\r\n\tAtherosclerosis is a systemic disease. Some 60% of patients with peripheral artery disease will have ischaemic heart disease, and 30% have cerebrovascular disease. Within five years of diagnosis, 10-15% of patients with intermittent claudication will die from cardiovascular disease. Therefore, management begins with the identification and modification of risk factors that are common to peripheral artery disease, heart disease, and stroke. Treatment goals include reducing cardiovascular risk and improving functional capacity. Revascularization is indicated for persistent symptoms. \r\n\tThe main objective of the book is to deal with peripheral arterial disease in the most diverse aspects. Addressing issues such as pathophysiology, signs and symptoms, clinical aspects, treatment, and prognosis. \r\n\t
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\n
1. Introduction
\n
Wearable technologies are becoming increasingly popular as personal health system, enabling continuous real-time monitoring of human health on a daily basis and outside clinical environments [1, 2, 3]. The wearable device market is currently having a worldwide profit of around $34 billion and is expected to reach above $50 billion by 2022 owing to wearables’ ease of use, flexibility, and convenience [4]. Real-time monitoring, operational efficiency, and fitness tracking are reported as main factors supporting the market growth of health wearable devices such as smart watches, smart glasses, and other wellness gadgets, with expected $12.1 billion world market by 2021 [5].
\n
In the past decade, the recent progress in developing wearable devices was more focused on monitoring physical parameters, such as motion, respiration rate, etc. [3, 6, 7]. Today, there is a great interest in evolving wearable sensors capable of detecting chemical markers relevant to the status of health. Different approaches have been applied by researchers to design and fabricate wearable biosensors for remote monitoring of metabolites and electrolytes in body fluids including tear, sweat, and saliva [3, 8, 9, 10]. A great example would be the development of small and reliable sensors that would allow continuous glucose monitoring in diabetic patients [11, 12]. Diabetes is a chronic disease that can significantly impact on quality of life and reduce life expectancy. However, diabetics can stay one step ahead of the disease by monitoring their blood glucose level to minimize the complication of the disease by proper administration of insulin. Currently, blood analysis is the gold standard method for measuring the level of glucose in patient’s blood. However, this technique cannot be applied without penetrating the skin, which can be painful and inconvenient, and requires user obedience. Therefore, current research focuses on the development of portable and wearable devices capable of continuous glucose sensing through noninvasive detection techniques.
\n
\n
\n
2. Tear analysis
\n
A majority of the recent studies in this field have targeted the area of personalized medicine, endeavoring to develop miniaturized wearable devices featuring real-time glucose monitoring in diabetic patients [12, 13, 14, 15]. One great example is contact lens which is an ideal wearable device that can be worn for hours without any pain or discomfort [16]. Integration of glucose biosensors into contact lenses has recently been demonstrated by several research groups [9, 17, 18]. However, the level of glucose in tear fluid is very low (0.1–0.6 mM), requiring a high sensitivity of the sensor for picking up the signal from expected chemical reaction [3, 19]. Yao et al. [16] have fabricated a contact lens with integrated sensor for continuous tear glucose monitoring with wireless communication system over a distance of several centimeters. The sensor demonstrated a fast response of 20 s with a minimum detection of less than 0.01 mM glucose, which is 10–60 times lower than glucose level in human tear [16].
\n
In addition to glucose, lactate is an important metabolite in the human body, which gets converted into l-lactate under hypoxic condition [20]. l-Lactate levels in tear fluid is about 1–5 mmol L−1, which might increase significantly due to some heath conditions including ischemia, inadequate tissue oxygenation, stroke, and different types of cancer [21]. Thomas et al. [22] demonstrated an invasive detection of lactate in human tear by integrating an amperometric lactate sensor with Pt working (WE) and reference (RE) electrodes as well as a counter electrode (CE) as current drain, on a polymer-based contact lens, measuring lactate in situ in human tears without any need for physical sampling [22].
\n
Very recently, Park et al. [17] reported a novel approach for fabricating fully transparent and stretchable smart contact lens capable of wirelessly monitoring the level of glucose in the tears of diabetic patients. Figure 1 shows the layout of fabricated devices made of glucose sensors, wireless circuit, and display pixel on soft and transparent contact lens substrate (Figure 1a and b). The circuit diagram of the device is illustrated in Figure 1a, with radio frequency antenna receiving signals from a transmitter and a rectifier converting the signals to DC (Figure 1a and c). A continuous network of ultralong Ag nanofibers was used as stretchable electrodes for the antenna and interconnects (Figure 1d). In the case of any change in the concentration of glucose in tear, the sensor resistance changes resulting in the light-emitting diode (LED) pixel turning on or off. The device was tested in vitro using a live rabbit, providing substantial finding for smart contact lenses as one of the promising wearable devices in healthcare system [17].
\n
Figure 1.
(a) (i) Schematic illustration and (ii) operation of the soft, smart contact lens and (iii) the circuit diagram of the smart contact lens system. The soft, smart contact lens is composed of (b) a hybrid substrate; (c) functional devices including rectifier, LED, and glucose sensor; and (d) a transparent, stretchable conductor for antenna and interconnects [17].
\n
\n
\n
3. Sweat analysis
\n
In addition to tear, sweat electrolyte concentrations and blood serum are related [2, 8]. As one of the most readily accessible human biofluids, a great deal of information about the human body and its physical performance could be obtained via monitoring sweat electrolyte concentrations [23, 24]. Several groups have reported the key biomarkers in human sweat (e.g., sodium level, pH change, lactate concentration) relevant to human health and well-being, for monitoring athletic performance during sporting activities [25]. Jia et al. fabricated a skin-worn tattoo-based sensor for real-time monitoring of lactate in human sweat, offering substantial benefits for biomedical as well as sport applications [25]. In another approach, Curto et al. [26] fabricated a wearable and flexible microfluidic platform capable of monitoring changes in the sweat pH in real time. Anastasova et al. [27] developed a flexible microfluidic device for real-time monitoring of metabolite such as lactate as well as electrolytes such as pH and sodium in human sweat. Recently, Gao et al. [28] developed a flexible and wearable device (Figure 2) made of arrays of sensors for real-time monitoring of heavy metals, such as Zn, Cu, and Hg in human sweat. The device fabrication method is presented in Figure 2a, showing the deposition and stripping steps on microelectrodes. The sensing mechanism was based on an electrochemical detection of targeted heavy metals through four microelectrodes, including Au and Bi working electrodes, Ag reference electrode, and an Au counter electrode (Figure 2b and c). The fabricated device demonstrated high stability and selectivity toward heavy metals, providing a great platform to advancing the field of wearable biosensors for healthcare application, via monitoring the level of some heavy metals in human sweat [28]. A balanced level of Zn is necessary in the human body as a low and high Zn concentration can lead to pneumonia and liver damages, respectively [29, 30]. High level of Cu in the human body can lead to several diseases including Wilson’s disease and heart, kidney, and liver failures as well as brain diseases [31, 32]. The fabricated device demonstrated high stability and selectivity toward heavy metals, providing a great platform to advancing the field of wearable biosensors for healthcare application [28].
\n
Figure 2.
(a) A schematic showing the concept of deposition and stripping on microelectrodes. (b) A schematic showing the composition of the microsensor array. (c) Optical image of a flexible sensor array interfacing with a flexible printed circuit connector [28].
\n
\n
\n
4. Saliva analysis
\n
Saliva, as a great diagnostic fluid, can be used in personal health devices for real-time monitoring of chemical markers including salivary lactate analysis [33]. Chai et al. developed a saliva nanosensor with a radio-frequency identification tag, integrated into dental implants for detecting cardiac biomarkers in saliva and predicting close heart attack in patients suffering from cardiovascular diseases [34]. In another approach, an instrumented mouthguard was designed and fabricated by Kim et al. [35] for measuring salivary uric acid levels which could be a biomarker for several diseases including hyperuricemia, gout, physical stress, and renal syndrome. The fabricated device showed high selectivity and sensitivity to low level of uric acid as well as great stability during a 4-h operation period [35]. Mannoor et al. [36] developed a hybrid biosensor made of graphene layers printed onto water-soluble silk, for noninvasive detection of bacteria through body fluids including sweat and saliva. This graphene/silk hybrid device illustrated an extremely high sensitivity to bacteria in body fluid with detection limits down to a single bacterium [36]. In addition, the fabricated device provided the potential users with battery-free operation and wireless communication system via radio frequency [36]. Arakawa et al. [37] designed and fabricated a salivary sensor equipped with a wireless measurement system, embedded onto a mouthguard support, featuring a high sensitivity toward detection of glucose over a range of 5–1000 μmol L−1. The device demonstrated a great stability during a 5-h real-time glucose monitoring period in an artificial saliva with a phantom jaw [37]. In a similar approach, de Castro et al. [38] developed a microfluidic paper-based device integrated into a mouthguard, for continues monitoring of glucose and nitrite in human saliva. The saliva samples were collected from periodontitis and/or diabetes patients as well as healthy individuals. The fabricated device featured a low detection limit of 27 and 7 μmol L−1 for glucose and nitrite, respectively [38].
\n
\n
\n
5. Summary
\n
In summary, there is a great potential for micro- and nanosensors’ integration into healthcare monitoring devices, developing new technologies for noninvasive detection of diseases in the human body. Flexible wearable devices offer promising capabilities in real-time monitoring of body fluids including tear, sweat, and saliva. However, more research is required to expand the use of wearable platforms in continuous analysis of body fluids, providing reliable real-time detection of targeting ions and proteins, among other complex analytes.
\n
\n\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/69186.pdf",chapterXML:"https://mts.intechopen.com/source/xml/69186.xml",downloadPdfUrl:"/chapter/pdf-download/69186",previewPdfUrl:"/chapter/pdf-preview/69186",totalDownloads:792,totalViews:0,totalCrossrefCites:2,totalDimensionsCites:2,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:59,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"March 21st 2019",dateReviewed:"August 22nd 2019",datePrePublished:null,datePublished:"December 4th 2019",dateFinished:"September 21st 2019",readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/69186",risUrl:"/chapter/ris/69186",book:{id:"7654",slug:"wearable-devices-the-big-wave-of-innovation"},signatures:"Noushin Nasiri",authors:[{id:"234150",title:"Dr.",name:"Noushin",middleName:null,surname:"Nasiri",fullName:"Noushin Nasiri",slug:"noushin-nasiri",email:"noushin.nasiri@mq.edu.au",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/234150/images/system/234150.jpg",institution:{name:"Macquarie University",institutionURL:null,country:{name:"Australia"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Tear analysis",level:"1"},{id:"sec_3",title:"3. Sweat analysis",level:"1"},{id:"sec_4",title:"4. Saliva analysis",level:"1"},{id:"sec_5",title:"5. Summary",level:"1"}],chapterReferences:[{id:"B1",body:'Trung TQ , Lee NE. Flexible and stretchable physical sensor integrated platforms for wearable human-activity monitoring and personal healthcare. Advanced Materials. 2016;28(22):4338-4372\n'},{id:"B2",body:'Nakata S, Arie T, Akita S, Takei K. Wearable, flexible, and multifunctional healthcare device with an ISFET chemical sensor for simultaneous sweat pH and skin temperature monitoring. ACS Sensors. 2017;2(3):443-448\n'},{id:"B3",body:'Tricoli A, Nasiri N, De S. Wearable and miniaturized sensor technologies for personalized and preventive medicine. Advanced Functional Materials. 2017;27(15):1605271\n'},{id:"B4",body:'Arnold JF, Sade RM. Wearable technologies in collegiate sports: The ethics of collecting biometric data from student-athletes. 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Comparison of breath gases, including acetone, with blood glucose and blood ketones in children and adolescents with type 1 diabetes. Journal of Breath Research. 2014;8(4):046010\n'},{id:"B15",body:'Chu MX, Miyajima K, Takahashi D, Arakawa T, Sano K, Sawada S-I, et al. Soft contact lens biosensor for in situ monitoring of tear glucose as non-invasive blood sugar assessment. Talanta. 2011;83(3):960-965\n'},{id:"B16",body:'Yao H, Liao Y, Lingley A, Afanasiev A, Lähdesmäki I, Otis B, et al. A contact lens with integrated telecommunication circuit and sensors for wireless and continuous tear glucose monitoring. Journal of Micromechanics and Microengineering. 2012;22(7):075007\n'},{id:"B17",body:'Park J, Kim J, Kim S-Y, Cheong WH, Jang J, Park Y-G, et al. Soft, smart contact lenses with integrations of wireless circuits, glucose sensors, and displays. Science Advances. 2018;4(1):eaap9841\n'},{id:"B18",body:'Badugu R, Lakowicz JR, Geddes CD. Noninvasive continuous monitoring of physiological glucose using a monosaccharide-sensing contact lens. Analytical Chemistry. 2004;76(3):610-618\n'},{id:"B19",body:'Lin Y-R, Hung C-C, Chiu H-Y, Chang P-H, Li B-R, Cheng S-J, et al. Noninvasive glucose monitoring with a contact lens and smartphone. Sensors. 2018;18(10):3208\n'},{id:"B20",body:'Farandos NM, Yetisen AK, Monteiro MJ, Lowe CR, Yun SH. Contact lens sensors in ocular diagnostics. Advanced Healthcare Materials. 2015;4(6):792-810\n'},{id:"B21",body:'Pankratov D, González-Arribas E, Blum Z, Shleev S. Tear based bioelectronics. Electroanalysis. 2016;28(6):1250-1266\n'},{id:"B22",body:'Thomas N, Lähdesmäki I, Parviz BA. A contact lens with an integrated lactate sensor. Sensors & Actuators, B: Chemical. 2012;162(1):128-134\n'},{id:"B23",body:'Liu G, Ho C, Slappey N, Zhou Z, Snelgrove SE, Brown M, et al. A wearable conductivity sensor for wireless real-time sweat monitoring. Sensors & Actuators, B: Chemical. 2016;227:35-42\n'},{id:"B24",body:'Pribil MM, Laptev GU, Karyakina EE, Karyakin AA. Noninvasive hypoxia monitor based on gene-free engineering of lactate oxidase for analysis of undiluted sweat. Analytical Chemistry. 2014;86(11):5215-5219\n'},{id:"B25",body:'Jia W, Bandodkar AJ, Valdés-Ramírez G, Windmiller JR, Yang Z, Ramírez J, et al. Electrochemical tattoo biosensors for real-time noninvasive lactate monitoring in human perspiration. Analytical Chemistry. 2013;85(14):6553-6560\n'},{id:"B26",body:'Curto VF, Fay C, Coyle S, Byrne R, O’Toole C, Barry C, et al. Real-time sweat pH monitoring based on a wearable chemical barcode micro-fluidic platform incorporating ionic liquids. Sensors & Actuators, B: Chemical. 2012;171-172:1327-1334\n'},{id:"B27",body:'Anastasova S, Crewther B, Bembnowicz P, Curto V, Ip HM, Rosa B, et al. A wearable multisensing patch for continuous sweat monitoring. Biosensors & Bioelectronics. 2017;93:139-145\n'},{id:"B28",body:'Gao W, Nyein HY, Shahpar Z, Fahad HM, Chen K, Emaminejad S, et al. Wearable microsensor array for multiplexed heavy metal monitoring of body fluids. ACS Sensors. 2016;1(7):866-874\n'},{id:"B29",body:'Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database of Systematic Reviews. 2016;12:CD005978\n'},{id:"B30",body:'Mohammad MK, Zhou Z, Cave M, Barve A, McClain CJ. Zinc and liver disease. Nutrition in Clinical Practice. 2012;27(1):8-20\n'},{id:"B31",body:'Crisponi G, Nurchi VM, Fanni D, Gerosa C, Nemolato S, Faa G. Copper-related diseases: From chemistry to molecular pathology. Coordination Chemistry Reviews. 2010;254(7-8):876-889\n'},{id:"B32",body:'Huster D. Wilson disease. Best Practice & Research. Clinical Gastroenterology. 2010;24(5):531-539\n'},{id:"B33",body:'Lee J, Garon E, Wong D. Salivary diagnostics. Orthodontics & Craniofacial Research. 2009;12(3):206-211\n'},{id:"B34",body:'Chai PR, Castillo-Mancilla J, Buffkin E, Darling C, Rosen RK, Horvath KJ, et al. Utilizing an ingestible biosensor to assess real-time medication adherence. Journal of Medical Toxicology. 2015;11(4):439-444\n'},{id:"B35",body:'Kim J, Imani S, de Araujo WR, Warchall J, Valdés-Ramírez G, Paixão TRLC, et al. Wearable salivary uric acid mouthguard biosensor with integrated wireless electronics. Biosensors & Bioelectronics. 2015;74:1061-1068\n'},{id:"B36",body:'Mannoor MS, Tao H, Clayton JD, Sengupta A, Kaplan DL, Naik RR, et al. Graphene-based wireless bacteria detection on tooth enamel. Nature Communications. 2012;3:763\n'},{id:"B37",body:'Arakawa T, Kuroki Y, Nitta H, Chouhan P, Toma K, Sawada S-I, et al. Mouthguard biosensor with telemetry system for monitoring of saliva glucose: A novel cavitas sensor. Biosensors and Bioelectronics. 2016;84:106-111\n'},{id:"B38",body:'de Castro LF, de Freitas SV, Duarte LC, de Souza JAC, Paixão TR, Coltro WK. Salivary diagnostics on paper microfluidic devices and their use as wearable sensors for glucose monitoring. Analytical and Bioanalytical Chemistry. 2019:1-10\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Noushin Nasiri",address:"noushin.nasiri@mq.edu.au",affiliation:'
School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
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1. Introduction
The shared knowledge of educators about the etiology of sexual abuse of students by school employees – what to look for, how to respond, and what actions might reduce risk – is simply inadequate to the scope of the harm. A report from the United States Government Accountability Office (GAO), Child Welfare Federal Agencies Can Better Support State Efforts to Prevent and Respond to Sexual Abuse by School Personnel [1], noted the lack of research on the patterns of sexual abuse in schools. Additionally, an earlier GAO report, K-12 Education Selected Cases of Public and Private Schools that Hired or Retained Individuals with Histories of Sexual Misconduct [2], reached similar conclusions.
The problem is three-fold. (1) Ten percent of public school students report being sexually abused by a school employee [3]. (2) There is little in the existing research that identifies and describes the school culture, patterns, and conditions in which educator sexual misconduct occurs. (3) Because no one has systematically documented the school culture and the behaviors and patterns of adults who sexually abuse children in schools, school professionals fail to understand what patterns and behaviors should trigger concern, supervision, investigation, and/or reporting.
Stopping sexual misconduct directed toward students means understanding the process that adults use to prepare students to be abused so that they do not tell, do not fight, and acquiesce. This process, called grooming, has the purpose of gaining student trust, as well as the trust of parents and colleagues.
2. Review of the literature
Grooming behaviors and patterns are red flags, signaling that something is not quite right and that attention and monitoring, and supervision are needed. Most employee to student sexual misconduct in educational organizations involves a pattern of “preparing” the student for the misconduct so that the student trusts the employee. Rarely does the misconduct begin with unwanted sexual touching, although that occurs later in the process.
Sexual misconduct in schools and other youth serving organizations nearly always begins with grooming. Kenneth Lanning, retired supervisory Special Agent from the FBI and a seminal researcher of criminal sexual behavior since the 1970’s, describes grooming as “specific nonviolent techniques used by some child molesters to gain access to and control of their child victims” [4]. The patterns, now referred to as grooming, were at one time referred to as seduction within the prevention community. That label changed overtime as researchers learned more about how children are persuaded into targets. The change in terminology had more to do with the perception of the words than the actual behaviors. Lanning and others use the words interchangeably to describe “patterned behavior designed to create opportunities for sexual assault, minimize victim resistance or withdrawal, and reduce disclosure or belief.” [4].
Jim Tanner and Stephen Brake [5] developed a framework for understanding the grooming process. They make a distinction between grooming the individual and grooming the “environment. Because offenders need to find potential targets, gain their trust, reduce discovery by others, and reduce the target’s credibility if discovered, they groom victims to “overcome resistance, maintain access, and minimize disclosure” [5]. Offenders need access to targets, need to be desirable to targets, and need to convince the target that everything that is happening is normal. The goal is compliance from the child, often misinterpreted as consent. Children aren’t legally or emotionally able to consent – this is not an equal interaction – therefore compliance is used by the offender as a stand-in for consent, drawing the child into a belief system that the child has control or power when that is not the case.
Offenders must not only gain the trust of the victim, but also that of the community in which he or she works as well as the environment of the child. Typically, the offender grooms the work and community environment first, then grooms potential victims, then the actual victim or victim’s family. Prior to physical sexual abuse of the potential target, the offender seeks to be someone admired by colleagues, recognized in the community as a productive and valuable member, and appreciated by parents as someone who is helpful to the success of their children.
Environmental and individual grooming can occur at the same time, but commonly the offender has first established his or herself as a highly regarded education and/or coaching professional. Tanner and Brake [5] have summarized this process, displayed in Table 1.
Purpose of victim grooming
Overcome resistance, maintain access, and minimized disclosure
Target of victim grooming
Emotionally vulnerable child
Goals of victim grooming
Access/affiliate Allure/accept Alibi/assure
Actions of victim grooming
Gaining trust, access, relationship
Bond
Form a special bond, keep secrets, special lures
Reliance
Push and pull of victim. Make victim need offender
Attenuate
Reduce resistance through slow progression and explanation of normalcy
Trap
Prevent disclosure through grooming, threats, guilt, and fear
Environmental Grooming
Purpose of Environmental Grooming
Find victims and reduce the probability of being reported or victim being believed
Target of Environmental Grooming
Parents/family, teachers, social organizations, peers, significant others, etc.
Goals of environmental grooming
Access: provide entrée Allure: create interest Alibi: minimize risk
Actions of environmental grooming
Position
Social, Personal
Charm
Personality
Power
Political, fiscal, absolute
Celebrity
Fame
Table 1.
Tanner and Blake’s summary of child victim grooming.
Grooming is rarely perceived as a violent act. Instead, it consists of actions that bond the target to the offender such as time spent together, secrets, gifts, special attention. The process presents the offender to the child as kind, gentle, understanding, caring, generous, charming, and accessible. A goal of the offender is to be desirable, needed, and wanted by the child. As the child is progressively drawn-in to this “special” bond, the offender assures the child that the relationship is “normal”, often by telling the target that he or she is more mature than the other students, or smarter, or extra special. The more an offender can minimize the nature of the offense and shape it into an acceptable relationship -- counselor, teacher who cares, friend, father figure, peer -- the more the student is led to believe that what is happening is acceptable.
Generally, the only time the offender uses threatening methods are when the student tries to stop the predator after the grooming period and well into the physical or emotional sexual misconduct. At this point the offender uses threats, guilt and fear to keep the student involved. Most grooming and sexual misconduct toward students by adults occurs right in the school: in empty classrooms, in hallways, in offices. Sometimes the abuse is played out in front of other students. It is not unusual for a teacher to take a student into a storage room attached to the classroom and have sexual intercourse while the rest of the class does seat work. Recess and lunch are prime offending times.
Preventing sexual misconduct and abuse directed toward students requires adult bystanders and other students to understand the “red flags” of grooming behavior. The purpose of this study was to identify and describe grooming behaviors that school employees use in their quest to cross sexual boundaries with students.
3. Methods
3.1 Description of the study
If we could (or would) do postmortem examinations each time a student is sexually abused by an adult in a school, we might be able to identify the places where policies, training, supervision, and reporting failed to prevent the abuse. These are sensitive issues for school administrators and communities and, most of the time, the stakeholders just want to put the ugly incident behind them, a response which does little to prevent future abuse. However valuable direct inquiry might be, it turns out not to be feasible to get permission to interview students, teachers, administrators, victims, parents of victims, and predators when an employee has sexually abused a student. Very few, if any, organizations allow such scrutiny.
3.2 Methodological framework
This study uses documents from civil litigation where a parent or child has filed a suit against a school district for not preventing the abuse of the child by a school employee and where the school employee predator has been convicted in a criminal trial of sexually abusing a student. These documents provide the range, detail, and putative accuracy of case evidence that is otherwise unavailable to researchers. Specifically, we analyzed expert witness reports that were developed from civil legal documents. The use of civil legal documents introduces a methodological dimension that is not often deployed in education research, and thus provides an additional approach to education research. These documents provide robust documentation for undertaking these multiple case studies which allow for individual incident descriptions as well as a synthesis of variables across cases. Court and legal records are not uncommon sources of data in social science and historical research [6], but rarely used in non-legal education research.
The documents on which the expert reports used for this study came were based on multiple case records used in civil litigation that the senior author read and analyzed to produce an expert witness report. In each case, the expert report included the same topics and format and produced a report between 50 and 100 pages. It is the report that the researchers in this study used to identify red flags of grooming.
3.3 Sample
The sample was drawn from 220 expert reports written by the senior author between 2004 and 2020 as expert reports in civil litigation. Essentially, the reports represent case study descriptions of the patterns and behaviors of grooming and sexual misconduct as well as the extent that school organizations met prevention protocols. The purpose of this study was to identify red flags of grooming across cases, red flags which were described in the report.
There were six parameters for selection of the reports to be included in this study (1) a student has been sexually abused by an employee of the school district; (2) the employee has admitted the sexual abuse and been found guilty in criminal court; (3) the school is a PK12 school; (4) the report included information on grooming red flags; (5) consent for use of documents has been given by the plaintiff attorneys; and (6) the criminal and civil cases were closed.
Although this sample is not random (a technique not available in these circumstances), it is a purposeful selection that has characteristics of both snowball and judgment sampling. The cases initially reviewed are varied and are from 33 states; represent both state and federal complaints; include elementary and secondary student plaintiffs; represent urban, rural, and suburban school districts; contain both high- and low-income schools; incorporate schools that serve predominantly white, predominantly black or Latina/o, or mixed race student enrollments. The victims in these cases are both males and females and the predators are both males and females. Thus, the sample replicates the socio-demographic properties of school districts and plaintiffs from the country as a whole.
3.4 Data sources
Litigation and trial data are commonly used in other disciplines, but rarely in education research. Never-the-less the public has a “qualified right of access to court proceedings and records, rooted in the common law. The First Amendment also confers on the public a qualified right of access”, including in civil trials [7]. Among the data points for analysis that are included in civil case documentation are school district policies, training materials and requirements, hiring policies and practices, personnel files, student files, medical/mental health files, environmental scans of the school buildings, police files from the criminal prosecution, and pictures of classrooms.
Depositions, as sworn testimony, are as close to that person’s “truth” as is likely to be available. People being deposed swear an oath to tell the truth and the penalties of perjury apply, just as they would in trial testimony. In the cases analyzed, there are depositions from the victim, family members, the abuser, members of the abuser’s family, classmates of the victim, and school personnel – teachers, coaches, custodians, school lunch monitors, teacher aids, building administrators, district administrators, and school board members. This is a broad and inclusive group of people who are “telling the story” in the civil cases/settings/contexts of sexual abuse.
3.5 Coding
We developed a set of codes that were descriptive of red flag behavior by an adult directed toward a child in these cases. Coding was done on documents in which all identifiers were removed. No school district names or names of people involved were available to coders. They were replaced with role identifiers (for instance, “principal”, “2nd grade teacher, student target). Codes aligned with Tanner and Blake’s grooming categories.
The authors coded the documents in pairs with the senior author serving as a third coder where there were differences in coding decisions.
4. Findings
Red flag grooming strategies to gain trust of targets, colleagues, or parents are described with examples from cases. Pseudonyms are used in all descriptions.
4.1 Who gets groomed?
In K-12 school settings there is a good deal of variation when it comes to the characteristics of students who are targeted for sexual misconduct by predators and in what types of school these violations occur. In other words: students of all genders, races, academic backgrounds, and personalities are groomed and are targets of sexual misconduct in all kinds of schools at all levels. In this study, we are reporting examples of grooming from both independent and public schools in the United States where elementary, middle, and high school females and males have been targeted with sexualized behavior by school employees. The majority of the cases were male employees grooming female students and others in the environment, followed by male employees grooming male students, then female employees grooming male students. We did not have any cases of female employees grooming female students.
Not all school employees who were grooming a student engaged in grooming the environment, but most who crossed sexual boundaries with students also needed parents and their colleagues to trust and like them, and, therefore, worked to gain their trust. Before actual sexual misconduct can occur, boundaries have to be crossed. Boundary violations occur in public, in front of others. Once boundaries are crossed and trust is gained, much of the abuse occurs in private settings such as closed classrooms, cars, or via social media interactions.
4.2 Tanner and Blake grooming categories
We examined the expert witness documents for examples of the grooming patterns described by Tanner and Blake and found examples of all in these cases with bonding, reliance, and attenuation (or normalization) the most prevalent.
4.2.1 Bonding
Bonding boundary crossing is what most bystanders see and it rarely announces as sexual abuse. School employees who targeted students often start out by identifying a special bond, “you aren’t like other students”, “you are so mature”, “I can talk to you” are all phrases that were used to make students feel special. Female students often reported that male employees would talk about their personal emotional and sexual lives with a wife or girlfriend. “He told me he wasn’t happy in his marriage and that his wife didn’t understand him. He said I was different.” Bonding also came through secrets that could not be shared, “no one can know about us” and comparisons “when I was your age, I had the same problems with my mother.”
In many cases where boundaries are crossed and grooming occurs, students, parents, and other educators and administrators mistook these actions that crossed professional and appropriate boundaries as “prosocial behavior” (Tanner & Brake, 2013). Typically, prosocial behavior, such as compliments and direct attention in the classroom, are seen as positive educator behaviors when attempting to mentor students or forge beneficial educator-student relationships for the purpose of improving child learning. Thus, school employees often used tutorial help as a way to bond. A not uncommon pattern is for a teacher to talk with the student or the parent and describe the student as bright and capable, but falling behind. The teacher then offers to help the student catch up and advance. Students reported they felt special and liked the extra attention. Parents reported they were grateful for the extra time given to their child.
But the differences between prosocial and bonding grooming behaviors is the focus of this behavior –behaviors directed toward all or most students vs. a specific student. Teachers who offer to help lots of students, in open settings, are very different from teachers helping a select student in a regularly closed environment.
A similar pattern revolves around food. A targeted student is invited to have lunch with the teacher in the classroom and the teacher brings the food. Other students are not invited or allowed. Intensity and repetition of these behaviors with a single student moves this from pro-social to boundary crossing and grooming. These boundary violations are carefully planned transgressions that scale in boldness relative to how often the predator can get away with the behavior in the presence of bystanders.
Use of personal – not school sanctioned and monitored -- social media is a common vehicle for bonding grooming. Using a private platform is much like being alone with a student behind a closed locked door. There is no way to monitor and the interactions are hidden and private. For example, in one school, observers frequently reported that a teacher, “was communicating with his 6th grade students via Facebook,” thus establishing a private, personal, out of school communication pathway to groom students. When grooming through social media, direct or private messages can escalate quickly due to the relative ease of access predators have to students who may view it as normal behavior because that is how they communicate with their peers. Back and forth texts escalate into more intimate and private conversations and often include exchanges of photos of body parts or other sexual displays. It is not uncommon for hundreds of text messages to be exchanged in a school day, with intimate, connecting, and escalating messages.
4.2.2 Reliance
Another way that victims are groomed is to increase their reliance on the school employee. Sometimes that relates to grades, as in trading grades for time, “I didn’t have to do my homework. As long as I spent time with him, he would give me a grade.” Sometimes it translates into legitimate help when the school employee is tutoring and teaching a student, but withholds that learning if the student does not comply. Sometimes it is providing food or transportation. Gifts and money are also used in the reliance process, offering students things they do not have. Often those things are cell phones and iPads that provide the adult with easy access to the student. Other times students are given trendy clothes and accessories. But in all cases, the adult is using this grooming strategy as a way to tie the student to him or her, to increase the student’s reliance on the adult.
4.2.3 Attenuate: Normalize
Predators work to normalize boundary crossing behavior. They are aided in this by schools that (1) do not teach students or other adults about what is acceptable adult to student behavior and that (2) fail to train students and adult bystanders how and when to report.
Boundary violations in the public eye, for example over public forums on social media or in full classrooms, are often defined by their subtlety--the goal of which is to progressively make children feel that these violations are “normal” or par for the course. Child targets often do not know how to code these actions, having not been taught about what is acceptable behavior from a school employee. As a result, they do not report these behaviors to authority figures who could intervene to interrupt the grooming process. For instance, a student bystander noted that a male teacher would rub up against female students: “…he [teacher] made her uncomfortable and … he would rub his penis against her back while touching her shoulder.” Students often reported that the teacher “hugged” all the girls or “hung out” with a group of students all the time. Sometimes the normalcy of boundary crossing blinds bystander employees to the reality of the violation. Violating school employees may give student victim rides to and from school or to other locations and are often seen by both adults and students leaving the school. And yet, this misconduct goes largely unreported even though in most schools it is an explicitly prohibited action. When queried about these actions, both students and adults would report that “I just assumed it was OK. No one said anything about it.”
Adult conversations with students – often in the classroom or to groups of students during lunch or other non-class times – include sexual topics, personal disclosure of adult sexual activity and preferences, and questions to students about their sexual lives. These are disguised as “normal” interactions and topics with students, but they are grooming behaviors that seek to normalize sexual talk. These behaviors often go uninterrupted or only lightly reprimanded by other employees who overhear the boundary crossing conversations.
Normalizing also occurs when the adult behaves the same way as the student, acting as a peer. This is often presented as romance, leading other students to believe (either overtly or covertly) that it is OK for adults who work in the school to date a student. Bystander students, as a result, see sexualized behavior between the adult and, in most cases, a high school student, and explain it as ‘normal’ romantic behavior: “They are dating…They are boyfriend and girlfriend…[the predator] didn’t molest [the victim], they were just making out.”
For instance, a male teacher who had been grooming a female student reacted when she threw a Jell-O cup he had given her onto the floor. The teacher intruded on another class the student was in and threw what was described as a tantrum, “throwing things around…slamm[ing the door]…and star[ing] at [the student].” The bystander teacher of the current class period should have recognized and reported the obvious red flags indicating teacher-student boundary violations. The behavior of the abuser resembled an angry tantrum reminiscent of teenage lovers having a fall out, rather than a teacher simply being angry at a student misbehaving. Students described these behaviors as typical boyfriend/girlfriend actions, indicating how the adult had normalized these behaviors so that they were not seen as inappropriate, but, rather, indications of normal romance.
Those who groom students look for ways to touch students. In one middle school, two female students were in a classroom with a male teacher-predator talking about “getting away from someone that’s trying to hurt you.” The teacher grabbed one of the victims by the arm and said he did it “to show…that it’s not as easy to get away from someone as you think.” After the teacher was arrested, the girls were questioned and related what had happened. They explained that although they thought it was inappropriate behavior, they did not report the teacher, assuming that it was something teachers could do and that they thought they would not be believed.
Hugs are often normalized. For example, a teacher in an elementary school who hugs students in the hallway between classes and “when the kids would come in from recess” broadcasts an image of friendliness when the intent is to normalize inappropriate touching of children. The teachers who do this often portray this behavior as giving students extra support, “letting them know we care”, a rationalization that is accepted by students, parents, and colleagues. In middle and high school, hugs are normalized across all students as praise or reward. That practice camouflages hugs for sexual purposes.
Students make sense of these boundary crossings and potentially illegal behavior from their own frame of reference. They do this because the adults in the school have not taught them another lesson, the policies of behavior (if they exist) have not been explained, and the culture of the school encourages everyone to look the other way, rather than teaching what the appropriate teacher-student boundaries are and what to do if they see them being violated.
4.2.4 Trap
When school employees were suspected of sexual misconduct and questioned by school leadership or law enforcement, many sent messages – usually through texts – to the students they had targeted warning them not to “tell”. The messages often reminded the students that “I could go to jail if you tell.” “You would be hurting my family if you tell”. “You will get in trouble if you tell”. Although not common, some student targets reported that abusers threatened their family members – “He said he would kill my mother if I told.” “He said he would kill my sister if I told.” “I was afraid he would hurt my family.” More often, though, the employee abuser played on the student’s feelings for the abuser, “He told me he would go to jail. I didn’t want him to go to jail. I just wanted it to stop.”
4.3 Overall patterns across grooming actions
Some patterns were used across the victim grooming categories of Tanner and Blake.
4.3.1 Isolation
It is said that grooming occurs in public and sexual abuse in isolation. For the most part, that is true. But grooming can also occur in isolation. Bonding, reliance, and attenuation happen in public spaces and isolated environments. Isolation is not only a tactic to keep actions hidden, but also a strategy to remove the target from friends and family, leaving the employer abuser as the only person the student can confide in.
Isolation is a type of red flag that can go unnoticed due to its nature in being seen as “helpful” or “beneficial” to the victim from an outside perspective, or simply going unnoticed. Isolation is a way that gives the abuser access to the victim, without any suspicion or detection from outside environments. This can take many forms such as having individual coaching sessions, private tutoring, or one-on-one help after school in a classroom.
In one school a teacher, Mr. Park, offered to tutor a student, Jane Doe. This gave him access to her without other students and behind closed doors. Mr. Park began pressuring Jane Doe to meet him outside of school. Jane Doe described this pattern: “If I found a way to make it happen, he would find a place.” Jane Doe finally agreed, and they decided to meet. Mr. Park picked up Jane Doe at the 99 Cent Store” and they went to his house, where sexual activity occurred. Jane Doe was receiving tutoring from Mr. Park, which eventually allowed him to isolate her in his home away from other outside environments and interference. Isolating a victim can be especially dangerous because it can lead to sexual abuse and misconduct due to the fact that it goes unnoticed by other faculty and administrators.
There are also instances where isolation occurs on school grounds during the school day. When J.L. did not return to the classroom in a timely manner, her teacher went to look for her and found her with the male classroom aid. They were both stepping out of a dark recessed area outside an empty classroom. The male aid told J.L’s teacher that J.L. was afraid to go to the restroom alone. The aid would watch J.L. in the classroom, looking for ways to isolate her in the building that could be explained as “helping”. J.L.’s teacher noticed that whenever J.L. left the classroom, the aid left soon after with a variety of excuses. The teacher also noticed that whenever this happened the aid and J.L. returned to the classroom at the same time. And yet, J.L.’s teacher did not report these behaviors.
A similar scenario occurred in an elementary school when a male paraprofessional targeted a first grade boy. He isolated the male student by driving the student around in his car, which the student thought was fun. The time spent on these drives provided an opportunity to form a bond. By offering to help the family with transportation when the male student stayed late for tutoring or activities, the teacher built the trust of the parents which developed into a strong connection to this family. The boy’s parents described the teacher as one of the family and reported that they were so happy the teacher was helping their son.
4.3.2 Gifts
Providing resources or gifts are very common grooming tactics used to pressure victims into gratitude for receiving this specific kind of attention from an authority figure. Gift giving is used to gain trust and make the victim feel indebted to the adult predator. Gifts serve both a bonding and a reliance function.
An example of gift giving occurred in a middle school between a teacher and an eighth grade student. Mr. Toledo targeted a female student for sexual activity and began a full on “courtship”, buying her gifts and providing her with things she would not otherwise have. One day, for instance, he texted her and told her that he put a “surprise in her locker”. When S.G. went to her locker, she found a pink iPad mini. And she was delighted and excited to have it. When she took it home, her mother questioned her about it. Finally, S.G. broke down and told her mother that Mr. Toledo had given it to her. S.G. felt special when she got this gift. And she wanted to keep it. And it made her like Mr. Toledo even more. Mr. Toledo counted on that. He knew that an expensive and lavish gift would escalate his access to S.G. and make it less likely that S.G. would rebuff his next steps. This gift bonded S.G. to him and also increased her reliance on him.
Gift giving to girls as a grooming step is not uncommon. But, depending upon the gift, it may be more likely to raise concerns from parents. Parents aren’t aware of food and candy and privilege handouts to their child from an adult employee in the school, but they are likely to notice “things” that get brought home. For instance, teacher Park targeted Marianna and began giving her extra school supplies. When she brought these home, her mother noted them, but assumed they were part of the school package. Even when she realized that they were not given to all children, Marianna’s mother treated the supplies as a way the teacher was helping her child succeed in school. However, when Marianne came home with a new purse, given to her by Mr. Park, her mother knew immediately that this was an inappropriate gift. A realization came to too late to stop Mr. Park from sexual activity with her daughter. The extra school supplies given to Marianna allowed Mr. Park to groom Marianna and make her feel special, portraying the grooming as “helping”. Typically, parents and administrators would not question who supplied school supplies to a student whose family could not afford them. And yet, they served the same purpose as the gift of the purse: gaining the trust and good feelings of a child while crossing boundaries and manipulating a child’s affections.
4.4 Environmental grooming
In many of these cases, parents were groomed to trust the teacher, usually because the teacher was providing their child with academic support. “We were really grateful that [the teacher] was helping our daughter with her math.” Often parents commented on how friendly the teacher was. In other cases, the teacher befriended the parent, usually a single mother, and provided support such as stopping by with dinner and conversation or, in some cases offering to babysit when the parent needed help.
A not atypical pattern was a male school employee targeting a male student who was the child of a female single parent. The teacher would contact the mother, expressing concern about her son’s academic work. The teacher usually praised the boy as being bright, but who needed some extra guidance to get on track. The teacher then offered to tutor the child. The teacher would inject himself into the household, offering to bring the boy (and often siblings) home from school, provide little extras to the household – food, movies, toys – and become a confidant to the mother. The mother described the experience as a dream come true. Worried about the effects of raising a male child in a fatherless home, she felt grateful that “the teacher everyone hoped their child would get” was helping her son learn and providing her son with a good role model. The grooming of the mother was an essential part of this pattern.
Colleagues were also actively groomed by abusers. After a teacher had been arrested or convicted, colleagues reported how surprised they were. The following were typical of comments colleagues made. “He was always so helpful, offering to take care of things after school so that I could get home to my kids.” “I just couldn’t believe it. He was the nicest person. Always there to help and focused on the well-being of students.” “He was teacher of the year in our school district.”
5. Conclusions
In Fall of 2019, an estimated 56.6 million children in the United States entered classrooms with 3.7 million teachers, 938,000 administrators, and other staff members (NCES.ed.gov; Department for Professional Employees, 2019). The most recent generalizable available data collected at the student level of victimization document that seven percent of students report being the target of physical abuse by a school employee, most often a teacher or coach [3]. When multiple forms of assault are combined – verbal sexual misconduct (sexual stories or talk about a student’s or teacher’s sex life) and visual sexual misconduct (pornography, masturbating in front of students) – 10% of students report being victims nationally. Thus, 5.66 million students report sexual abuse by employees in schools.
Prevention of school employee sexual misconduct requires that bystanders [school staff, parents, other students] understand the behaviors by abusers that would indicate that a student is being targeted for sexual misconduct. These behaviors are referred to as grooming and are red flags that should signal boundary crossing and possible sexual misconduct by an employee.
Documenting and describing these behaviors is a step toward prevention. The more able bystanders are to recognize boundary crossing and grooming – and report what they see – the safer students are from school employee sexual misconduct and abuse in school.
All of the cases reviewed for this chapter include grooming behaviors by the school employee directed toward the student. Abusers used tactics to bond with the student by forming special relationships, keeping secrets, receiving special gifts, and one-on-one attention. Abusers also worked to keep the student reliant on the abuser for emotional support as well as for academic help and gifts Abusers worked hard to normalize boundary crossing so that these grooming behaviors would go unreported. When they were reported, abusers used traps and threats to prevent disclosure.
Individual targets were not the only ones groomed, however. Parents, siblings, and colleagues were also groomed to like and trust the abuser in an attempt to ensure that the grooming and sexual misconduct directed toward the student would go unreported. While understanding what grooming looks like will not stop all sexual exploitation of students, knowing the warning signs and red flags and reporting them immediately will go a long way in preventing sexual misconduct.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"sexual abuse, students, grooming, sexual misconduct, schools",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/77769.pdf",chapterXML:"https://mts.intechopen.com/source/xml/77769.xml",downloadPdfUrl:"/chapter/pdf-download/77769",previewPdfUrl:"/chapter/pdf-preview/77769",totalDownloads:124,totalViews:0,totalCrossrefCites:0,dateSubmitted:"May 22nd 2021",dateReviewed:"July 5th 2021",datePrePublished:"August 2nd 2021",datePublished:null,dateFinished:"August 2nd 2021",readingETA:"0",abstract:"The sexual exploitation of students is a worldwide problem. In the U.S., the problem is three-fold: (1) Ten percent of public school students report being sexually abused by a school employee. (2) There is little in the existing research that identifies and describes the school culture, patterns, and conditions in which educator sexual misconduct occurs. (3) Because no one has systematically documented the school culture and the behaviors and patterns of adults who sexually abuse children in schools, school professionals fail to understand what patterns and behaviors should trigger concern, supervision, investigation, and/or reporting. Stopping sexual misconduct directed toward students means understanding the process that adults use to prepare students to be abused so that they do not tell, do not fight, and acquiesce. This process, called grooming, has the purpose of gaining student trust, as well as the trust of parents and colleagues. This study examines school employee sexual misconduct toward students in school in the United States and is based upon an analysis of 222 cases of school employee sexual misconduct toward a student where a school employee was convicted of student sexual abuse. The findings identify red flag grooming patterns used with students, colleagues, and parents.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/77769",risUrl:"/chapter/ris/77769",signatures:"Charol Shakeshaft, Mitchell Parry, Eve Chong, Syeda Saima and Najia Lindh",book:{id:"10207",type:"book",title:"Sexual Abuse - An Interdisciplinary Approach",subtitle:null,fullTitle:"Sexual Abuse - An Interdisciplinary Approach",slug:null,publishedDate:null,bookSignature:"Dr. Ersi Abaci Kalfoglou and Dr. Sotirios Kalfoglou",coverURL:"https://cdn.intechopen.com/books/images_new/10207.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-398-4",printIsbn:"978-1-83969-397-7",pdfIsbn:"978-1-83969-399-1",isAvailableForWebshopOrdering:!0,editors:[{id:"68678",title:"Dr.",name:"Ersi Abaci",middleName:null,surname:"Kalfoglou",slug:"ersi-abaci-kalfoglou",fullName:"Ersi Abaci Kalfoglou"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Review of the literature",level:"1"},{id:"sec_3",title:"3. Methods",level:"1"},{id:"sec_3_2",title:"3.1 Description of the study",level:"2"},{id:"sec_4_2",title:"3.2 Methodological framework",level:"2"},{id:"sec_5_2",title:"3.3 Sample",level:"2"},{id:"sec_6_2",title:"3.4 Data sources",level:"2"},{id:"sec_7_2",title:"3.5 Coding",level:"2"},{id:"sec_9",title:"4. Findings",level:"1"},{id:"sec_9_2",title:"4.1 Who gets groomed?",level:"2"},{id:"sec_10_2",title:"4.2 Tanner and Blake grooming categories",level:"2"},{id:"sec_10_3",title:"4.2.1 Bonding",level:"3"},{id:"sec_11_3",title:"4.2.2 Reliance",level:"3"},{id:"sec_12_3",title:"4.2.3 Attenuate: Normalize",level:"3"},{id:"sec_13_3",title:"4.2.4 Trap",level:"3"},{id:"sec_15_2",title:"4.3 Overall patterns across grooming actions",level:"2"},{id:"sec_15_3",title:"4.3.1 Isolation",level:"3"},{id:"sec_16_3",title:"4.3.2 Gifts",level:"3"},{id:"sec_18_2",title:"4.4 Environmental grooming",level:"2"},{id:"sec_20",title:"5. Conclusions",level:"1"},{id:"sec_24",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'United States Government Accountability Office (GAO) (2014). Child Welfare Federal Agencies Can Better Support State Efforts to Prevent and Respond to Sexual Abuse by School Personnel.'},{id:"B2",body:'United States Government Accountability Office (GAO) (2010). K-12 Education Selected Cases of Public and Private Schools that Hired or Retained Individuals with Histories of Sexual Misconduct.'},{id:"B3",body:'Shakeshaft, C. Educator Sexual Misconduct with Students: A Synthesis of Existing Literature on Prevalence, Planning and Evaluation Service, Office of the Undersecretary, US Department of Education'},{id:"B4",body:'Lanning, K. (2018). The evolution of grooming: Concept and Term, Journal of Interpersonal Violence, Vol 33, p. 6.'},{id:"B5",body:'Tanner, J. and Brake, S. (2013). Exploring Sex Offender Grooming, http://www.stephenbrakeassociates.com/Exploring%20Sex%20Offender%20Grooming.pdf'},{id:"B6",body:'Welsh, S., Dawson, M. & Nierobisz, A. (2002). Legal Factors, Extra-Legal Factors, or Changes in the Law? Using Criminal Justice Research to Understand the Resolution of Sexual Harassment Complaints.'},{id:"B7",body:'Reagan, R. (2010). Sealing court records and proceeding: A pocket guide. Federal Judicial Center, p. 2.'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Charol Shakeshaft",address:"cshakeshaft@vcu.edu",affiliation:'
Virginia Commonwealth University, Richmond, VA, USA
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The study does so with a particular emphasis on the income inequality and poverty effects of trade liberalisation in South Asia on households in Sri Lanka. A static multi-country computable general equilibrium model for South Asia (SAMGEM) is formulated by incorporating a multiple household framework into the Global Trade Analysis Project (GTAP) model. A non-parametric extended representative household agent approach is used to estimate the income inequality and poverty effects of trade liberalisation in South Asia by using micro-household survey data. The findings revealed that amongst the different trade policy options considered, unilateral trade liberalisation ensures the highest welfare to all South Asian members followed by the customs union (with the exception of Sri Lanka) and the SAFTA. The poverty and income equality analysis for the Sri Lankan economy suggests that poverty is predominant in the rural and the estate sectors and Sri Lanka can achieve a significant progress towards poverty reduction as a result of implementing trade reforms.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Sumudu Perera, Mahinda Siriwardana and Stuart Mounter",authors:[{id:"99337",title:"Prof.",name:"Mahinda",middleName:null,surname:"Siriwardana",slug:"mahinda-siriwardana",fullName:"Mahinda Siriwardana"},{id:"202270",title:"Dr.",name:"Sumudu",middleName:null,surname:"Perera",slug:"sumudu-perera",fullName:"Sumudu Perera"},{id:"202271",title:"Dr.",name:"Stuart",middleName:null,surname:"Mounter",slug:"stuart-mounter",fullName:"Stuart Mounter"}]},{id:"56377",doi:"10.5772/intechopen.69948",title:"Trade Facilitation, Economic Development and Poverty Alleviation: South Asia at a Glance",slug:"trade-facilitation-economic-development-and-poverty-alleviation-south-asia-at-a-glance",totalDownloads:1412,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"South Asia faces enormous economic challenges unmitigated by generally poor economic growth. Increasing economic imbalance between countries hinders regional development. Recently, it has been confirmed that trade liberalisation aimed at expanding trade, has been insufficient in optimising the potential contribution of trade to economic development and reduce poverty. Thus, economists pay attention on Trade Facilitation (TF) which has the potential to contribute to economic development. This has motivated us to examine how TF can achieve this development in South Asia, where trade has yet to make its full contribution to economic growth. The aim of this chapter is to examine the economic impacts of TF on trade and economic growth in South Asia. Our analysis revealed that poor TF restricts trade between countries as it increases Trade Transaction Costs (TTCs). Trade delays are relatively high and affect the region’s landlocked countries even more adversely. An efficiently facilitated trading system will enable these countries to participate more actively in global trade. There has been greater focus on TF policies in South Asia, however due to the complexity of TF measures and their investment needs, it is difficult to identify which TF measures have the most significance for the region.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Subashini Perera, Mahinda Siriwardana and Stuart Mounter",authors:[{id:"99337",title:"Prof.",name:"Mahinda",middleName:null,surname:"Siriwardana",slug:"mahinda-siriwardana",fullName:"Mahinda Siriwardana"},{id:"202271",title:"Dr.",name:"Stuart",middleName:null,surname:"Mounter",slug:"stuart-mounter",fullName:"Stuart Mounter"},{id:"202617",title:"Ms.",name:"Subashini",middleName:null,surname:"Perera",slug:"subashini-perera",fullName:"Subashini Perera"}]},{id:"55494",doi:"10.5772/intechopen.69197",title:"Poverty Alleviation: The Case of Croatia",slug:"poverty-alleviation-the-case-of-croatia",totalDownloads:1213,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In economic literature, poverty is usually defined as the inability to satisfy basic material needs, particularly adequate nutrition, but also ensuring satisfactory housing, means of production and other assets. The goal of the chapter is to present the current situation of poverty in Croatia with the intention to identify measures for the enhancement of poverty alleviation. From the multidimensional perspective, what matters is a focus on the opportunities—such as a possibility for education and employment, adequate contact to markets and so on—that are available to people. If a person does not possess sufficient capabilities or endowments, he or she has a limited possibility to escape from the unfavourable situation. Poverty in Croatia is stagnant—those who become poor need a long period to escape from poverty. The inactive and persons unemployed are the dominant groups of the poor in Croatia. The current social protection system is a mix of old and new programmes and it has been adjusted in response to altering social needs and opportunities. Successful poverty reduction is associated with the improvement of the labour market, a consistent increase in decentralisation of financial sources and services, the reduction of corruption, carefully reallocating expenditures and improving coordination among existing social programmes.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Predrag Bejaković",authors:[{id:"200644",title:"Dr.",name:"Predrag",middleName:null,surname:"Bejakovic",slug:"predrag-bejakovic",fullName:"Predrag Bejakovic"}]}],mostDownloadedChaptersLast30Days:[{id:"55340",title:"Poverty and Its Alleviation: The Case of Pakistan",slug:"poverty-and-its-alleviation-the-case-of-pakistan",totalDownloads:3703,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"This chapter aims to look at the current status of poverty and existing social policies in Pakistan. Poverty is one of the concerns for the governments of almost all countries including Pakistan. There is a continuous research on the policy measurements by national and international organizations in Pakistan, which demonstrated the decline in poverty. The government has launched many social policies in the past three decades to help the nation in reducing the poverty. Apart from government, many national and international organizations have also contributed a lot in the effort of reducing the poverty. However, there is very little research available on the effectiveness of these social policies, and on the need of social policy areas in particular. Disparity among the urban and rural population is another important factor, which has been discussed in almost every research on poverty. Still, very few social policies in Pakistan are focusing on rural population. Therefore, the issue of social policy needs fresh exploration in the country, which is necessary to make new social policies that can benefit all citizens.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Muhammad Azeem Ashraf",authors:[{id:"198873",title:"Dr.",name:"Muhammad Azeem",middleName:null,surname:"Ashraf",slug:"muhammad-azeem-ashraf",fullName:"Muhammad Azeem Ashraf"}]},{id:"56377",title:"Trade Facilitation, Economic Development and Poverty Alleviation: South Asia at a Glance",slug:"trade-facilitation-economic-development-and-poverty-alleviation-south-asia-at-a-glance",totalDownloads:1415,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"South Asia faces enormous economic challenges unmitigated by generally poor economic growth. Increasing economic imbalance between countries hinders regional development. Recently, it has been confirmed that trade liberalisation aimed at expanding trade, has been insufficient in optimising the potential contribution of trade to economic development and reduce poverty. Thus, economists pay attention on Trade Facilitation (TF) which has the potential to contribute to economic development. This has motivated us to examine how TF can achieve this development in South Asia, where trade has yet to make its full contribution to economic growth. The aim of this chapter is to examine the economic impacts of TF on trade and economic growth in South Asia. Our analysis revealed that poor TF restricts trade between countries as it increases Trade Transaction Costs (TTCs). Trade delays are relatively high and affect the region’s landlocked countries even more adversely. An efficiently facilitated trading system will enable these countries to participate more actively in global trade. There has been greater focus on TF policies in South Asia, however due to the complexity of TF measures and their investment needs, it is difficult to identify which TF measures have the most significance for the region.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Subashini Perera, Mahinda Siriwardana and Stuart Mounter",authors:[{id:"99337",title:"Prof.",name:"Mahinda",middleName:null,surname:"Siriwardana",slug:"mahinda-siriwardana",fullName:"Mahinda Siriwardana"},{id:"202271",title:"Dr.",name:"Stuart",middleName:null,surname:"Mounter",slug:"stuart-mounter",fullName:"Stuart Mounter"},{id:"202617",title:"Ms.",name:"Subashini",middleName:null,surname:"Perera",slug:"subashini-perera",fullName:"Subashini Perera"}]},{id:"55593",title:"Inequality as Determinant of the Persistence of Poverty",slug:"inequality-as-determinant-of-the-persistence-of-poverty",totalDownloads:2112,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter aims to establish the relationship between inequality and poverty to explain why poverty persists. For this purpose, four parts are developed. The first one illustrates data on inequality and poverty in the world. In the second one, the background of both problems is traced in order to conceptualize them and determine their relationship. In the third one, a simulation exercise is carried out to show the mentioned relationship; besides, correlations between corruption, inequality, and poverty are made for 18 countries around the world that bear witness to the link between these variables. Finally, it is pointed out that persistent poverty reduction will only succeed if the different types of inequalities are reduced or limited, since it is unacceptable that more than 10% of the inhabitants of the earth live in extreme poverty or that just eight people have the same wealth as half of mankind.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Julián Augusto Casas Herrera",authors:[{id:"200579",title:"M.Sc.",name:"Julián",middleName:null,surname:"Casas",slug:"julian-casas",fullName:"Julián Casas"}]},{id:"56015",title:"The Impact of Trade Liberalisation on Poverty and Welfare in South Asia: A Special Reference to Sri Lanka",slug:"the-impact-of-trade-liberalisation-on-poverty-and-welfare-in-south-asia-a-special-reference-to-sri-l",totalDownloads:1607,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"This chapter evaluates the economic impacts of SAFTA relative to alternative trade policies to determine which policies best deliver increased welfare to citizens, thereby helping to alleviate income disparities and poverty in the region. The study does so with a particular emphasis on the income inequality and poverty effects of trade liberalisation in South Asia on households in Sri Lanka. A static multi-country computable general equilibrium model for South Asia (SAMGEM) is formulated by incorporating a multiple household framework into the Global Trade Analysis Project (GTAP) model. A non-parametric extended representative household agent approach is used to estimate the income inequality and poverty effects of trade liberalisation in South Asia by using micro-household survey data. The findings revealed that amongst the different trade policy options considered, unilateral trade liberalisation ensures the highest welfare to all South Asian members followed by the customs union (with the exception of Sri Lanka) and the SAFTA. The poverty and income equality analysis for the Sri Lankan economy suggests that poverty is predominant in the rural and the estate sectors and Sri Lanka can achieve a significant progress towards poverty reduction as a result of implementing trade reforms.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Sumudu Perera, Mahinda Siriwardana and Stuart Mounter",authors:[{id:"99337",title:"Prof.",name:"Mahinda",middleName:null,surname:"Siriwardana",slug:"mahinda-siriwardana",fullName:"Mahinda Siriwardana"},{id:"202271",title:"Dr.",name:"Stuart",middleName:null,surname:"Mounter",slug:"stuart-mounter",fullName:"Stuart Mounter"},{id:"202270",title:"Dr.",name:"Sumudu",middleName:null,surname:"Perera",slug:"sumudu-perera",fullName:"Sumudu Perera"}]},{id:"55494",title:"Poverty Alleviation: The Case of Croatia",slug:"poverty-alleviation-the-case-of-croatia",totalDownloads:1216,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In economic literature, poverty is usually defined as the inability to satisfy basic material needs, particularly adequate nutrition, but also ensuring satisfactory housing, means of production and other assets. The goal of the chapter is to present the current situation of poverty in Croatia with the intention to identify measures for the enhancement of poverty alleviation. From the multidimensional perspective, what matters is a focus on the opportunities—such as a possibility for education and employment, adequate contact to markets and so on—that are available to people. If a person does not possess sufficient capabilities or endowments, he or she has a limited possibility to escape from the unfavourable situation. Poverty in Croatia is stagnant—those who become poor need a long period to escape from poverty. The inactive and persons unemployed are the dominant groups of the poor in Croatia. The current social protection system is a mix of old and new programmes and it has been adjusted in response to altering social needs and opportunities. Successful poverty reduction is associated with the improvement of the labour market, a consistent increase in decentralisation of financial sources and services, the reduction of corruption, carefully reallocating expenditures and improving coordination among existing social programmes.",book:{id:"5946",slug:"poverty-inequality-and-policy",title:"Poverty, Inequality and Policy",fullTitle:"Poverty, Inequality and Policy"},signatures:"Predrag Bejaković",authors:[{id:"200644",title:"Dr.",name:"Predrag",middleName:null,surname:"Bejakovic",slug:"predrag-bejakovic",fullName:"Predrag Bejakovic"}]}],onlineFirstChaptersFilter:{topicId:"67",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). 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He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,annualVolume:11402,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. 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