-organization is the “capacity of a system to make its own structure more complex” ([10], p. 79). Hierarchy is the arrangement of systems and subsystems that tends to arise when self-organizing systems engage in the “process of creating new structures and increasing complexity” ([10], p. 82). In a manner consistent with Twigg [5], Meadows says resilience arises from the rich structure of many feedback loops that can work in different ways to restore a system even after a large disturbance. Resilient systems can be dynamic in nature and evolve over time.
\nA few weeks into the semester, the three Dickinson professors assigned the students to one of four research teams. The teams were asked to develop questions for three different types of semi-structured interviews. Each type was intended for one of three different groups of interviewees: individual household members; key informants; and focus group participants. The teams shared proposed interview questions with the professors, took their comments, and engaged in fine-tuning. When ready, each team forwarded their work to the ICMS graduate students, who provided further comments to the students and translated the survey instruments. All four teams used the “Toolkit for Measuring Community Disaster Resilience” [11] and Twigg [5] as their points of reference for designing their surveys. To illustrate, \nTable 1\n provides a condensed version of the focus group survey instrument created by one of the four teams.
\nThank you for taking the time to talk with us today. We are a group of students from Dickinson College in the United States and we are working with the Institute for Crisis Management Studies of Tribhuvan University in Kathmandu to learn about your community and the challenges it faces. The goal of the interview is to understand how weather and climate-related events and other hazards have affected your community and how resilient you and the community are in anticipating and adapting to these events and disasters.. .. Participation in the conversation is totally voluntary.. .. May we have your permission to audio and video record the conversation? \nTo what hazards is the community currently exposed?\n Prompt: Disasters (large storms, landslides, earthquakes, floods, and disease) Prompt: Weather or climate related (heat, drought, erosion, and rainfall) \nPlease write answers on the cards. Let us place the cards on the table and discuss the results. \nOf the weather and climate-related hazards you noted, which have gotten more frequent or intense?\n \nOver what time period: 5, 10, or 15 years?\n \nHow have the hazards you described affected the community?\n Prompts: Food availability/production, water, health, livelihoods, and income. What areas of the community are most at risk to the hazards? \nWhat members of the community are the most affected/impacted?\n Prompts: Women/men, poor/wealthy, and caste/ethnicity Why do you think this is? \nWhat actions has the community taken to reduce the impacts of the hazards?\n Have the actions you described improved the situation and/or reduced risks? How does the community work together to cope or respond to changing conditions? Where does the community get information to improve the situation? If something happens (weather event, disaster, etc.), where does the community turn for help? Do you seek assistance (financial, resources, and training) from groups outside the community? Has it been helpful? Do you think the community has a clear understanding of actions that can reduce risks associated with hazards? \nWhat more do you think should happen to address the hazards and to meet the community needs?\n | \n
Example of a focus group survey instrument: Subset of comments, permission requests, and questions.
The geography of Kavrepalanchok District, and Nepal more generally, includes five major zones. From the lowest elevation to the highest, they are the Terai, Siwalik, Middle Hills, High Hills, and the Mountains including the Himalayas.
\nThe two major agricultural regions that served as the focus of the Nepal Mosaic were the Terai and the Siwalik. The Terai has a warm, subtropical climate, and land that can be irrigated to grow rice and vegetables. The Terai generates most of Nepal’s’ agricultural output [12].
\nAt the time of the research, teams learned that farmers of the Siwalik primarily planted maize and millet as their major subsistence crops on terraces dug into the hillsides. Rainfall was a major source of water in the zone, but the land did not retain much of the water that resulted from rainfall. Springs, streams, and natural aquifers were other important water sources that were supplemented by man-made water-channeling infrastructure and water-storage ponds and facilities. Land in the Siwalik was subject to landslides. Far more devastating, in April of 2015, an earthquake of magnitude 7.8 on the Richter scale, centered in Gorkha, a district near Kathmandu, killed 9000 people and resulted in billions of rupees in damage. In the wards of Panchkhal located in the Siwalik, the earthquake destroyed buildings and homes, and disrupted aquifers and water-infrastructure.
\nDue to the elevation differences, each zone had its own microclimate. Nonetheless, all models forecasted increases in temperatures at the country level in coming decades that ranged from 2° to 6° Celsius, increases more pronounced than those at the global level. Projections for rainfall trends were even more varied than those of climate change, yielding results that ranged from a 30 percent decrease to a 100 percent increase by 2100, when compared to the 1970–1999 average. Moreover, climate change could destabilize the monsoon season, leading rainfall to increase and become more intense during a shorter season [13].
\nThose factors led Nepal’s Ministry of Population and the Environment ([14], p. 1) to say:
\nNepal is one of the most vulnerable countries to climate change, water-induced disasters and hydro-meteorological extreme events such as droughts, storms, floods, inundation, landslides, debris flow, soil erosion, and avalanches.
\nNepal’s population tripled between 1960 and 2010. As of 2017, it totaled approximately 30 million people and was expected to continue to grow into the future, though at a slower rate. Nepal was characterized as a Least Developed Country by the United Nations. Roughly one in four people lived below the international poverty level of US$ 1.25 per day. Agriculture accounted for nearly one-third of Nepal’s GDP; thus, the onset of climate change had contributed to the struggles of the people ([15], p. 17). Furthermore, Nepal had inadequate infrastructure and was not a destination for foreign direct investment, factors that together suggested a shortage of the technological and financial resources needed to adapt to climate change.
\nNepal broke into a civil war in 1996, fueled by sharp disparities in living standards between rural and urban populations and by discrimination against social classes, women, and indigenous ethnic groups. A peace agreement was signed between insurgents and authorities in 2006. An Interim Constitution agreed in 2007 ended the 240-year-long Hindu Monarchy. In the ensuing decade, nine different coalition governments were formed. In September of 2015, the current Constitution of Nepal replaced the 2007 Interim constitution.
\nIn the decade following post-war reunification, government reform was slow in coming. For example, the first local elections in 20 years in the wards of Panchkahl took place in the summer of 2017 [16], only a few months before the Dickinson research trip. At the outset, local governments were headed by unelected bureaucrats or community leaders, leading to increases in corruption [17]. During that era, building capacity for local governance was clearly not a priority. To fill the void, community groups emerged and worked alongside nongovernmental organizations to help promote collaboration and resilience in the face of challenges.
\nAs of 2017, the governance structure of Nepal consisted of seven provinces, which collectively comprised 77 districts. In turn, each district was made up of municipalities, each municipality of wards, and each ward of various villages or clusters of people who did not have their own formal governance structures.
\nOnce in Nepal, the Dickinson student teams were partnered with a pair of graduate students—one male and one female for each team—who served as guides, and as language and cultural translators. In the field, each of the four teams conducted interviews in accordance with the semi-structured interviews they had previously created. Each team managed to conduct about 20 household interviews, six or so expert interviews, and two focus group interviews. (In each case, teams asked for participants’ permission to record the interview.) Given the outmigration in some wards by single young men and by husbands in search of more stable income for their families, women were more highly represented than men in the interviews.
\nWhile in the field, students took turns each day asking primary and follow up questions and taking notes. Each evening, the teams reviewed what they had heard, and revised and upgraded their notes. When the teams returned to campus, they spent the final 4 weeks of the semester further refining their data and revisiting course materials and other sources as they completed their respective 50-page team-written research reports.
\nIn spring of 2018, Ms. House and Mr. Weisman, students who had both participated in the program, enrolled in a special co-research course with Professor Fratantuono. Together, all three carefully reread and discussed the 50-page papers submitted by each student team at end of 2017. As they did so, Professor Fratantuono took the lead in shaping a systems-model that synthesized concepts from the program and themes that emerged as all three authors interpreted the reports. As the model evolved, it served as a framework for describing data. First versions of this chapter were written in spring of 2018. Since that time, Professor Fratantuono has revised the model and the chapter.
\nThe model incorporates ideas and imagery suggested by Meadows. She illustrates systems using stocks, flows, flow valves, and feedback loops. She explains that systems may display sub-optimal or problematic behavior. If so, she proposes 12 leverage points to promote system alteration ([10], pp. 145-165). Although Meadows does not make the distinction, the three authors say that the 12 alterations may be of two types: system modification or system transformation. Modification entails adjusting, repairing, rearranging, or embellishing components of an existing sub-system or system. Transformation entails either changing the membership, rules, purpose, or even the conceptualization of an existing system; or incorporating a new sub-system into an existing hierarchy. The model—a diagrammatic representation [18]—is presented in \nFigure 1\n. \nFigure 2\n is the Legend for the symbols in \nFigure 1\n.
\nModel of elements and interconnections that promote human security.
Legend for \nFigure 1\n.
Recalling Twigg [5], the upper left corner of \nFigure 1\n identifies four relevant types of community members: households and proprietors, organized community groups, nongovernmental organizations, and local government officials.
\nThe model includes three tiers. The left-most stock of the upper tier represents tangible resources (people and economic resources) and intangible resources (trust, legitimacy, intercultural competency, and goal-related knowledge) available to community members. The second stock represents capabilities (organizational and operational) relevant to a community’s efforts to adapt to challenges, and hence relevant to the community’s resilience in the face of fresh water shortages Twigg [5].
\nThe upper tier also includes two flow valves. Flow valves control the volume and rate at which information, water, money or other factors flow from stock-to-stock. Valves are adjusted by either natural forces or human actions. The left-most valve indicates that developments beyond the system boundary contribute to resources available to a community. The second indicates that members will use the stocks of available resources as inputs to capabilities ([19], pp. 103-105).
\nThe bottom tier of the model includes three more stocks and four more flow valves. The first three valves suggest the ability of members to leverage one or more of the capabilities included in stock 2 as they engage in actions that, respectively, influence flows into one of the three stocks. The fourth, right-most valve indicates that the level of human security attained in a community may have implications for developments beyond the system boundary. Of note, stock 2 and stock 5, labeled in larger font, are the most important to the specification of the model: contingent on human actions, Capabilities enabling Adaptation and Resilience in the face of fresh water scarcity contribute to rising Levels of Human Security.
\nBalancing and reinforcing feedback loops are present throughout the model. The loops influence the degree to which human actions open or close a flow valve. In this model, while balancing loops amplify actions that deplete a stock’s magnitude, reinforcing loops amplify actions that restore or elevate a magnitude. In the top and bottom tiers, the model includes loops between one stock and one flow valve.
\nFor example, in the bottom tier, the flow valve that precedes the stock of available water represents actions by community members—for example, fetch water—to make fresh water available for use. A reinforcing loop indicates the ability of rainfall—perhaps enhanced by new storage methods—to restore or amplify the stock. In turn, the valve that follows the stock represents actions that that draw down the water stock. The associated balancing feedback loop (illustrated with a dashed arrow) indicates that both the use of water, plus other contributing factors such as a hotter climate, will draw down the magnitude of the stock.
\nThe middle tier includes two lightly shaded stocks: satisfaction or frustration experienced by community members resulting from the outcome of previous efforts to enhance human security. As suggested by the various rays, respectively, emanating from those two stocks, satisfaction will enhance the influence of reinforcing loops throughout the model, and frustration the influence of balancing loops.
\nThe students did encounter subcommunities that had different vulnerabilities to shortages of fresh water.
\nIn Koshidekha ward, located in the Terai, members explained that many people had to travel long distances to collect water from a holding pond, or from the Sun Koshi River. In Hokse ward, while some farmers worked the land of the Siwalik, others worked the land of the Terai. A subset of the latter group, those working the valley floor and growing crops near a stream, had reliable access to water for field irrigation, resulting in larger crop yields and higher incomes than those realized by farmers working the nearby hills, who had to carry water to their crops.
\nIn both wards, location-related factors created disparities in the vulnerability of some people: those who resided the farthest from sources had to work much harder at water fetching and storage (stock 3 and the associated inflow valve). Furthermore, at that point in time, there were no capabilities (stock 2) that could be leveraged in the short-term to overcome those location-related challenges.
\nIn Kharelthok ward, located in the Siwalik, the research team interviewed a teacher at a school for disabled children. She explained that her students had historically been socially ostracized by other ward members and thus disadvantaged. As well, the level of human security of the children (stock 5) was fragile, since their capacity for adaptation was quite limited (stock 2) and they required more fresh water resources than other community members to perform activities that supported contributors to human security (stock 3 and stock 4 and associated flow valves). To illustrate, their education involved training in self-care skills such and using the toilet, and they needed to bathe and have their clothes washed more often than did other same-age children. Essentially, the training was intended to help them leverage the capabilities relevant to the three sets of inflow valves in the lower tier of \nFigure 1\n.
\nGiven efforts by the school to raise awareness, community members had begun to recognize the children’s basic rights, to respect their participation in the community, and to recognize they needed support in times of need. Enhanced recognition and ensuing social validation elevated the children’s human security (stock 5).
\nIn Nepali society, husbands and fathers often dominated a household. In community meetings, the voice of men could override the opinions of women; or worse, women were sometimes discouraged by men from using newly formed skills. Those dispositions made it difficult for women to advocate their interests and to express their insights with other ward members about ways that water might be more effectively and efficiently utilized (inflow valve to stock 5). Those factors essentially acted as constraints on the influence of reinforcing feedback loops on the intangible stocks of knowledge and on capabilities relevant to adaptation and resilience (stock 1 and stock 2), and as well increased frustration (shaded stock) among women.
\nFurthermore, women were disproportionately impacted by the shortage of fresh water. They bore the responsibility for making difficult daily decisions about priorities and tradeoffs in order to conserve scarce water for their families (flow from stock 3 to stock 4).
\nMore dramatic, fresh water shortages and existing social mores had implications for a woman’s health (stock 4 and stock 5). For example, the strenuous chore of collecting and carrying water (inflow valve to stock 3) could lead a woman to suffer a prolapsed uterus.
\nAs well, women who attempted to maintain hygiene during menstruation were challenged by a lack of fresh water (stock 4). Even more troubling, the leader of a women’s group located in Hokse explained that the general water shortage had led farmers to turn to various chemically based products such as pesticides to boost productivity; thus, when rains did occur, chemical residuals included in water runoff resulted in health threats when women used the supposed fresh water for personal care (stock 5).
\nFurthermore, women of the Kharelthok and Sathighar Bhagawati wards said other challenges arose when a woman was pregnant. That is, since some men prioritized water use for agriculture (inflow valve to stock 3), a lack of fresh water for properly preparing food could reduce a woman’s intake of important sources of nutrition, thereby threatening the health of both the woman and her unborn child (stock 5).
\nFrustrations were often associated with Government Initiatives. As a first illustration, in Sathighar Bhagawati, in the wake of the earthquake, one person said that a local NGO had to pressure the government to bring relief. Another said that when providing relief, the government did not deliver all the funds it had promised and that the funds had been unequally shared (stocks 1 and 2 and associated inflow valve to stock 2). As a result, community stakeholders were unsure whether they should wait for the remaining promised funds and projects or should themselves take the first steps. The uncertainty hindered progress toward improving community resilience (balancing feedback loops influencing stock 2).
\nOne farmer took issue with the arms-length relationship the ward office had with community members. Although receptive to immediate needs, the office had little interest in prevention and rarely visited locales to get a first-hand understanding of a reported problem. That disposition squeezed information flows and detracted from the government’s ability to provide in a timely fashion appropriate resources to enhance capabilities and strengthen resilience. As well, those factors increased frustration and thus the detrimental effects of the balancing feedback loops associated with stock 1 and stock 2.
\nA technician working at an agricultural cooperative said that the government had not provided enough support after the earthquake. That perception eroded trust in government and caused both decreased political engagement and lower voter turnout in subsequent elections.
\nPerhaps most provocative, a person in Kharelthok explained that the 2015 earthquake had damaged homes and other infrastructure throughout the ward. Water (stock 3) was needed to do construction; but water was also in short supply for other uses. The government announced an initiative to build a road that ran upward from the valley, through the village of Manesau, and then further upward to the village of Manegau. To help finance the project (stock 1), the ward office collected NPR 15,000 (US$ 134) from each Manegau household. Nonetheless, construction stalled, leading villagers to claim that ward officials had misused the funds. A budget released by the ward office included reimbursement; but that did not quell the anger of villagers. In protest, they cut off supply from a water tap running downhill to Manesau. Experiencing an extreme shortage of fresh water, the downhill community chopped down trees to further impede access to Manegau. At the time of the research, local leaders were holding hearings to resolve the conflict; but the team could not stay on site long enough to hear the outcome.
\nIn contrast to the previous set of examples, the following set illustrates that successful collaborative efforts generated satisfaction among stakeholders.
\nAcross the four wards, the research teams met women who had been motivated to form self-help groups in which they had autonomy and that enabled them to provide inclusive, informal support to one another and other villagers. Despite challenges, including a shortage of financial resources (stock 1), the women’s groups had earned trust and legitimacy both within the community, and with external organizations.
\nSome women’s groups tried to help poor and uneducated women by reaching out to them via pamphlets posted on community information boards about their activities. They initiated training programs to improve various skills, including IT and computer courses and unemployment training (stock 2); and supported sewing shops that employed women (stock 4). As well, one team found that the group they interviewed collected funds and provided loans in times of hardship (stock 1), a model based on historic self-help councils.
\nWomen had sometimes benefitted from external assistance. For example, the Red Cross had provided training in rudimentary medical matters to members of one group, who then passed their knowledge on to other villagers (stock 1). Through hard work, those women had become authorities on healthcare and livelihood training (stock 4) in their respective villages.
\nCollectively, those initiatives suggested capabilities associated with two thematic arenas of resilience suggested by Twigg [5]: knowledge and education (stock 1); and risk management and vulnerability reduction (stock 2).
\nIn Hokse, the team interviewed the Vice President (VP) of an agriculture-focused cooperative that was active among several villages of the ward. The organization was the product of a merger between two previously existing but independently operating cooperatives. The first had provided seeds, tools and water pumps to farmers at subsidized rates; the second had concentrated on helping manage villagers’ savings. When founded in 2012, the cooperative had 30 members. By 2017, membership had expanded to roughly 800 people. Cooperative members had to be Nepali citizens and residents of a ward within the municipality. Membership fees ranged from $3 to $25; but nonmembers could make contributions.
\nAlthough staff at the local cooperative level reported to the district cooperative association, they did not get much technical support from the district—that general support came from regional and national organizations. Nonetheless, the local cooperative did receive loans of up to four million rupees (approximately $62,500 in 2017) from the district office at a low rate of interest. Those resources enabled the co-op to extend loans of up to $1000 that could help farmers harvest crops or purchase livestock and land (stock 1). The VP noted that loans were typically repaid in full and on time; but sometimes, a bad harvest would force farmers to delay their payments until the following year.
\nThe VP explained that if more funds were to become available, then the cooperative could extend loans to help rebuild homes that had been impacted by the 2015 Gorkha earthquake and were still in a state of disrepair. Furthermore, women could apply for loans at a reduced rate of interest that enabled them to explore entrepreneurship.
\nThe VP also offered insights on a few other matters. The expansion of the cooperative had prompted new methods for two-way communication among community members and the cooperative, including a Facebook page, phone calls, and notice boards; an insurance program for local crops and cattle; and training to farmers to introduce organic farming methods (inflow valve to stock 4).
\nNavjyoti is affiliated with the Sisters of Charity of Nazareth, an international congregation. They became active in Nepal in 1988. They focused on the poor and on women via educational initiatives. Community members appreciated their efforts (shaded Stock of satisfaction).
\nA worker for the organization explained that prior to the earthquake of 2015, among other activities, they had provided skills training for women (stock 1 and inflow valve to stock 2) and had channeled funds to women’s-groups for farming or economic development (stock 3). Following the disaster, Navjyoti expanded outreach to the broader Koshidekha community.
\nAt the time of interviews by the research team, several households shared water from a single tap that ran for only part of the day at very low pressure. In response, Navjyoti planned to support the Sun Koshi River Project, an effort to expand the number of pumps that could force-feed water to communities. When completed, the additional pumps would give community members greater access to fresh water (stock 3) that would be used to enhance the Contributors to Human Security (stock 4).
\nHowever, the Project would require substantial monetary resources. Although Navjyoti was willing to cover 60 percent of the cost, they hoped to receive contributions from households to cover the remaining 40 percent. Since many households could not afford the fee, Navjyoti was also ready to recruit volunteers to contribute their time and labor in lieu of money.
\nIn Kharelthok, the Red Cross maintained an active presence. It had helped establish a committee of community members that met each month to identify problems and develop proposed solutions to the Red Cross workers. Ward members explained that the Red Cross had provided different types of assistance, ranging from hearing aids for the elderly to funds for a disabled young woman so she could start a business and support herself (stock 4).
\nCommunity members also noted, however, that Red Cross efforts were sometimes off-target. To illustrate, while some farmers explained the organization had shared seeds (stock 1) with the community that were no longer useful in the dryer climate, others noted that although it had subsidized animal husbandry (stock 2), cattle and goats required a disproportionate amount of water.
\nIn retrospect, in the four wards visited, the stock of fresh water was being drawn down both by typical activities and as well by the influences of climate change, the residual effects of the Gorkha earthquake on water infrastructure, and the atypical need to use water for construction projects to repair earthquake-related damage. Access to fresh water, often determined by locational factors, was a key determinant of human security.
\nThe capabilities required to enhance access to available stocks of fresh water and to more effectively utilize stocks were significant contributors to the level of human security in each of the four wards. In turn, the presence or magnitude of such capabilities was contingent on the degree to which stakeholders had engaged in collaborative efforts. Successful collaborations contributed to positive feedback loops and additional collaboration: success bred success. In contrast, government shortcomings as a collaborator indicated that the bureaus had further work to do in order to be trusted partners.
\nSystem modification had taken place in the wards visited by the teams. Two sets of initiatives had increased information flows. First, the agricultural cooperative used numerous communication strategies to learn about community members’ needs, address those needs, and inform the community about services. Second, the Red Cross and Navjyoti had provided education and training dedicated to enhancing the knowledge of various community members, thereby allowing communities to navigate tough circumstances.
\nLooking ahead, members of various wards identified access to additional financial resources as their most immediate need as a first step toward gaining access to fresh water and thereby enhancing human security. An illustration was associated with the efforts by the agricultural cooperative. Even more striking were the funds sought by Navjyoti to help finance the Sun Koshi River Project, dedicated to installation of numerous water pumps to provide fresh water to communities in the Terai.
\nMeadows [10] says that while “the rules of a system define its scope, boundaries, and degrees of freedom,” ([10], p. 158) self-organization in human systems reflects the ability to “create whole new structures and behaviors” ([10], p. 159). The authors regard alterations of those types as transformations.
\nA striking development in the four wards had been the emergence of citizens groups (women’s groups; agricultural cooperative) and international nongovernmental organizations (Navjyoti; Red Cross) as system stakeholders. Those changes took place in the space left open by immature local government. As a qualification, however, although international NGOs had successfully encouraged communities to generate their own responses and at the same time provided resources to make those responses successful, initiatives that were off target prevented the community from self-organizing and ultimately decreased its ability to respond to its own problems. Nonetheless, and more important, interviews suggested that in most cases, those stakeholders who engaged in collaboration in different subcommunities were the most reliable and effective target for new stocks of tangible and intangible resources.
\nAlterations associated with rules and self-organization had begun to spill over to goals. That is, efforts by IGOs to cooperate with members of villages and wards had for the most part strengthened the capabilities relevant to adaptation and resilience and ultimately to human security. Nevertheless, although increased self-organization had challenged traditional power structures and created new hierarchies, self-organization had also led to conflict as was the case for the protesters who cut off the water flow between Manegau and Manesau. Such instances tended to reduce the levels of trust community members assigned to collaboration partners. At the same time, governments at the ward level—and in some cases even the district level—had not yet earned legitimacy in the eyes of most community members. Essentially, to move on from those types of outcomes and enhance community resilience, there was a need for more learning-by-doing among community members as well as for further maturation and engagement of local government as a system stakeholder.
\nWhile communities had made progress in their efforts to promote human security, there were of course avenues for additional progress associated with system transformation. In the wards visited, there was some early evidence of changing paradigms. The most poignant illustration surfaced in the interview with the woman who headed the school for the disabled. She noted that a greater number of community members had come to recognize the fundamental right of their disabled compatriots to dignity and full status.
\nFurthermore, in the wards visited, there was also some evidence about the rising status and autonomy of women. As a counterpoint, however, there was also evidence that long-held existing paradigms had prevented women from being able to make important decisions regarding water use, elevated threats to their health, reduced their voice in community forums, and constrained their opportunities to develop independent sources of income. The latter set of circumstances suggested that deep-seated cultural dispositions would not be transformed in a short period of time.
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\n\nRead more about Open Access in Horizon 2020 here.
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