Search results for: stress related traits
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13340

Search results for: stress related traits

680 Internet Memes as Meaning-Making Tools within Subcultures: A Case Study of Lolita Fashion

Authors: Victoria Esteves

Abstract:

Online memes have not only impacted different aspects of culture, but they have also left their mark on particular subcultures, where memes have reflected issues and debates surrounding specific spheres of interest. This is the first study that outlines how memes can address cultural intersections within the Lolita fashion community, which are much more specific and which fall outside of the broad focus of politics and/or social commentary. This is done by looking at the way online memes are used in this particular subculture as a form of meaning-making and group identity reinforcement, demonstrating not only the adaptability of online memes to specific cultural groups but also how subcultures tailor these digital objects to discuss both community-centered topics and more broad societal aspects. As part of an online ethnography, this study focuses on qualitative content analysis by taking a look at some of the meme communication that has permeated Lolita fashion communities. Examples of memes used in this context are picked apart in order to understand this specific layered phenomenon of communication, as well as to gain insights into how memes can operate as visual shorthand for the remix of meaning-making. There are existing parallels between internet culture and cultural behaviors surrounding Lolita fashion: not only is the latter strongly influenced by the former (due to its highly globalized dispersion and lack of physical shops, Lolita fashion is almost entirely reliant on the internet for its existence), both also emphasize curatorial roles through a careful collaborative process of documenting significant aspects of their culture (e.g., Know Your Meme and Lolibrary). Further similarities appear when looking at ideas of inclusion and exclusion that permeate both cultures, where memes and language are used in order to both solidify group identity and to police those who do not ascribe to these cultural tropes correctly, creating a feedback loop that reinforces subcultural ideals. Memes function as excellent forms of communication within the Lolita community because they reinforce its coded ideas and allows a kind of participation that echoes other cultural groups that are online-heavy such as fandoms. Furthermore, whilst the international Lolita community was mostly self-contained within its LiveJournal birthplace, it has become increasingly dispersed through an array of different social media groups that have fragmented this subculture significantly. The use of memes is key in maintaining a sense of connection throughout this now fragmentary experience of fashion. Memes are also used in the Lolita fashion community to bridge the gap between Lolita fashion related community issues and wider global topics; these reflect not only an ability to make use of a broader online language to address specific issues of the community (which in turn provide a very community-specific engagement with remix practices) but also memes’ ability to be tailored to accommodate overlapping cultural and political concerns and discussions between subcultures and broader societal groups. Ultimately, online memes provide the necessary elasticity to allow their adaption and adoption by subcultural groups, who in turn use memes to extend their meaning-making processes.

Keywords: internet culture, Lolita fashion, memes, online community, remix

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679 Assessment of Nuclear Medicine Radiation Protection Practices Among Radiographers and Nurses at a Small Nuclear Medicine Department in a Tertiary Hospital

Authors: Nyathi Mpumelelo; Moeng Thabiso Maria

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BACKGROUND AND OBJECTIVES: Radiopharmaceuticals are used for diagnosis, treatment, staging and follow up of various diseases. However, there is concern that the ionizing radiation (gamma rays, α and ß particles) emitted by radiopharmaceuticals may result in exposure of radiographers and nurses with limited knowledge of the principles of radiation protection and safety, raising the risk of cancer induction. This study aimed at investigation radiation safety awareness levels among radiographers and nurses at a small tertiary hospital in South Africa. METHODS: An analytical cross-sectional study. A validated two-part questionnaire was implemented to consenting radiographers and nurses working in a Nuclear Medicine Department. Part 1 gathered demographic information (age, gender, work experience, attendance to/or passing ionizing radiation protection courses). Part 2 covered questions related to knowledge and awareness of radiation protection principles. RESULTS: Six radiographers and five nurses participated (27% males and 73% females). The mean age was 45 years (age range 20-60 years). The study revealed that neither professional development courses nor radiation protection courses are offered at the Nuclear Medicine Department understudy. However, 6/6 (100%) radiographers exhibited a high level of awareness of radiation safety principles on handling and working with radiopharmaceuticals which correlated to their years of experience. As for nurses, 4/5 (80%) showed limited knowledge and awareness of radiation protection principles irrespective of the number of years in the profession. CONCLUSION: Despite their major role of caring for patients undergoing diagnostic and therapeutic treatments, the nurses showed limited knowledge of ionizing radiation and associated side effects. This was not surprising since they never received any formal basic radiation safety course. These findings were not unique to this Centre. A study conducted in a Kuwaiti Radiology Department also established that the vast majority of nurses did not understand the risks of working with ionizing radiation. Similarly, nurses in an Australian hospital exhibited knowledge limitations. However, nursing managers did provide the necessary radiation safety training when requested. In Guatemala and Saudi Arabia, where there was shortage of professional radiographers, nurses underwent radiography training, a course that equipped them with basic radiation safety principles. The radiographers in the Centre understudy unlike others in various parts of the world demonstrated substantial knowledge and awareness on radiation protection. Radiations safety courses attended when an opportunity arose played a critical role in their awareness. The knowledge and awareness levels of these radiographers were comparable to their counterparts in Sudan. However, it was much more above that of their counterparts in Jordan, Nigeria, Nepal and Iran who were found to have limited awareness and inadequate knowledge on radiation dose. Formal radiation safety and awareness courses and workshops can play a crucial role in raising the awareness of nurses and radiographers on radiation safety for their personal benefit and that of their patients.

Keywords: radiation safety, radiation awareness, training, nuclear medicine

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678 Regeneration of Cesium-Exhausted Activated Carbons by Microwave Irradiation

Authors: Pietro P. Falciglia, Erica Gagliano, Vincenza Brancato, Alfio Catalfo, Guglielmo Finocchiaro, Guido De Guidi, Stefano Romano, Paolo Roccaro, Federico G. A. Vagliasindi

Abstract:

Cesium-137 (¹³⁷Cs) is a major radionuclide in spent nuclear fuel processing, and it represents the most important cause of contamination related to nuclear accidents. Cesium-137 has long-term radiological effects representing a major concern for the human health. Several physico-chemical methods have been proposed for ¹³⁷Cs removal from impacted water: ion-exchange, adsorption, chemical precipitation, membrane process, coagulation, and electrochemical. However, these methods can be limited by ionic selectivity and efficiency, or they present very restricted full-scale application due to equipment and chemical high costs. On the other hand, adsorption is considered a more cost-effective solution, and activated carbons (ACs) are known as a low-cost and effective adsorbent for a wide range of pollutants among which radionuclides. However, adsorption of Cs onto ACs has been investigated in very few and not exhaustive studies. In addition, exhausted activated carbons are generally discarded in landfill, that is not an eco-friendly and economic solution. Consequently, the regeneration of exhausted ACs must be considered a preferable choice. Several alternatives, including conventional thermal-, solvent-, biological- and electrochemical-regeneration, are available but are affected by several economic or environmental concerns. Microwave (MW) irradiation has been widely used in industrial and environmental applications and it has attracted many attentions to regenerating activated carbons. The growing interest in MW irradiation is based on the passive ability of the irradiated medium to convert a low power irradiation energy into a rapid and large temperature increase if the media presents good dielectric features. ACs are excellent MW-absorbers, with a high mechanical strength and a good resistance towards heating process. This work investigates the feasibility of MW irradiation for the regeneration of Cs-exhausted ACs. Adsorption batch experiments were carried out using commercially available granular activated carbon (GAC), then Cs-saturated AC samples were treated using a controllable bench-scale 2.45-GHz MW oven and investigating different adsorption-regeneration cycles. The regeneration efficiency (RE), weight loss percentage, and textural properties of the AC samples during the adsorption-regeneration cycles were also assessed. Main results demonstrated a relatively low adsorption capacity for Cs, although the feasibility of ACs was strictly linked to their dielectric nature, which allows a very efficient thermal regeneration by MW irradiation. The weight loss percentage was found less than 2%, and an increase in RE after three cycles was also observed. Furthermore, MW regeneration preserved the pore structure of the regenerated ACs. For a deeper exploration of the full-scale applicability of MW regeneration, further investigations on more adsorption-regeneration cycles or using fixed-bed columns are required.

Keywords: adsorption mechanisms, cesium, granular activated carbons, microwave regeneration

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677 Phytochemical Screening and in vitro Antibacterial and Antioxidant Potential of Microalgal Strain, Cymbella

Authors: S. Beekrum, B. Odhav, R. Lalloo, E. O. Amonsou

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Marine microalgae are rich sources of the novel and biologically active metabolites; therefore, they may be used in the food industry as natural food ingredients and functional foods. They have several biological applications related with health benefits, among others. In the past decades, food scientists have been searching for natural alternatives to replace synthetic antioxidants. The use of synthetic antioxidants has decreased due to their suspected activity as promoters of carcinogenesis, as well as consumer rejection of synthetic food additives. The aim of the study focused on screening of phytochemicals from Cymbella biomass extracts, and to examine the in vitro antioxidant and antimicrobial potential. Cymbella biomass was obtained from CSIR (South Africa), and four different solvents namely methanol, acetone, n-hexane and water were used for extraction. To take into account different antioxidant mechanisms, seven different antioxidant assays were carried out. These include free radical scavenging (DPPH assay), Trolox equivalent antioxidant capacity (TEAC assay), radical cation (ABTS assay), superoxide anion radical scavenging, reducing power, determination of total phenolic compounds and determination of total flavonoid content. The total content of phenol and flavonoid in extracts were determined as gallic acid equivalent, and as rutin equivalent, respectively. The in vitro antimicrobial effect of extracts were tested against some pathogens (Staphylococcus aureus, Listeria monocytogenes, Bacillus subtilis, Salmonella enteritidis, Escherichia coli, Pseudomonas aeruginosa and Candida albicans), using the disc diffusion assay. Qualitative analyses of phytochemicals were conducted by chemical tests to screen for the presence of tannins, flavonoids, terpenoids, phenols, steroids, saponins, glycosides and alkaloids. The present investigation revealed that all extracts showed relatively strong antibacterial activity against most of the tested bacteria. The methanolic extract of the biomass contained a significantly high phenolic content of 111.46 mg GAE/g, and the hexane extract contained 65.279 mg GAE/g. Results of the DPPH assay showed that the biomass contained strong antioxidant capacity, 79% in the methanolic extract and 85% in the hexane extract. Extracts have displayed effective reducing power and superoxide anion radical scavenging. Results of this study have highlighted potential antioxidant activity in the methanol and hexane extracts. The obtained results of the phytochemical screening showed the presence of terpenoids, flavonoids, phenols and saponins. The use of Cymbella as a natural antioxidant source and a potential source of antibacterial compounds and phytochemicals in the food industry appears promising and should be investigated further.

Keywords: antioxidants, antimicrobial, Cymbella, microalgae, phytochemicals

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676 In Response to Worldwide Disaster: Academic Libraries’ Functioning During COVID-19 Pandemic Without a Policy

Authors: Dalal Albudaiwi, Mike Allen, Talal Alhaji, Shahnaz Khadimehzadah

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As a pandemic, COVID-19 has impacted the whole world since November 2019. In other words, every organization, industry, and institution has been negatively affected by the Coronavirus. The uncertainty of how long the pandemic will last caused chaos at all levels. As with any other institution, public libraries were affected and transmitted into online services and resources. As internationally, have been witnessed that some public libraries were well-prepared for such disasters as the pandemic, and therefore, collections, users, services, technologies, staff, and budgets were all influenced. Public libraries’ policies did not mention any plan regarding such a pandemic. Instead, there are several rules in the guidelines about disasters in general, such as natural disasters. In this pandemic situation, libraries have been involved in different uneasy circumstances. However, it has always been apparent to public libraries the role they play in serving their communities in excellent and critical times. It dwells into the traditional role public libraries play in providing information services and sources to satisfy their information-based community needs. Remarkably increasing people’s awareness of the importance of informational enrichment and enhancing society’s skills in dealing with information and information sources. Under critical circumstances, libraries play a different role. It goes beyond the traditional part of information providers to the untraditional role of being a social institution that serves the community with whatever capabilities they have. This study takes two significant directions. The first focuses on investigating how libraries have responded to COVID-19 and how they manage disasters within their organization. The second direction focuses on how libraries help their communities to act during disasters and how to recover from the consequences. The current study examines how libraries prepare for disasters and the role of public libraries during disasters. We will also propose “measures” to be a model that libraries can use to evaluate the effectiveness of their response to disasters. We intend to focus on how libraries responded to this new disaster. Therefore, this study aims to develop a comprehensive policy that includes responding to a crisis such as Covid-19. An analytical lens inside the libraries as an organization and outside the organization walls will be documented based on analyzing disaster-related literature published in the LIS publication. The study employs content analysis (CA) methodology. CA is widely used in the library and information science. The critical contribution of this work is to propose solutions it provides to libraries and planers to prepare crisis management plans/ policies, specifically to face a new global disaster such as the COVID-19 pandemic. Moreover, the study will help library directors to evaluate their strategies and to improve them properly. The significance of this study lies in guiding libraries’ directors to enhance the goals of the libraries to guarantee crucial issues such as: saving time, avoiding loss, saving budget, acting quickly during a crisis, maintaining libraries’ role during pandemics, finding out the best response to disasters, and creating plan/policy as a sample for all libraries.

Keywords: Covid-19, policy, preparedness, public libraries

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675 Structure Domains Tuning Magnetic Anisotropy and Motivating Novel Electric Behaviors in LaCoO₃ Films

Authors: Dechao Meng, Yongqi Dong, Qiyuan Feng, Zhangzhang Cui, Xiang Hu, Haoliang Huang, Genhao Liang, Huanhua Wang, Hua Zhou, Hawoong Hong, Jinghua Guo, Qingyou Lu, Xiaofang Zhai, Yalin Lu

Abstract:

Great efforts have been taken to reveal the intrinsic origins of emerging ferromagnetism (FM) in strained LaCoO₃ (LCO) films. However, some macro magnetic performances of LCO are still not well understood and even controversial, such as magnetic anisotropy. Determining and understanding magnetic anisotropy might help to find the true causes of FM in turn. Perpendicular magnetic anisotropy (PMA) was the first time to be directly observed in high-quality LCO films with different thickness. The in-plane (IP) and out of plane (OOP) remnant magnetic moment ratio of 30 unit cell (u.c.) films is as large as 20. The easy axis lays in the OOP direction with an IP/OOP coercive field ratio of 10. What's more, the PMA could be simply tuned by changing the thickness. With the thickness increases, the IP/OOP magnetic moment ratio remarkably decrease with magnetic easy axis changing from OOP to IP. Such a huge and tunable PMA performance exhibit strong potentials in fundamental researches or applications. What causes PMA is the first concern. More OOP orbitals occupation may be one of the micro reasons of PMA. A cluster-like magnetic domain pattern was found in 30 u.c. with no obvious color contrasts, similar to that of LaAlO₃/SrTiO₃ films. And the nanosize domains could not be totally switched even at a large OOP magnetic field of 23 T. It indicates strong IP characters or none OOP magnetism of some clusters. The IP magnetic domains might influence the magnetic performance and help to form PMA. Meanwhile some possible nonmagnetic clusters might be the reason why the measured moments of LCO films are smaller than the calculated values 2 μB/Co, one of the biggest confusions in LCO films.What tunes PMA seems much more interesting. Totally different magnetic domain patterns were found in 180 u.c. films with cluster magnetic domains surrounded by < 110 > cross-hatch lines. These lines were regarded as structure domain walls (DWs) determined by 3D reciprocal space mapping (RSM). Two groups of in-plane features with fourfold symmetry were observed near the film diffraction peaks in (002) 3D-RSM. One is along < 110 > directions with a larger intensity, which is well match the lines on the surfaces. The other is much weaker and along < 100 > directions, which is from the normal lattice titling of films deposited on cubic substrates. The < 110 > domain features obtained from (103) and (113) 3D-RSMs exhibit similar evolution of the DWs percentages and magnetic behavior. Structure domains and domain walls are believed to tune PMA performances by transform more IP magnetic moments to OOP. Last but not the least, thick films with lots of structure domains exhibit different electrical transport behaviors. A metal-to-insulator transition (MIT) and an angular dependent negative magnetic resistivity were observed near 150 K, higher than FM transition temperature but similar to that of spin-orbital coupling related 1/4 order diffraction peaks.

Keywords: structure domain, magnetic anisotropy, magnetic domain, domain wall, 3D-RSM, strain

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674 In Search of Innovation: Exploring the Dynamics of Innovation

Authors: Michal Lysek, Mike Danilovic, Jasmine Lihua Liu

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HMS Industrial Networks AB has been recognized as one of the most innovative companies in the industrial communication industry worldwide. The creation of their Anybus innovation during the 1990s contributed considerably to the company’s success. From inception, HMS’ employees were innovating for the purpose of creating new business (the creation phase). After the Anybus innovation, they began the process of internationalization (the commercialization phase), which in turn led them to concentrate on cost reduction, product quality, delivery precision, operational efficiency, and increasing growth (the growth phase). As a result of this transformation, performing new radical innovations have become more complicated. The purpose of our research was to explore the dynamics of innovation at HMS from the aspect of key actors, activities, and events, over the three phases, in order to understand what led to the creation of their Anybus innovation, and why it has become increasingly challenging for HMS to create new radical innovations for the future. Our research methodology was based on a longitudinal, retrospective study from the inception of HMS in 1988 to 2014, a single case study inspired by the grounded theory approach. We conducted 47 interviews and collected 1 024 historical documents for our research. Our analysis has revealed that HMS’ success in creating the Anybus, and developing a successful business around the innovation, was based on three main capabilities – cultivating customer relations on different managerial and organizational levels, inspiring business relations, and balancing complementary human assets for the purpose of business creation. The success of HMS has turned the management’s attention away from past activities of key actors, of their behavior, and how they influenced and stimulated the creation of radical innovations. Nowadays, they are rhetorically focusing on creativity and innovation. All the while, their real actions put emphasis on growth, cost reduction, product quality, delivery precision, operational efficiency, and moneymaking. In the process of becoming an international company, HMS gradually refocused. In so doing they became profitable and successful, but they also forgot what made them innovative in the first place. Fortunately, HMS’ management has come to realize that this is the case and they are now in search of recapturing innovation once again. Our analysis indicates that HMS’ management is facing several barriers to innovation related path dependency and other lock-in phenomena. HMS’ management has been captured, trapped in their mindset and actions, by the success of the past. But now their future has to be secured, and they have come to realize that moneymaking is not everything. In recent years, HMS’ management have begun to search for innovation once more, in order to recapture their past capabilities for creating radical innovations. In order to unlock their managerial perceptions of customer needs and their counter-innovation driven activities and events, to utilize the full potential of their employees and capture the innovation opportunity for the future.

Keywords: barriers to innovation, dynamics of innovation, in search of excellence and innovation, radical innovation

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673 Analysis of Engagement Methods in the College Classroom Post Pandemic

Authors: Marsha D. Loda

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College enrollment is declining and generation Z, today’s college students, are struggling. Before the pandemic, researchers characterized this generational cohort as unique. Gen Z has been called the most achievement-oriented generation, as they enjoy greater economic status, are more racially and ethnically diverse, and better educated than any other generation. However, they are also the most likely generation to suffer from depression and anxiety. Gen Z has grown up largely with usually well-intentioned but overprotective parents who inadvertently kept them from learning life skills, likely impacting their ability to cope with and to effectively manage challenges. The unprecedented challenges resulting from the pandemic up ended their world and left them emotionally reeling. One of the ramifications of this for higher education is how to reengage current Gen Z students in the classroom. This research presents qualitative findings from 24 single-spaced pages of verbatim comments from college students. Research questions concerned what helps them learn and what they abhor, as well as how to engage them with the university outside of the classroom to aid in retention. Students leave little doubt about what they want to experience in the classroom. In order of mention, students want discussion, to engage with questions, to hear how a topic relates to real life and the real world, to feel connections with the professor and fellow students, and to have an opportunity to give their opinions. They prefer a classroom that involves conversation, with interesting topics and active learning. “professor talks instead of lecturing” “professor builds a connection with the classroom” “I am engaged because it feels like a respectful conversation” Similarly, students are direct about what they dislike in a classroom. In order of frequency, students dislike teachers unenthusiastically reading word or word from notes or presentations, repeating the text without adding examples, or addressing how to apply the information. “All lecture. I can read the book myself” “Not taught how to apply the skill or lesson” “Lectures the entire time. Lesson goes in one ear and out the other.” Pertaining to engagement outside the classroom, Gen Z challenges higher education to step outside the box. They don’t want to just hear from professionals in their field, they want to meet and interact with them. Perhaps because of their dependence on technology and pandemic isolation, they seem to reach out for assistance in forming social bonds. “I believe fun and social events are the best way to connect with students and get them involved. Cookouts, raffles, socials, or networking events would all most likely appeal to many students”. “Events… even if they aren’t directly related to learning. Maybe like movie nights… doing meet ups at restaurants”. Qualitative research suggests strategy. This research is rife with strategic implications to improve learning, increase engagement and reduce drop-out rates among Generation Z higher education students. It also compliments existing research on student engagement. With college enrollment declining by some 1.3 million students over the last two years, this research is both timely and important.

Keywords: college enrollment, generation Z, higher education, pandemic, student engagement

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672 Dueling Burnout: The Dual Role Nurse

Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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671 The Effectiveness of an Occupational Therapy Metacognitive-Functional Intervention for the Improvement of Human Risk Factors of Bus Drivers

Authors: Navah Z. Ratzon, Rachel Shichrur

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Background: Many studies have assessed and identified the risk factors of safe driving, but there is relatively little research-based evidence concerning the ability to improve the driving skills of drivers in general and in particular of bus drivers, who are defined as a population at risk. Accidents involving bus drivers can endanger dozens of passengers and cause high direct and indirect damages. Objective: To examine the effectiveness of a metacognitive-functional intervention program for the reduction of risk factors among professional drivers relative to a control group. Methods: The study examined 77 bus drivers working for a large public company in the center of the country, aged 27-69. Twenty-one drivers continued to the intervention stage; four of them dropped out before the end of the intervention. The intervention program we developed was based on previous driving models and the guiding occupational therapy practice framework model in Israel, while adjusting the model to the professional driving in public transportation and its particular risk factors. Treatment focused on raising awareness to safe driving risk factors identified at prescreening (ergonomic, perceptual-cognitive and on-road driving data), with reference to the difficulties that the driver raises and providing coping strategies. The intervention has been customized for each driver and included three sessions of two hours. The effectiveness of the intervention was tested using objective measures: In-Vehicle Data Recorders (IVDR) for monitoring natural driving data, traffic accident data before and after the intervention, and subjective measures (occupational performance questionnaire for bus drivers). Results: Statistical analysis found a significant difference between the degree of change in the rate of IVDR perilous events (t(17)=2.14, p=0.046), before and after the intervention. There was significant difference in the number of accidents per year before and after the intervention in the intervention group (t(17)=2.11, p=0.05), but no significant change in the control group. Subjective ratings of the level of performance and of satisfaction with performance improved in all areas tested following the intervention. The change in the ‘human factors/person’ field, was significant (performance : t=- 2.30, p=0.04; satisfaction with performance : t=-3.18, p=0.009). The change in the ‘driving occupation/tasks’ field, was not significant but showed a tendency toward significance (t=-1.94, p=0.07,). No significant differences were found in driving environment-related variables. Conclusions: The metacognitive-functional intervention significantly improved the objective and subjective measures of safety of bus drivers’ driving. These novel results highlight the potential contribution of occupational therapists, using metacognitive functional treatment, to preventing car accidents among the healthy drivers population and improving the well-being of these drivers. This study also enables familiarity with advanced technologies of IVDR systems and enriches the knowledge of occupational therapists in regards to using a wide variety of driving assessment tools and making the best practice decisions.

Keywords: bus drivers, IVDR, human risk factors, metacognitive-functional intervention

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670 An Audit of Climate Change and Sustainability Teaching in Medical School

Authors: Karolina Wieczorek, Zofia Przypaśniak

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Climate change is a rapidly growing threat to global health, and part of the responsibility to combat it lies within the healthcare sector itself, including adequate education of future medical professionals. To mitigate the consequences, the General Medical Council (GMC) has equipped medical schools with a list of outcomes regarding sustainability teaching. Students are expected to analyze the impact of the healthcare sector’s emissions on climate change. The delivery of the related teaching content is, however, often inadequate and insufficient time is devoted for exploration of the topics. Teaching curricula lack in-depth exploration of the learning objectives. This study aims to assess the extent and characteristics of climate change and sustainability subjects teaching in the curriculum of a chosen UK medical school (Barts and The London School of Medicine and Dentistry). It compares the data to the national average scores from the Climate Change and Sustainability Teaching (C.A.S.T.) in Medical Education Audit to draw conclusions about teaching on a regional level. This is a single-center audit of the timetabled sessions of teaching in the medical course. The study looked at the academic year 2020/2021 which included a review of all non-elective, core curriculum teaching materials including tutorials, lectures, written resources, and assignments in all five years of the undergraduate and graduate degrees, focusing only on mandatory teaching attended by all students (excluding elective modules). The topics covered were crosschecked with GMC Outcomes for graduates: “Educating for Sustainable Healthcare – Priority Learning Outcomes” as gold standard to look for coverage of the outcomes and gaps in teaching. Quantitative data was collected in form of time allocated for teaching as proxy of time spent per individual outcomes. The data was collected independently by two students (KW and ZP) who have received prior training and assessed two separate data sets to increase interrater reliability. In terms of coverage of learning outcomes, 12 out of 13 were taught (with the national average being 9.7). The school ranked sixth in the UK for time spent per topic and second in terms of overall coverage, meaning the school has a broad range of topics taught with some being explored in more detail than others. For the first outcome 4 out of 4 objectives covered (average 3.5) with 47 minutes spent per outcome (average 84 min), for the second objective 5 out of 5 covered (average 3.5) with 46 minutes spent (average 20), for the third 3 out of 4 (average 2.5) with 10 mins pent (average 19 min). A disproportionately large amount of time is spent delivering teaching regarding air pollution (respiratory illnesses), which resulted in the topic of sustainability in other specialties being excluded from teaching (musculoskeletal, ophthalmology, pediatrics, renal). Conclusions: Currently, there is no coherent strategy on national teaching of climate change topics and as a result an unstandardized amount of time spent on teaching and coverage of objectives can be observed.

Keywords: audit, climate change, sustainability, education

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669 Corporate Governance and Disclosure Practices of Listed Companies in the ASEAN: A Conceptual Overview

Authors: Chen Shuwen, Nunthapin Chantachaimongkol

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Since the world has moved into a transitional period, known as globalization; the business environment is now more complicated than ever before. Corporate information has become a matter of great importance for stakeholders, in order to understand the current situation. As a result of this, the concept of corporate governance has been broadly introduced to manage and control the affairs of corporations while businesses are required to disclose both financial and non-financial information to public via various communication channels such as the annual report, the financial report, the company’s website, etc. However, currently there are several other issues related to asymmetric information such as moral hazard or adverse selection that still occur intensively in workplaces. To prevent such problems in the business, it is required to have an understanding of what factors strengthen their transparency, accountability, fairness, and responsibility. Under aforementioned arguments, this paper aims to propose a conceptual framework that enables an investigation on how corporate governance mechanism influences disclosure efficiency of listed companies in the Association of Southeast Asia Nations (ASEAN) and the factors that should be considered for further development of good behaviors, particularly in regards to voluntary disclosure practices. To achieve its purpose, extensive reviews of literature are applied as a research methodology. It is divided into three main steps. Firstly, the theories involved with both corporate governance and disclosure practices such as agency theory, contract theory, signaling theory, moral hazard theory, and information asymmetry theory are examined to provide theoretical backgrounds. Secondly, the relevant literatures based on multi- perspectives of corporate governance, its attributions and their roles on business processes, the influences of corporate governance mechanisms on business performance, and the factors determining corporate governance characteristics as well as capability are reviewed to outline the parameters that should be included in the proposed model. Thirdly, the well-known regulatory document OECD principles and previous empirical studies on the corporate disclosure procedures are evaluated to identify the similarities and differentiations with the disclosure patterns in the ASEAN. Following the processes and consequences of the literature review, abundant factors and variables are found. Further to the methodology, additional critical factors that also have an impact on the disclosure behaviors are addressed in two groups. In the first group, the factors which are linked to the national characteristics - the quality of national code, legal origin, culture, the level of economic development, and so forth. Whereas in the second group, the discoveries which refer to the firm’s characteristics - ownership concentration, ownership’s rights, controlling group, and so on. However, because of research limitations, only some literature are chosen and summarized to form part of the conceptual framework that explores the relationship between corporate governance and the disclosure practices of listed companies in ASEAN.

Keywords: corporate governance, disclosure practice, ASEAN, listed company

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668 R&D Diffusion and Productivity in a Globalized World: Country Capabilities in an MRIO Framework

Authors: S. Jimenez, R.Duarte, J.Sanchez-Choliz, I. Villanua

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There is a certain consensus in economic literature about the factors that have influenced in historical differences in growth rates observed between developed and developing countries. However, it is less clear what elements have marked different paths of growth in developed economies in recent decades. R&D has always been seen as one of the major sources of technological progress, and productivity growth, which is directly influenced by technological developments. Following recent literature, we can say that ‘innovation pushes the technological frontier forward’ as well as encourage future innovation through the creation of externalities. In other words, productivity benefits from innovation are not fully appropriated by innovators, but it also spread through the rest of the economies encouraging absorptive capacities, what have become especially important in a context of increasing fragmentation of production This paper aims to contribute to this literature in two ways, first, exploring alternative indexes of R&D flows embodied in inter-country, inter-sectorial flows of good and services (as approximation to technology spillovers) capturing structural and technological characteristic of countries and, second, analyzing the impact of direct and embodied R&D on the evolution of labor productivity at the country/sector level in recent decades. The traditional way of calculation through a multiregional input-output framework assumes that all countries have the same capabilities to absorb technology, but it is not, each one has different structural features and, this implies, different capabilities as part of literature, claim. In order to capture these differences, we propose to use a weight based on specialization structure indexes; one related with the specialization of countries in high-tech sectors and the other one based on a dispersion index. We propose these two measures because, as far as we understood, country capabilities can be captured through different ways; countries specialization in knowledge-intensive sectors, such as Chemicals or Electrical Equipment, or an intermediate technology effort across different sectors. Results suggest the increasing importance of country capabilities while increasing the trade openness. Besides, if we focus in the country rankings, we can observe that with high-tech weighted R&D embodied countries as China, Taiwan and Germany arose the top five despite not having the highest intensities of R&D expenditure, showing the importance of country capabilities. Additionally, through a fixed effects panel data model we show that, in fact, R&D embodied is important to explain labor productivity increases, in fact, even more that direct R&D investments. This is reflecting that globalization is more important than has been said until now. However, it is true that almost all analysis done in relation with that consider the effect of t-1 direct R&D intensity over economic growth. Nevertheless, from our point of view R&D evolve as a delayed flow and it is necessary some time to be able to see its effects on the economy, as some authors have already claimed. Our estimations tend to corroborate this hypothesis obtaining a gap between 4-5 years.

Keywords: economic growth, embodied, input-output, technology

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667 Moderate Electric Field and Ultrasound as Alternative Technologies to Raspberry Juice Pasteurization Process

Authors: Cibele F. Oliveira, Debora P. Jaeschke, Rodrigo R. Laurino, Amanda R. Andrade, Ligia D. F. Marczak

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Raspberry is well-known as a good source of phenolic compounds, mainly anthocyanin. Some studies pointed out the importance of these bioactive compounds consumption, which is related to the decrease of the risk of cancer and cardiovascular diseases. The most consumed raspberry products are juices, yogurts, ice creams and jellies and, to ensure the safety of these products, raspberry is commonly pasteurized, for enzyme and microorganisms inactivation. Despite being efficient, the pasteurization process can lead to degradation reactions of the bioactive compounds, decreasing the products healthy benefits. Therefore, the aim of the present work was to evaluate moderate electric field (MEF) and ultrasound (US) technologies application on the pasteurization process of raspberry juice and compare the results with conventional pasteurization process. For this, phenolic compounds, anthocyanin content and physical-chemical parameters (pH, color changes, titratable acidity) of the juice were evaluated before and after the treatments. Moreover, microbiological analyses of aerobic mesophiles microorganisms, molds and yeast were performed in the samples before and after the treatments, to verify the potential of these technologies to inactivate microorganisms. All the pasteurization processes were performed in triplicate for 10 min, using a cylindrical Pyrex® vessel with a water jacket. The conventional pasteurization was performed at 90 °C using a hot water bath connected to the extraction cell. The US assisted pasteurization was performed using 423 and 508 W cm-2 (75 and 90 % of ultrasound intensity). It is important to mention that during US application the temperature was kept below 35 °C; for this, the water jacket of the extraction cell was connected to a water bath with cold water. MEF assisted pasteurization experiments were performed similarly to US experiments, using 25 and 50 V. Control experiments were performed at the maximum temperature of US and MEF experiments (35 °C) to evaluate only the effect of the aforementioned technologies on the pasteurization. The results showed that phenolic compounds concentration in the juice was not affected by US and MEF application. However, it was observed that the US assisted pasteurization, performed at the highest intensity, decreased anthocyanin content in 33 % (compared to in natura juice). This result was possibly due to the cavitation phenomena, which can lead to free radicals formation and accumulation on the medium; these radicals can react with anthocyanin decreasing the content of these antioxidant compounds in the juice. Physical-chemical parameters did not present statistical differences for samples before and after the treatments. Microbiological analyses results showed that all the pasteurization treatments decreased the microorganism content in two logarithmic cycles. However, as values were lower than 1000 CFU mL-1 it was not possible to verify the efficacy of each treatment. Thus, MEF and US were considered as potential alternative technologies for pasteurization process, once in the right conditions the application of the technologies decreased microorganism content in the juice and did not affected phenolic and anthocyanin content, as well as physical-chemical parameters. However, more studies are needed regarding the influence of MEF and US processes on microorganisms’ inactivation.

Keywords: MEF, microorganism inactivation, anthocyanin, phenolic compounds

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666 Changes of Chemical Composition and Physicochemical Properties of Banana during Ethylene-Induced Ripening

Authors: Chiun-C.R. Wang, Po-Wen Yen, Chien-Chun Huang

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Banana is produced in large quantities in tropical and subtropical areas. Banana is one of the important fruits which constitute a valuable source of energy, vitamins and minerals. The ripening and maturity standards of banana vary from country to country depending on the expected shelf life of market. The compositions of bananas change dramatically during ethylene-induced ripening that are categorized as nutritive values and commercial utilization. Nevertheless, there is few study reporting the changes of physicochemical properties of banana starch during ethylene-induced ripening of green banana. The objectives of this study were to investigate the changes of chemical composition and enzyme activity of banana and physicochemical properties of banana starch during ethylene-induced ripening. Green bananas were harvested and ripened by ethylene gas at low temperature (15℃) for seven stages. At each stage, banana was sliced and freeze-dried for banana flour preparation. The changes of total starch, resistant starch, chemical compositions, physicochemical properties, activity of amylase, polyphenolic oxidase (PPO) and phenylalanine ammonia lyase (PAL) of banana were analyzed each stage during ripening. The banana starch was isolated and analyzed for gelatinization properties, pasting properties and microscopic appearance each stage of ripening. The results indicated that the highest total starch and resistant starch content of green banana were 76.2% and 34.6%, respectively at the harvest stage. Both total starch and resistant starch content were significantly declined to 25.3% and 8.8%, respectively at the seventh stage. Soluble sugars content of banana increased from 1.21% at harvest stage to 37.72% at seventh stage during ethylene-induced ripening. Swelling power of banana flour decreased with the progress of ripening stage, but solubility increased. These results strongly related with the decreases of starch content of banana flour during ethylene-induced ripening. Both water insoluble and alcohol insoluble solids of banana flour decreased with the progress of ripening stage. Both activity of PPO and PAL increased, but the total free phenolics content decreased, with the increases of ripening stages. As ripening stage extended, the gelatinization enthalpy of banana starch significantly decreased from 15.31 J/g at the harvest stage to 10.55 J/g at the seventh stage. The peak viscosity and setback increased with the progress of ripening stages in the pasting properties of banana starch. The highest final viscosity, 5701 RVU, of banana starch slurry was found at the seventh stage. The scanning electron micrograph of banana starch showed the shapes of banana starch appeared to be round and elongated forms, ranging in 10-50 μm at the harvest stage. As the banana closed to ripe status, some parallel striations were observed on the surface of banana starch granular which could be caused by enzyme reaction during ripening. These results inferred that the highest resistant starch was found in the green banana at the harvest stage could be considered as a potential application of healthy foods. The changes of chemical composition and physicochemical properties of banana could be caused by the hydrolysis of enzymes during the ethylene-induced ripening treatment.

Keywords: ethylene-induced ripening, banana starch, resistant starch, soluble sugars, physicochemical properties, gelatinization enthalpy, pasting characteristics, microscopic appearance

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665 Decomposition of the Discount Function Into Impatience and Uncertainty Aversion. How Neurofinance Can Help to Understand Behavioral Anomalies

Authors: Roberta Martino, Viviana Ventre

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Intertemporal choices are choices under conditions of uncertainty in which the consequences are distributed over time. The Discounted Utility Model is the essential reference for describing the individual in the context of intertemporal choice. The model is based on the idea that the individual selects the alternative with the highest utility, which is calculated by multiplying the cardinal utility of the outcome, as if the reception were instantaneous, by the discount function that determines a decrease in the utility value according to how the actual reception of the outcome is far away from the moment the choice is made. Initially, the discount function was assumed to have an exponential trend, whose decrease over time is constant, in line with a profile of a rational investor described by classical economics. Instead, empirical evidence called for the formulation of alternative, hyperbolic models that better represented the actual actions of the investor. Attitudes that do not comply with the principles of classical rationality are termed anomalous, i.e., difficult to rationalize and describe through normative models. The development of behavioral finance, which describes investor behavior through cognitive psychology, has shown that deviations from rationality are due to the limited rationality condition of human beings. What this means is that when a choice is made in a very difficult and information-rich environment, the brain does a compromise job between the cognitive effort required and the selection of an alternative. Moreover, the evaluation and selection phase of the alternative, the collection and processing of information, are dynamics conditioned by systematic distortions of the decision-making process that are the behavioral biases involving the individual's emotional and cognitive system. In this paper we present an original decomposition of the discount function to investigate the psychological principles of hyperbolic discounting. It is possible to decompose the curve into two components: the first component is responsible for the smaller decrease in the outcome as time increases and is related to the individual's impatience; the second component relates to the change in the direction of the tangent vector to the curve and indicates how much the individual perceives the indeterminacy of the future indicating his or her aversion to uncertainty. This decomposition allows interesting conclusions to be drawn with respect to the concept of impatience and the emotional drives involved in decision-making. The contribution that neuroscience can make to decision theory and inter-temporal choice theory is vast as it would allow the description of the decision-making process as the relationship between the individual's emotional and cognitive factors. Neurofinance is a discipline that uses a multidisciplinary approach to investigate how the brain influences decision-making. Indeed, considering that the decision-making process is linked to the activity of the prefrontal cortex and amygdala, neurofinance can help determine the extent to which abnormal attitudes respect the principles of rationality.

Keywords: impatience, intertemporal choice, neurofinance, rationality, uncertainty

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664 Patterns of Change in Specific Behaviors of Autism Symptoms for Boys and for Girls Across Childhood

Authors: Einat Waizbard, Emilio Ferrer, Meghan Miller, Brianna Heath, Derek S. Andrews, Sally J. Rogers, Christine Wu Nordahl, Marjorie Solomon, David G. Amaral

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Background: Autism symptoms are comprised of social-communication deficits and restricted/repetitive behaviors (RRB). The severity of these symptoms can change during childhood, with differences between boys and girls. From the literature, it was found that young autistic girls show a stronger tendency to decrease and a weaker tendency to increase their overall autism symptom severity levels compared to young autistic boys. It is not clear, however, which symptoms are driving these sex differences across childhood. In the current study, we evaluated the trajectories of independent autism symptoms across childhood and compared the patterns of change in such symptoms between boys and girls. Method: The study included 183 children diagnosed with autism (55 girls) evaluated three times across childhood, at ages 3, 6 and 11. We analyzed 22 independent items from the Autism Diagnostic Observation Scheudule-2 (ADOS-2), the gold-standard assessment tool for autism symptoms, each item representing a specific autism symptom. First, we used latent growth curve models to estimate the trajectories for the 22 ADOS-2 items for each child in the study. Second, we extracted the factor scores representing the individual slopes for each ADOS-2 item (i.e., slope representing that child’s change in that specific item). Third, we used factor analysis to identify common patterns of change among the ADOS-2 items, separately for boys and girls, i.e., which autism symptoms tend to change together and which change independently across childhood. Results: The best-emerging patterns for both boys and girls identified four common factors: three factors representative of changes in social-communication symptoms and one factor describing changes in RRB. Boys and girls showed the same pattern of change in RRB, with four items (e.g., speech abnormalities) changing together across childhood and three items (e.g., mannerisms) changing independently of other items. For social-communication deficits in boys, three factors were identified: the first factor included six items representing initiating and engaging in social-communication (e.g., quality of social overtures, conversation), the second factor included five items describing responsive social-communication (e.g., response to name) and the third factor included three items related to different aspects of social-communication (e.g., level of language). Girls’ social-communications deficits also loaded onto three factors: the first factor included five items (e.g., unusual eye contact), the second factor included six items (e.g., quality of social response), and the third factor included four items (e.g., showing). Some items showed similar patterns of change for both sexes (e.g., responsive joint attention), while other items showed differences (e.g., shared enjoyment). Conclusions: Girls and boys had different patterns of change in autism symptom severity across childhood. For RRB, both sexes showed similar patterns. For social-communication symptoms, however, there were both similarities and differences between boys and girls in the way symptoms changed over time. The strongest patterns of change were identified for initiating and engaging in social communication for boys and responsive social communication for girls.

Keywords: autism spectrum disorder, autism symptom severity, symptom trajectories, sex differences

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663 Spatial Analysis and Determinants of Number of Antenatal Health Care Visit Among Pregnant Women in Ethiopia: Application of Spatial Multilevel Count Regression Models

Authors: Muluwerk Ayele Derebe

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Background: Antenatal care (ANC) is an essential element in the continuum of reproductive health care for preventing preventable pregnancy-related morbidity and mortality. Objective: The aim of this study is to assess the spatial pattern and predictors of ANC visits in Ethiopia. Method: This study was done using Ethiopian Demographic and Health Survey data of 2016 among 7,174 pregnant women aged 15-49 years which was a nationwide community-based cross-sectional survey. Spatial analysis was done using Getis-Ord Gi* statistics to identify hot and cold spot areas of ANC visits. Multilevel glmmTMB packages adjusted for spatial effects were used in R software. Spatial multilevel count regression was conducted to identify predictors of antenatal care visits for pregnant women, and proportional change in variance was done to uncover the effect of individual and community-level factors of ANC visits. Results: The distribution of ANC visits was spatially clustered Moran’s I = 0.271, p<.0.001, ICC = 0.497, p<0.001). The highest spatial outlier areas of ANC visit was found in Amhara (South Wollo, Weast Gojjam, North Shewa), Oromo (west Arsi and East Harariga), Tigray (Central Tigray) and Benishangul-Gumuz (Asosa and Metekel) regions. The data was found with excess zeros (34.6%) and over-dispersed. The expected ANC visit of pregnant women with pregnancy complications was higher at 0.7868 [ARR= 2.1964, 95% CI: 1.8605, 2.5928, p-value <0.0001] compared to pregnant women who had no pregnancy complications. The expected ANC visit of a pregnant woman who lived in a rural area was 1.2254 times higher [ARR=3.4057, 95% CI: 2.1462, 5.4041, p-value <0.0001] as compared to a pregnant woman who lived in an urban. The study found dissimilar clusters with a low number of zero counts for a mean number of ANC visits surrounded by clusters with a higher number of counts of an average number of ANC visits when other variables held constant. Conclusion: This study found that the number of ANC visits in Ethiopia had a spatial pattern associated with socioeconomic, demographic, and geographic risk factors. Spatial clustering of ANC visits exists in all regions of Ethiopia. The predictor age of the mother, religion, mother’s education, husband’s education, mother's occupation, husband's occupation, signs of pregnancy complication, wealth index and marital status had a strong association with the number of ANC visits by each individual. At the community level, place of residence, region, age of the mother, sex of the household head, signs of pregnancy complications and distance to health facility factors had a strong association with the number of ANC visits.

Keywords: Ethiopia, ANC, spatial, multilevel, zero inflated Poisson

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662 Newly Designed Ecological Task to Assess Cognitive Map Reading Ability: Behavioral Neuro-Anatomic Correlates of Mental Navigation

Authors: Igor Faulmann, Arnaud Saj, Roland Maurer

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Spatial cognition consists in a plethora of high level cognitive abilities: among them, the ability to learn and to navigate in large scale environments is probably one of the most complex skills. Navigation is thought to rely on the ability to read a cognitive map, defined as an allocentric representation of ones environment. Those representations are of course intimately related to the two geometrical primitives of the environment: distance and direction. Also, many recent studies point to a predominant hippocampal and para-hippocampal role in spatial cognition, as well as in the more specific cluster of navigational skills. In a previous study in humans, we used a newly validated test assessing cognitive map processing by evaluating the ability to judge relative distances and directions: the CMRT (Cognitive Map Recall Test). This study identified in topographically disorientated patients (1) behavioral differences between the evaluation of distances and of directions, and (2) distinct causality patterns assessed via VLSM (i.e., distinct cerebral lesions cause distinct response patterns depending on the modality (distance vs direction questions). Thus, we hypothesized that: (1) if the CMRT really taps into the same resources as real navigation, there would be hippocampal, parahippocampal, and parietal activation, and (2) there exists underlying neuroanatomical and functional differences between the processing of this two modalities. Aiming toward a better understanding of the neuroanatomical correlates of the CMRT in humans, and more generally toward a better understanding of how the brain processes the cognitive map, we adapted the CMRT as an fMRI procedure. 23 healthy subjects (11 women, 12 men), all living in Geneva for at least 2 years, underwent the CMRT in fMRI. Results show, for distance and direction taken together, than the most active brain regions are the parietal, frontal and cerebellar parts. Additionally, and as expected, patterns of brain activation differ when comparing the two modalities. Furthermore, distance processing seems to rely more on parietal regions (compared to other brain regions in the same modality and also to direction). It is interesting to notice that no significant activity was observed in the hippocampal or parahippocampal areas. Direction processing seems to tap more into frontal and cerebellar brain regions (compared to other brain regions in the same modality and also to distance). Significant hippocampal and parahippocampal activity has been shown only in this modality. This results demonstrated a complex interaction of structures which are compatible with response patterns observed in other navigational tasks, thus showing that the CMRT taps at least partially into the same brain resources as real navigation. Additionally, differences between the processing of distances and directions leads to the conclusion that the human brain processes each modality distinctly. Further research should focus on the dynamics of this processing, allowing a clearer understanding between the two sub-processes.

Keywords: cognitive map, navigation, fMRI, spatial cognition

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661 Lessons from Implementation of a Network-Wide Safety Huddle in Behavioral Health

Authors: Deborah Weidner, Melissa Morgera

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The model of care delivery in the Behavioral Health Network (BHN) is integrated across all five regions of Hartford Healthcare and thus spans the entirety of the state of Connecticut, with care provided in seven inpatient settings and over 30 ambulatory outpatient locations. While safety has been a core priority of the BHN in alignment with High Reliability practices, safety initiatives have historically been facilitated locally in each region or within each entity, with interventions implemented locally as opposed to throughout the network. To address this, the BHN introduced a network wide Safety Huddle during 2022. Launched in January, the BHN Safety Huddle brought together internal stakeholders, including medical and administrative leaders, along with executive institute leadership, quality, and risk management. By bringing leaders together and introducing a network-wide safety huddle into the way we work, the benefit has been an increase in awareness of safety events occurring in behavioral health areas as well as increased systemization of countermeasures to prevent future events. One significant discussion topic presented in huddles has pertained to environmental design and patient access to potentially dangerous items, addressing some of the most relevant factors resulting in harm to patients in inpatient and emergency settings for behavioral health patients. The safety huddle has improved visibility of potential environmental safety risks through the generation of over 15 safety alerts cascaded throughout the BHN and also spurred a rapid improvement project focused on standardization of patient belonging searches to reduce patient access to potentially dangerous items on inpatient units. Safety events pertaining to potentially dangerous items decreased by 31% as a result of standardized interventions implemented across the network and as a result of increased awareness. A second positive outcome originating from the BHN Safety Huddle was implementation of a recommendation to increase the emergency Narcan®(naloxone) supply on hand in ambulatory settings of the BHN after incidents involving accidental overdose resulted in higher doses of naloxone administration. By increasing the emergency supply of naloxone on hand in all ambulatory and residential settings, colleagues are better prepared to respond in an emergency situation should a patient experience an overdose while on site. Lastly, discussions in safety huddle spurred a new initiative within the BHN to improve responsiveness to assaultive incidents through a consultation service. This consult service, aligned with one of the network’s improvement priorities to reduce harm events related to assaultive incidents, was borne out of discussion in huddle in which it was identified that additional interventions may be needed in providing clinical care to patients who are experiencing multiple and/ or frequent safety events.

Keywords: quality, safety, behavioral health, risk management

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660 Measurement of Influence of the COVID-19 Pandemic on Efficiency of Japan’s Railway Companies

Authors: Hideaki Endo, Mika Goto

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The global outbreak of the COVID-19 pandemic has seriously affected railway businesses. The number of railway passengers decreased due to the decline in the number of commuters and business travelers to avoid crowded trains and a sharp drop in inbound tourists visiting Japan. This has affected not only railway businesses but also related businesses, including hotels, leisure businesses, and retail businesses at station buildings. In 2021, the companies were divided into profitable and loss-making companies. This division suggests that railway companies, particularly loss-making companies, needed to decrease operational inefficiency. To measure the impact of COVID-19 and discuss the sustainable management strategies of railway companies, we examine the cost inefficiency of Japanese listed railway companies by applying stochastic frontier analysis (SFA) to their operational and financial data. First, we employ the stochastic frontier cost function approach to measure inefficiency. The cost frontier function is formulated as a Cobb–Douglas type, and we estimated parameters and variables for inefficiency. This study uses panel data comprising 26 Japanese-listed railway companies from 2005 to 2020. This period includes several events deteriorating the business environment, such as the financial crisis from 2007 to 2008 and the Great East Japan Earthquake of 2011, and we compare those impacts with those of the COVID-19 pandemic after 2020. Second, we identify the characteristics of the best-practice railway companies and examine the drivers of cost inefficiencies. Third, we analyze the factors influencing cost inefficiency by comparing the profiles of the top 10 railway companies and others before and during the pandemic. Finally, we examine the relationship between cost inefficiency and the implementation of efficiency measures for each railway company. We obtained the following four findings. First, most Japanese railway companies showed the lowest cost inefficiency (most efficient) in 2014 and the highest in 2020 (least efficient) during the COVID-19 pandemic. The second worst occurred in 2009 when it was affected by the financial crisis. However, we did not observe a significant impact of the 2011 Great East Japan Earthquake. This is because no railway company was influenced by the earthquake in this operating area, except for JR-EAST. Second, the best-practice railway companies are KEIO and TOKYU. The main reason for their good performance is that both operate in and near the Tokyo metropolitan area, which is densely populated. Third, we found that non-best-practice companies had a larger decrease in passenger kilometers than best-practice companies. This indicates that passengers made fewer long-distance trips because they refrained from inter-prefectural travel during the pandemic. Finally, we found that companies that implement more efficiency improvement measures had higher cost efficiency and they effectively used their customer databases through proactive DX investments in marketing and asset management.

Keywords: COVID-19 pandemic, stochastic frontier analysis, railway sector, cost efficiency

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659 Effect of Timing and Contributing Factors for Early Language Intervention in Toddlers with Repaired Cleft Lip and Palate

Authors: Pushpavathi M., Kavya V., Akshatha V.

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Introduction: Cleft lip and palate (CLP) is a congenital condition which hinders effectual communication due to associated speech and language difficulties. Expressive language delay (ELD) is a feature seen in this population which is influenced by factors such as type and severity of CLP, age at surgical and linguistic intervention and also the type and intensity of speech and language therapy (SLT). Since CLP is the most common congenital abnormality seen in Indian children, early intervention is a necessity which plays a critical role in enhancing their speech and language skills. The interaction between the timing of intervention and factors which contribute to effective intervention by caregivers is an area which needs to be explored. Objectives: The present study attempts to determine the effect of timing of intervention on the contributing maternal factors for effective linguistic intervention in toddlers with repaired CLP with respect to the awareness, home training patterns, speech and non-speech behaviors of the mothers. Participants: Thirty six toddlers in the age range of 1 to 4 years diagnosed as ELD secondary to repaired CLP, along with their mothers served as participants. Group I (Early Intervention Group, EIG) included 19 mother-child pairs who came to seek SLT soon after corrective surgery and group II (Delayed Intervention Group, DIG) included 16 mother-child pairs who received SLT after the age of 3 years. Further, the groups were divided into group A, and group B. Group ‘A’ received SLT for 60 sessions by Speech Language Pathologist (SLP), while Group B received SLT for 30 sessions by SLP and 30 sessions only by mother without supervision of SLP. Method: The mothers were enrolled for the Early Language Intervention Program and following this, their awareness about CLP was assessed through the Parental awareness questionnaire. The quality of home training was assessed through Mohite’s Inventory. Subsequently, the speech and non-speech behaviors of the mothers were assessed using a Mother’s behavioral checklist. Detailed counseling and orientation was done to the mothers, and SLT was initiated for toddlers. After 60 sessions of intensive SLT, the questionnaire and checklists were re-administered to find out the changes in scores between the pre- and posttest measurements. Results: The scores obtained under different domains in the awareness questionnaire, Mohite’s inventory and Mothers behavior checklist were tabulated and subjected to statistical analysis. Since the data did not follow normal distribution (i.e. p > 0.05), Mann-Whitney U test was conducted which revealed that there was no significant difference between groups I and II as well as groups A and B. Further, Wilcoxon Signed Rank test revealed that mothers had better awareness regarding issues related to CLP and improved home-training abilities post-orientation (p ≤ 0.05). A statistically significant difference was also noted for speech and non-speech behaviors of the mothers (p ≤ 0.05). Conclusions: Extensive orientation and counseling helped mothers of both EI and DI groups to improve their knowledge about CLP. Intensive SLT using focused stimulation and a parent-implemented approach enabled them to carry out the intervention in an effectual manner.

Keywords: awareness, cleft lip and palate, early language intervention program, home training, orientation, timing of intervention

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658 Exploring Nature and Pattern of Mentoring Practices: A Study on Mentees' Perspectives

Authors: Nahid Parween Anwar, Sadia Muzaffar Bhutta, Takbir Ali

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Mentoring is a structured activity which is designed to facilitate engagement between mentor and mentee to enhance mentee’s professional capability as an effective teacher. Both mentor and mentee are important elements of the ‘mentoring equation’ and play important roles in nourishing this dynamic, collaborative and reciprocal relationship. Cluster-Based Mentoring Programme (CBMP) provides an indigenous example of a project which focused on development of primary school teachers in selected clusters with a particular focus on their classroom practice. A study was designed to examine the efficacy of CBMP as part of Strengthening Teacher Education in Pakistan (STEP) project. This paper presents results of one of the components of this study. As part of the larger study, a cross-sectional survey was employed to explore nature and patterns of mentoring process from mentees’ perspectives in the selected districts of Sindh and Balochistan. This paper focuses on the results of the study related to the question: What are mentees’ perceptions of their mentors’ support for enhancing their classroom practice during mentoring process? Data were collected from mentees (n=1148) using a 5-point scale -‘Mentoring for Effective Primary Teaching’ (MEPT). MEPT focuses on seven factors of mentoring: personal attributes, pedagogical knowledge, modelling, feedback, system requirement, development and use of material, and gender equality. Data were analysed using SPSS 20. Mentees perceptions of mentoring practice of their mentors were summarized using mean and standard deviation. Results showed that mean scale scores on mentees’ perceptions of their mentors’ practices fell between 3.58 (system requirement) and 4.55 (personal attributes). Mentees’ perceives personal attribute of the mentor as the most significant factor (M=4.55) towards streamlining mentoring process by building good relationship between mentor and mentees. Furthermore, mentees have shared positive views about their mentors efforts towards promoting gender impartiality (M=4.54) during workshop and follow up visit. Contrary to this, mentees felt that more could have been done by their mentors in sharing knowledge about system requirement (e.g. school policies, national curriculum). Furthermore, some of the aspects in high scoring factors were highlighted by the mentees as areas for further improvement (e.g. assistance in timetabling, written feedback, encouragement to develop learning corners). Mentees’ perceptions of their mentors’ practices may assist in determining mentoring needs. The results may prove useful for the professional development programme for the mentors and mentees for specific mentoring programme in order to enhance practices in primary classrooms in Pakistan. Results would contribute into the body of much-needed knowledge from developing context.

Keywords: cluster-based mentoring programme, mentoring for effective primary teaching (MEPT), professional development, survey

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657 Influence of Iron Content in Carbon Nanotubes on the Intensity of Hyperthermia in the Cancer Treatment

Authors: S. Wiak, L. Szymanski, Z. Kolacinski, G. Raniszewski, L. Pietrzak, Z. Staniszewska

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The term ‘cancer’ is given to a collection of related diseases that may affect any part of the human body. It is a pathological behaviour of cells with the potential to undergo abnormal breakdown in the processes that control cell proliferation, differentiation, and death of particular cells. Although cancer is commonly considered as modern disease, there are beliefs that drastically growing number of new cases can be linked to the extensively prolonged life expectancy and enhanced techniques for cancer diagnosis. Magnetic hyperthermia therapy is a novel approach to cancer treatment, which may greatly contribute to higher efficiency of the therapy. Employing carbon nanotubes as nanocarriers for magnetic particles, it is possible to decrease toxicity and invasiveness of the treatment by surface functionalisation. Despite appearing in recent years, magnetic particle hyperthermia has already become of the highest interest in the scientific and medical environment. The reason why hyperthermia therapy brings so much hope for future treatment of cancer lays in the effect that it produces in malignant cells. Subjecting them to thermal shock results in activation of numerous degradation processes inside and outside the cell. The heating process initiates mechanisms of DNA destruction, protein denaturation and induction of cell apoptosis, which may lead to tumour shrinkage, and in some cases, it may even cause complete disappearance of cancer. The factors which have the major impact on the final efficiency of the treatment include temperatures generated inside the tissues, time of exposure to the heating process, and the character of an individual cancer cell type. The vast majority of cancer cells is characterised by lower pH, persistent hypoxia and lack of nutrients, which can be associated to abnormal microvasculature. Since in healthy tissues we cannot observe presence of these conditions, they should not be seriously affected by elevation of the temperature. The aim of this work is to investigate the influence of iron content in iron filled Carbon Nanotubes on the desired nanoparticles for cancer therapy. In the article, the development and demonstration of the method and the model device for hyperthermic selective destruction of cancer cells are presented. This method was based on the synthesis and functionalization of carbon nanotubes serving as ferromagnetic material nanocontainers. The methodology of the production carbon- ferromagnetic nanocontainers (FNCs) includes the synthesis of carbon nanotubes, chemical, and physical characterization, increasing the content of a ferromagnetic material and biochemical functionalization involving the attachment of the key addresses. The ferromagnetic nanocontainers were synthesised in CVD and microwave plasma system. The research work has been financed from the budget of science as a research project No. PBS2/A5/31/2013.

Keywords: hyperthermia, carbon nanotubes, cancer colon cells, radio frequency field

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656 Experimental Study of Infill Walls with Joint Reinforcement Subjected to In-Plane Lateral Load

Authors: J. Martin Leal-Graciano, Juan J. Pérez-Gavilán, A. Reyes-Salazar, J. H. Castorena, J. L. Rivera-Salas

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The experimental results about the global behavior of twelve 1:2 scaled reinforced concrete frames subject to in-plane lateral load are presented. The main objective was to generate experimental evidence about the use of steel bars within mortar bed joints as shear reinforcement in infill walls. Similar to the Canadian and New Zealand standards, the Mexican code includes specifications for this type of reinforcement. However, these specifications were obtained through experimental studies of load-bearing walls, mainly confined walls. Little information is found in the existing literature about the effects of joint reinforcement on the seismic behavior of infill masonry walls. Consequently, the Mexican code establishes the same equations to estimate the contribution of joint reinforcement for both confined walls and infill walls. Confined masonry construction and a reinforced concrete frame infilled with masonry walls have similar appearances. However, substantial differences exist between these two construction systems, which are mainly related to the sequence of construction and to how these structures support vertical and lateral loads. To achieve the objective established, ten reinforced concrete frames with masonry infill walls were built and tested in pairs, having both specimens in the pair identical characteristics except that one of them included joint reinforcement. The variables between pairs were the type of units, the size of the columns of the frame, and the aspect ratio of the wall. All cases included tie columns and tie beams on the perimeter of the wall to anchor the joint reinforcement. Also, two bare frames with identical characteristics to the infilled frames were tested. The purpose was to investigate the effects of the infill wall on the behavior of the system to in-plane lateral load. In addition, the experimental results were compared with the prediction of the Mexican code. All the specimens were tested in a cantilever under reversible cyclic lateral load. To simulate gravity load, constant vertical load was applied on the top of the columns. The results indicate that the contribution of the joint reinforcement to lateral strength depends on the size of the columns of the frame. Larger size columns produce a failure mode that is predominantly a sliding mode. Sliding inhibits the production of new inclined cracks, which are necessary to activate (deform) the joint reinforcement. Regarding the effects of joint reinforcement in the performance of confined masonry walls, many facts were confirmed for infill walls. This type of reinforcement increases the lateral strength of the wall, produces a more distributed cracking, and reduces the width of the cracks. Moreover, it reduces the ductility demand of the system at maximum strength. The prediction of the lateral strength provided by the Mexican code is a property in some cases; however, the effect of the size of the columns on the contribution of joint reinforcement needs to be better understood.

Keywords: experimental study, infill wall, infilled frame, masonry wall

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655 A Critical Analysis of the Current Concept of Healthy Eating and Its Impact on Food Traditions

Authors: Carolina Gheller Miguens

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Feeding is, and should be, pleasurable for living beings so they desire to nourish themselves while preserving the continuity of the species. Social rites usually revolve around the table and are closely linked to the cultural traditions of each region and social group. Since the beginning, food has been closely linked with the products each region provides, and, also, related to the respective seasons of production. With the globalization and facilities of modern life we are able to find an ever increasing variety of products at any time of the year on supermarket shelves. These lifestyle changes end up directly influencing food traditions. With the era of uncontrolled obesity caused by the dazzle with the large and varied supply of low-priced to ultra-processed industrial products now in the past, today we are living a time when people are putting aside the pleasure of eating to exclusively eat food dictated by the media as healthy. Recently the medicalization of food in our society has become so present in daily life that almost without realizing we make food choices conditioned to the studies of the properties of these foods. The fact that people are more attentive to their health is interesting. However, when this care becomes an obsessive disorder, which imposes itself on the pleasure of eating and extinguishes traditional customs, it becomes dangerous for our recognition as citizens belonging to a culture and society. This new way of living generates a rupture with the social environment of origin, possibly exposing old traditions to oblivion after two or three generations. Based on these facts, the presented study analyzes these social transformations that occur in our society that triggered the current medicalization of food. In order to clarify what is actually a healthy diet, this research proposes a critical analysis on the subject aiming to understand nutritional rationality and relate how it acts in the medicalization of food. A wide bibliographic review on the subject was carried out followed by an exploratory research in online (especially social) media, a relevant source in this context due to the perceived influence of such media in contemporary eating habits. Finally, this data was crossed, critically analyzing the current situation of the concept of healthy eating and medicalization of food. Throughout this research, it was noticed that people are increasingly seeking information about the nutritional properties of food, but instead of seeking the benefits of products that traditionally eat in their social environment, they incorporate external elements that often bring benefits similar to the food already consumed. This is because the access to information is directed by the media and exalts the exotic, since this arouses more interest of the population in general. Efforts must be made to clarify that traditional products are also healthy foods, rich in history, memory and tradition and cannot be replaced by a standardized diet little concerned with the construction of taste and pleasure, having a relationship with food as if it were a Medicinal product.

Keywords: food traditions, food transformations, healthy eating, medicalization of food

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654 Functional Switching of Serratia marcescens Transcriptional Regulator from Activator to Inhibitor of Quorum Sensing by Exogenous Addition

Authors: Norihiro Kato, Yuriko Takayama

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Some gram-negative bacteria enable the simultaneous activation of gene expression involved in N-acylhomoserine lactone (AHL) dependent cell-to-cell communication system. Such regulatory system for the bacterial group behavior is termed as quorum sensing (QS) because a diffusible AHL signal can accumulate around the cell during the increase of the cell density and trigger activation of the sequential QS process. By blocking the QS, the expression of diverse genes related to infection, antibiotic production, and biofilm formation is inhibited. Conditioning of QS by regulation of the DNA-receptor-AHL interaction is a potential target for enhancing host defenses against pathogenicity. We focused on engineered application of transcriptional regulator SpnR produced in opportunistic human pathogen Serratia marcescens. The SpnR can interact with AHL signals at an N-terminal domain and also with a promoter region of a QS target gene at a C-terminal domain. As the initial process of the QS activation, the SpnR forms a complex with the AHL to enhance the expression of pig cluster; the SpnR normally acts as an activator for the expression of the QS-dependent gene. In this research, we attempt to artificially control QS by changing the role of SpnR. The QS-dependent prodigiosin production is expected to inhibit by externally added SpnR in the culture broth of AS-1 strain because the AHL concentration was kept below the threshold by AHL-SpnR complex formation. Maltose-binding protein (MBP)-tagged SpnR (MBP-SpnR) was overexpressed in Escherichia coli and purified using an affinity chromatography equipped with an amylose resin column. The specific interaction between AHL and MBP-SpnR was demonstrated by quartz crystal microbalance (QCM) sensor. AHL with amino end-group was coupled with COOH-terminated self-assembled monolayer prepared on a gold electrode of 27-MHz quartz crystal sensor using water-soluble carbodiimide. After the injection of MBP-SpnR into a cup-type sensor cell filled with the buffer solution, time course of resonant frequency change (ΔFs) was determined. A decrease of ΔFs clearly showed the uptake of MBP-SpnR onto the AHL-immobilized electrode. Furthermore, no binding affinity was observed after the heat-inactivation of MBP-SpnR at 80ºC. These results suggest that MBP-SpnR possesses a specific affinity for AHL. MBP-SpnR was added to the culture medium as an AHL trap to study inhibitory effects on intracellularly accumulated prodigiosin. With approximately 2 µM MBP-SpnR, the amount of prodigiosin induced was half that of the control without any additives. In conclusion, the function of SpnR could be switched by adding it to the cell culture. Exogenously added MBP-SpnR possesses high affinity for AHL derived from cells and acts as an inhibitor of AHL-mediated QS.

Keywords: intracellular signaling, microbial biotechnology, quorum sensing, transcriptional regulator

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653 Aerosol Chemical Composition in Urban Sites: A Comparative Study of Lima and Medellin

Authors: Guilherme M. Pereira, Kimmo Teinïla, Danilo Custódio, Risto Hillamo, Célia Alves, Pérola de C. Vasconcellos

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South American large cities often present serious air pollution problems and their atmosphere composition is influenced by a variety of emissions sources. The South American Emissions Megacities, and Climate project (SAEMC) has focused on the study of emissions and its influence on climate in the South American largest cities and it also included Lima (Peru) and Medellin (Colombia), sites where few studies of the genre were done. Lima is a coastal city with more than 8 million inhabitants and the second largest city in South America. Medellin is a 2.5 million inhabitants city and second largest city in Colombia; it is situated in a valley. The samples were collected in quartz fiber filters in high volume samplers (Hi-Vol), in 24 hours of sampling. The samples were collected in intensive campaigns in both sites, in July, 2010. Several species were determined in the aerosol samples of Lima and Medellin. Organic and elemental carbon (OC and EC) in thermal-optical analysis; biomass burning tracers (levoglucosan - Lev, mannosan - Man and galactosan - Gal) in high-performance anion exchange ion chromatography with mass spectrometer detection; water soluble ions in ion chromatography. The average particulate matter was similar for both campaigns, the PM10 concentrations were above the recommended by World Health Organization (50 µg m⁻³ – daily limit) in 40% of the samples in Medellin, while in Lima it was above that value in 15% of the samples. The average total ions concentration was higher in Lima (17450 ng m⁻³ in Lima and 3816 ng m⁻³ in Medellin) and the average concentrations of sodium and chloride were higher in this site, these species also had better correlations (Pearson’s coefficient = 0,63); suggesting a higher influence of marine aerosol in the site due its location in the coast. Sulphate concentrations were also much higher at Lima site; which may be explained by a higher influence of marine originated sulphate. However, the OC, EC and monosaccharides average concentrations were higher at Medellin site; this may be due to the lower dispersion of pollutants due to the site’s location and a larger influence of biomass burning sources. The levoglucosan average concentration was 95 ng m⁻³ for Medellin and 16 ng m⁻³ and OC was well correlated with levoglucosan (Pearson’s coefficient = 0,86) in Medellin; suggesting a higher influence of biomass burning over the organic aerosol in this site. The Lev/Man ratio is often related to the type of biomass burned and was close to 18, similar to the observed in previous studies done at biomass burning impacted sites in the Amazon region; backward trajectories also suggested the transport of aerosol from that region. Biomass burning appears to have a larger influence on the air quality in Medellin, in addition the vehicular emissions; while Lima showed a larger influence of marine aerosol during the study period.

Keywords: aerosol transport, atmospheric particulate matter, biomass burning, SAEMC project

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652 Devulcanization of Waste Rubber Using Thermomechanical Method Combined with Supercritical CO₂

Authors: L. Asaro, M. Gratton, S. Seghar, N. Poirot, N. Ait Hocine

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Rubber waste disposal is an environmental problem. Particularly, many researches are centered in the management of discarded tires. In spite of all different ways of handling used tires, the most common is to deposit them in a landfill, creating a stock of tires. These stocks can cause fire danger and provide ambient for rodents, mosquitoes and other pests, causing health hazards and environmental problems. Because of the three-dimensional structure of the rubbers and their specific composition that include several additives, their recycling is a current technological challenge. The technique which can break down the crosslink bonds in the rubber is called devulcanization. Strictly, devulcanization can be defined as a process where poly-, di-, and mono-sulfidic bonds, formed during vulcanization, are totally or partially broken. In the recent years, super critical carbon dioxide (scCO₂) was proposed as a green devulcanization atmosphere. This is because it is chemically inactive, nontoxic, nonflammable and inexpensive. Its critical point can be easily reached (31.1 °C and 7.38 MPa), and residual scCO₂ in the devulcanized rubber can be easily and rapidly removed by releasing pressure. In this study thermomechanical devulcanization of ground tire rubber (GTR) was performed in a twin screw extruder under diverse operation conditions. Supercritical CO₂ was added in different quantities to promote the devulcanization. Temperature, screw speed and quantity of CO₂ were the parameters that were varied during the process. The devulcanized rubber was characterized by its devulcanization percent and crosslink density by swelling in toluene. Infrared spectroscopy (FTIR) and Gel permeation chromatography (GPC) were also done, and the results were related with the Mooney viscosity. The results showed that the crosslink density decreases as the extruder temperature and speed increases, and, as expected, the soluble fraction increase with both parameters. The Mooney viscosity of the devulcanized rubber decreases as the extruder temperature increases. The reached values were in good correlation (R= 0.96) with de the soluble fraction. In order to analyze if the devulcanization was caused by main chains or crosslink scission, the Horikx's theory was used. Results showed that all tests fall in the curve that corresponds to the sulfur bond scission, which indicates that the devulcanization has successfully happened without degradation of the rubber. In the spectra obtained by FTIR, it was observed that none of the characteristic peaks of the GTR were modified by the different devulcanization conditions. This was expected, because due to the low sulfur content (~1.4 phr) and the multiphasic composition of the GTR, it is very difficult to evaluate the devulcanization by this technique. The lowest crosslink density was reached with 1 cm³/min of CO₂, and the power consumed in that process was also near to the minimum. These results encourage us to do further analyses to better understand the effect of the different conditions on the devulcanization process. The analysis is currently extended to monophasic rubbers as ethylene propylene diene monomer rubber (EPDM) and natural rubber (NR).

Keywords: devulcanization, recycling, rubber, waste

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651 Impact of U.S. Insurance Reimbursement Policy on Healthcare Business and Entrepreneurship

Authors: Iris Xiaohong Quan, Sharon Qi, Kelly Tianqin Shi

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This study focuses on the critical role of insurance policies in a world grappling with increasing mental health challenges, as they significantly influence the dynamics of healthcare businesses and entrepreneurial ventures. The paper utilizes the mental health sector as a case to examine the impact of insurance policies on healthcare service providers, entrepreneurs, and individuals seeking mental health support. This paper addressed the following research questions: To what extent do changes in insurance reimbursement policies affect the accessibility and affordability of mental health services for patients, and how does this impact the overall demand for such services? What are the barriers and opportunities that mental health entrepreneurs face and what strategies and adaptations do mental health businesses employ when navigating the evolving landscape of insurance reimbursement policies? How do changes in insurance reimbursement policies, specifically related to mental health services, influence the financial viability and sustainability of mental health clinics and private practices? Employing a self-designed survey aimed at autism spectrum disorder (ASD) treatment companies, alongside two in-depth case studies and an analysis of pertinent insurance policies and documents, this research aims to elucidate the multifaceted influence of insurance policies on the mental health industry. The findings from this study reveal how insurance policies shape the landscape of mental health businesses and their operations. A total of 821 autism treatment organizations or offices were contacted by telephone between November 1, 2019, and January 31, 2020. About half of the offices (53.33%) were established in the past five years, and 80% were established in the past 15 years. There is a significant increase in the establishment of ABA service centers in the recent two decades as a result of autism insurance reform, the increasing social awareness of ASD, and the redefinition of autism. In addition, almost half of the ABA service providers we surveyed had a patient size ranging from 20 to 50 in the year when the residence state passed the legislation for autism insurance coverage. On average, an ABA service provider works with 5.3 insurance companies. This research find that insurance is the main source of revenue for most ABA service providers. However, our survey reveals that clients’ out of pocket payment has been the second main revenue sources. Despite the changes of regulations and insurance policies in all states, clients still have to pay a fraction of, if not all, the ABA treatment service fees out of pocket. This research shows that some ABA service providers seek federal and government funds and grants to support their services and businesses. Our further analysis with the in-depth case studies and other secondary data also indicate the rise of entrepreneurial startups in the mental health industry. Overall, this research sheds light on both the challenges and opportunities presented by insurance policies in the mental health sector, offering insights into the new industry landscape.

Keywords: entrepreneurship, healthcare policy, insurance policy, mental health industry

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