Search results for: model order selection
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 28267

Search results for: model order selection

547 Admissibility as a Property of Evidence in Modern Conditions

Authors: Iryna Teslenko

Abstract:

According to the provisions of the current criminal procedural legislation of Ukraine, the issue of admissibility of evidence is closely related to both the right to a fair trial and the presumption of innocence. The general rule is that evidence obtained improperly or illegally cannot be taken into account in a court case. Therefore, the evidence base of the prosecution, collected at the stage of the pre-trial investigation, compliance with the requirements of the law during the collection of evidence, is of crucial importance for the criminal process, the violation of which entails the recognition of the relevant evidence as inadmissible, which can nullify all the efforts of the pre-trial investigation body and the prosecution. Therefore, the issue of admissibility of evidence in criminal proceedings is fundamentally important and decisive for the entire process. Research on this issue began in December 2021. At that time, there was still no clear understanding of what needed to be conveyed to the scientific community. In February 2022, the lives of all citizens of Ukraine have totally changed. A war broke out in the country. At a time when the entire world community is on the path of humanizing society, respecting the rights and freedoms of man and citizen, a military conflict has arisen in the middle of Europe - one country attacked another, war crimes are being committed. The world still cannot believe it, but it is happening here and now, people are dying, infrastructure is being destroyed, war crimes are being committed, contrary to the signed and ratified international conventions, and contrary to all the acquisitions and development of world law. At this time, the life of the world has divided into before and after February 24, 2022, the world cannot be the same as it was before, and the approach to solving legal issues in the criminal process, in particular, issues of proving the commission of crimes and the involvement of certain persons in their commission. An international criminal has appeared in the humane European world, who disregards all norms of law and morality, and does not adhere to any principles. Until now, the practice of the European Court of Human Rights and domestic courts of Ukraine treated with certain formalism, such a property of evidence in criminal proceedings as the admissibility of evidence. Currently, we have information that the Office of the Prosecutor of the International Criminal Court in The Hague has started an investigation into war crimes in Ukraine and is documenting them. In our opinion, the world cannot allow formalism in bringing a war criminal to justice. There is a war going on in Ukraine, the cities are under round-the-clock missile fire from the aggressor country, which makes it impossible to carry out certain investigative actions. If due to formal deficiencies, the collected evidence is declared inadmissible, it may lead to the fact that the guilty people will not be punished. And this, in turn, sends a message to other terrorists in the world about the impunity of their actions, the system of deterring criminals from committing criminal offenses (crimes) will collapse due to the understanding of the inevitability of punishment, and this will affect the entire world security and European security in particular. Therefore, we believe that the world cannot allow chaos in the issue of general security, there should be a transformation of the approach in general to such a property of evidence in the criminal process as admissibility in order to ensure the inevitability of the punishment of criminals. We believe that the scientific and legal community should not allow criminals to avoid responsibility. The evil that is destroying Ukraine should be punished. We must all together prove that legal norms are not just words written on paper but rules of behavior of all members of society, their non-observance leads to mandatory responsibility. Everybody who commits crimes will be punished, which is inevitable, and this principle is the guarantor of world security in the future.

Keywords: admissibility of evidence, criminal process, war, Ukraine

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546 The Role of Piceatannol in Counteracting Glyceraldehyde-3-Phosphate Dehydrogenase Aggregation and Nuclear Translocation

Authors: Joanna Gerszon, Aleksandra Rodacka

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In the pathogenesis of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, protein and peptide aggregation processes play a vital role in contributing to the formation of intracellular and extracellular protein deposits. One of the major components of these deposits is the oxidatively modified glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Therefore, the purpose of this research was to answer the question whether piceatannol, a stilbene derivative, counteracts and/or slows down oxidative stress-induced GAPDH aggregation. The study also aimed to determine if this natural occurring compound prevents unfavorable nuclear translocation of GAPDH in hippocampal cells. The isothermal titration calorimetry (ITC) analysis indicated that one molecule of GAPDH can bind up to 8 molecules of piceatannol (7.3 ± 0.9). As a consequence of piceatannol binding to the enzyme, the loss of activity was observed. Parallel with GAPDH inactivation the changes in zeta potential, and loss of free thiol groups were noted. Nevertheless, the ligand-protein binding does not influence the secondary structure of the GAPDH. Precise molecular docking analysis of the interactions inside the active center allowed to presume that these effects are due to piceatannol ability to assemble a covalent binding with nucleophilic cysteine residue (Cys149) which is directly involved in the catalytic reaction. Molecular docking also showed that simultaneously 11 molecules of ligand can be bound to dehydrogenase. Taking into consideration obtained data, the influence of piceatannol on level of GAPDH aggregation induced by excessive oxidative stress was examined. The applied methods (thioflavin-T binding-dependent fluorescence as well as microscopy methods - transmission electron microscopy, Congo Red staining) revealed that piceatannol significantly diminishes level of GAPDH aggregation. Finally, studies involving cellular model (Western blot analyses of nuclear and cytosolic fractions and confocal microscopy) indicated that piceatannol-GAPDH binding prevents GAPDH from nuclear translocation induced by excessive oxidative stress in hippocampal cells. In consequence, it counteracts cell apoptosis. These studies demonstrate that by binding with GAPDH, piceatannol blocks cysteine residue and counteracts its oxidative modifications, that induce oligomerization and GAPDH aggregation as well as it prevents hippocampal cells from apoptosis by retaining GAPDH in the cytoplasm. All these findings provide a new insight into the role of piceatannol interaction with GAPDH and present a potential therapeutic strategy for some neurological disorders related to GAPDH aggregation. This work was supported by the by National Science Centre, Poland (grant number 2017/25/N/NZ1/02849).

Keywords: glyceraldehyde-3-phosphate dehydrogenase, neurodegenerative disease, neuroprotection, piceatannol, protein aggregation

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545 Glycemic Control in Rice Consumption among Households with Diabetes Patients: The Role of Food Security

Authors: Chandanee Wasana Kalansooriya

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Dietary behaviour is a crucial factor affecting diabetes control. With increasing rates of diabetes prevalence in Asian countries, examining their dietary patterns, which are largely based on rice, is timely required. It has been identified that higher consumption of some rice varieties is associated with increased risk of type 2 diabetes. Although diabetes patients are advised to consume healthier rice varieties, which contains low glycemic, several conditions, one of which food insecurity, make them difficult to preserve those healthy dietary guidelines. Hence this study tries to investigate how food security affects on making right decisions of rice consumption within diabetes affected households using a sample from Sri Lanka, a country which rice considered as the staple food and records the highest diabetes prevalence rate in South Asia. The study uses data from the Household Income and Expenditure Survey 2016, a nationally representative sample conducted by the Department of Census and Statistics, Sri Lanka. The survey used a two-stage stratified sampling method to cover different sectors and districts of the country and collected micro-data on demographics, health, income and expenditures of different categories. The study uses data from 2547 households which consist of one or more diabetes patients, based on the self-recorded health status. The Household Dietary Diversity Score (HDDS), which constructed based on twelve food groups, is used to measure the level of food security. Rice is categorized into three groups according to their Glycemic Index (GI), high GI, medium GI and low GI, and the likelihood and impact made by food security on each rice consumption categories are estimated using a Two-part Model. The shares of each rice categories out of total rice consumption is considered as the dependent variable to exclude the endogeneity issue between rice consumption and the HDDS. The results indicate that the consumption of medium GI rice is likely to increase with the increasing household food security, but low GI varieties are not. Households in rural and estate sectors are less likely and Tamil ethnic group is more likely to consume low GI rice varieties. Further, an increase in food security significantly decreases the consumption share of low GI rice, while it increases the share of medium GI varieties. The consumption share of low GI rice is largely affected by the ethnic variability. The effects of food security on the likelihood of consuming high GI rice varieties and changing its shares are statistically insignificant. Accordingly, the study concludes that a higher level of food security does not ensure diabetes patients are consuming healthy rice varieties or reducing consumption of unhealthy varieties. Hence policy attention must be directed towards educating people for making healthy dietary choices. Further, the study provides a room for further studies as it reveals considerable ethnic and sectorial differences in making healthy dietary decisions.

Keywords: diabetes, food security, glycemic index, rice consumption

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544 Impact of Experiential Learning on Executive Function, Language Development, and Quality of Life for Adults with Intellectual and Developmental Disabilities (IDD)

Authors: Mary Deyo, Zmara Harrison

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This study reports the outcomes of an 8-week experiential learning program for 6 adults with Intellectual and Developmental Disabilities (IDD) at a day habilitation program. The intervention foci for this program include executive function, language learning in the domains of expressive, receptive, and pragmatic language, and quality of life. The interprofessional collaboration aimed at supporting adults with IDD to reach person-centered, functional goals across skill domains is critical. This study is a significant addition to the speech-language pathology literature in that it examines a therapy method that potentially meets this need while targeting domains within the speech-language pathology scope of practice. Communication therapy was provided during highly valued and meaningful hands-on learning experiences, referred to as the Garden Club, which incorporated all aspects of planting and caring for a garden as well as related journaling, sensory, cooking, art, and technology-based activities. Direct care staff and an undergraduate research assistant were trained by SLP to be impactful language guides during their interactions with participants in the Garden Club. SLP also provided direct therapy and modeling during Garden Club. Research methods used in this study included a mixed methods analysis of a literature review, a quasi-experimental implementation of communication therapy in the context of experiential learning activities, Quality of Life participant surveys, quantitative pre- post- data collection and linear mixed model analysis, qualitative data collection with qualitative content analysis and coding for themes. Outcomes indicated overall positive changes in expressive vocabulary, following multi-step directions, sequencing, problem-solving, planning, skills for building and maintaining meaningful social relationships, and participant perception of the Garden Project’s impact on their own quality of life. Implementation of this project also highlighted supports and barriers that must be taken into consideration when planning similar projects. Overall findings support the use of experiential learning projects in day habilitation programs for adults with IDD, as well as additional research to deepen understanding of best practices, supports, and barriers for implementation of experiential learning with this population. This research provides an important contribution to research in the fields of speech-language pathology and other professions serving adults with IDD by describing an interprofessional experiential learning program with positive outcomes for executive function, language learning, and quality of life.

Keywords: experiential learning, adults, intellectual and developmental disabilities, expressive language, receptive language, pragmatic language, executive function, communication therapy, day habilitation, interprofessionalism, quality of life

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543 Gender Differences in Morbid Obese Children: Clinical Significance of Two Diagnostic Obesity Notation Model Assessment Indices

Authors: Mustafa M. Donma, Orkide Donma, Murat Aydin, Muhammet Demirkol, Burcin Nalbantoglu, Aysin Nalbantoglu, Birol Topcu

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Childhood obesity is an ever increasing global health problem, affecting both developed and developing countries. Accurate evaluation of obesity in children requires difficult and detailed investigation. In our study, obesity in children was evaluated using new body fat ratios and indices. Assessment of anthropometric measurements, as well as some ratios, is important because of the evaluation of gender differences particularly during the late periods of obesity. A total of 239 children; 168 morbid obese (MO) (81 girls and 87 boys) and 71 normal weight (NW) (40 girls and 31 boys) children, participated in the study. Informed consent forms signed by the parents were obtained. Ethics Committee approved the study protocol. Mean ages (years)±SD calculated for MO group were 10.8±2.9 years in girls and 10.1±2.4 years in boys. The corresponding values for NW group were 9.0±2.0 years in girls and 9.2±2.1 years in boys. Mean body mass index (BMI)±SD values for MO group were 29.1±5.4 kg/m2 and 27.2±3.9 kg/m2 in girls and boys, respectively. These values for NW group were calculated as 15.5±1.0 kg/m2 in girls and 15.9±1.1 kg/m2 in boys. Groups were constituted based upon BMI percentiles for age-and-sex values recommended by WHO. Children with percentiles >99 were grouped as MO and children with percentiles between 85 and 15 were considered NW. The anthropometric measurements were recorded and evaluated along with the new ratios such as trunk-to-appendicular fat ratio, as well as indices such as Index-I and Index-II. The body fat percent values were obtained by bio-electrical impedance analysis. Data were entered into a database for analysis using SPSS/PASW 18 Statistics for Windows statistical software. Increased waist-to-hip circumference (C) ratios, decreased head-to-neck C, height ‘to’ ‘two’-‘to’-waist C and height ‘to’ ‘two’-‘to’-hip C ratios were observed in parallel with the development of obesity (p≤0.001). Reference value for height ‘to’ ‘two’-‘to’-hip ratio was detected as approximately 1.0. Index-II, based upon total body fat mass, showed much more significant differences between the groups than Index-I based upon weight. There was not any difference between trunk-to-appendicular fat ratios of NW girls and NW boys (p≥0.05). However, significantly increased values for MO girls in comparison with MO boys were observed (p≤0.05). This parameter showed no difference between NW and MO states in boys (p≥0.05). However, statistically significant increase was noted in MO girls compared to their NW states (p≤0.001). Trunk-to-appendicular fat ratio was the only fat-based parameter, which showed gender difference between NW and MO groups. This study has revealed that body ratios and formula based upon body fat tissue are more valuable parameters than those based on weight and height values for the evaluation of morbid obesity in children.

Keywords: anthropometry, childhood obesity, gender, morbid obesity

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542 Advancing Equitable Healthcare for Trans and Gender-Diverse Students: A Community-Based Participatory Action Project

Authors: Al Huuskonen, Clio Lake, K. M. Naude, Polina Petlitsyna, Sorsha Henning, Julia Wimmers-Klick

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This project presents the outcomes of a community-based participatory action initiative aimed at advocating for equitable healthcare and human rights for trans, two-spirit, and gender-diverse individuals, building upon the University of British Columbia (UBC) Trans Coalition's ongoing efforts. Participatory Action Research (PAR) was chosen as the research method with the goal of improving trans rights on the UBC campus, particularly regarding equitable access to healthcare. PAR involves active community contribution throughout the research process, which in this case was done by way of liaising with student resource groups and advocacy leaders. The goals of this project were as follows: a) identify gaps in gender-affirming healthcare for UBC students by consulting the community and collaborating with UBC services, b) develop an information package outlining provincial and university-based health insurance for gender-affirming care (including hormone therapy and surgeries), FAQs, and resources for UBC's trans students, c) make this package available to UBC students and other national transgender advocacy organizations. The initiative successfully expanded the UBC AMS Student Health and Dental Plan to include gender-affirming procedural coverage, developed a care access guide for students, and advocated for improved health records inclusivity, mechanisms for trans students to report negative care experiences, and increased access to gender-affirming primary care through the on-campus health clinic. Collaboration with other universities' pride organizations and Trans Care BC yielded positive outcomes through broader coalition building and resource sharing. Ongoing efforts are underway to update provincial policies, particularly through expanding coverage under fair pharma care and addressing the compounding effects of the primary care crisis for trans individuals. The project's tangible results include improved trans rights on campus, especially in terms of healthcare access. Expanding healthcare coverage through student care benefits thousands of students, making the ability to undergo important affirming procedures more affordable. Providing students with information on extended coverage options and communication with their doctors further removes barriers to care and positively impacts student wellbeing. This initiative demonstrates the effectiveness of community-based participatory action in advancing equitable healthcare for trans and gender-diverse individuals and serves as a model for other institutions and organizations striving to promote inclusivity and advocate for marginalized populations' rights.

Keywords: equitable healthcare, trans and gender-diverse individuals, inclusivity, participatory action research project

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541 Calpoly Autonomous Transportation Experience: Software for Driverless Vehicle Operating on Campus

Authors: F. Tang, S. Boskovich, A. Raheja, Z. Aliyazicioglu, S. Bhandari, N. Tsuchiya

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Calpoly Autonomous Transportation Experience (CATE) is a driverless vehicle that we are developing to provide safe, accessible, and efficient transportation of passengers throughout the Cal Poly Pomona campus for events such as orientation tours. Unlike the other self-driving vehicles that are usually developed to operate with other vehicles and reside only on the road networks, CATE will operate exclusively on walk-paths of the campus (potentially narrow passages) with pedestrians traveling from multiple locations. Safety becomes paramount as CATE operates within the same environment as pedestrians. As driverless vehicles assume greater roles in today’s transportation, this project will contribute to autonomous driving with pedestrian traffic in a highly dynamic environment. The CATE project requires significant interdisciplinary work. Researchers from mechanical engineering, electrical engineering and computer science are working together to attack the problem from different perspectives (hardware, software and system). In this abstract, we describe the software aspects of the project, with a focus on the requirements and the major components. CATE shall provide a GUI interface for the average user to interact with the car and access its available functionalities, such as selecting a destination from any origin on campus. We have developed an interface that provides an aerial view of the campus map, the current car location, routes, and the goal location. Users can interact with CATE through audio or manual inputs. CATE shall plan routes from the origin to the selected destination for the vehicle to travel. We will use an existing aerial map for the campus and convert it to a spatial graph configuration where the vertices represent the landmarks and edges represent paths that the car should follow with some designated behaviors (such as stay on the right side of the lane or follow an edge). Graph search algorithms such as A* will be implemented as the default path planning algorithm. D* Lite will be explored to efficiently recompute the path when there are any changes to the map. CATE shall avoid any static obstacles and walking pedestrians within some safe distance. Unlike traveling along traditional roadways, CATE’s route directly coexists with pedestrians. To ensure the safety of the pedestrians, we will use sensor fusion techniques that combine data from both lidar and stereo vision for obstacle avoidance while also allowing CATE to operate along its intended route. We will also build prediction models for pedestrian traffic patterns. CATE shall improve its location and work under a GPS-denied situation. CATE relies on its GPS to give its current location, which has a precision of a few meters. We have implemented an Unscented Kalman Filter (UKF) that allows the fusion of data from multiple sensors (such as GPS, IMU, odometry) in order to increase the confidence of localization. We also noticed that GPS signals can easily get degraded or blocked on campus due to high-rise buildings or trees. UKF can also help here to generate a better state estimate. In summary, CATE will provide on-campus transportation experience that coexists with dynamic pedestrian traffic. In future work, we will extend it to multi-vehicle scenarios.

Keywords: driverless vehicle, path planning, sensor fusion, state estimate

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540 Scale up of Isoniazid Preventive Therapy: A Quality Management Approach in Nairobi County, Kenya

Authors: E. Omanya, E. Mueni, G. Makau, M. Kariuki

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HIV infection is the strongest risk factor for a person to develop TB. Isoniazid preventive therapy (IPT) for People Living with HIV (PLWHIV) not only reduces the individual patients’ risk of developing active TB but mitigates cross infection. In Kenya, IPT for six months was recommended through the National TB, Leprosy and Lung Disease Program to treat latent TB. In spite of this recommendation by the national government, uptake of IPT among PLHIV remained low in Kenya by the end of 2015. The USAID/Kenya and East Africa Afya Jijini project, which supports 42 TBHIV health facilities in Nairobi County, began addressing low uptake of IPT through Quality Improvement (QI) teams set up at the facility level. Quality is characterized by WHO as one of the four main connectors between health systems building blocks and health systems outputs. Afya Jijini implements the Kenya Quality Model for Health, which involves QI teams being formed at the county, sub-county and facility levels. The teams review facility performance to identify gaps in service delivery and use QI tools to monitor and improve performance. Afya Jijini supported the formation of these teams in 42 facilities and built the teams’ capacity to review data and use QI principles to identify and address performance gaps. When the QI teams began working on improving IPT uptake among PLHIV, uptake was at 31.8%. The teams first conducted a root cause analysis using cause and effect diagrams, which help the teams to brainstorm on and to identify barriers to IPT uptake among PLHIV at the facility level. This is a participatory process where program staff provides technical support to the QI teams in problem identification and problem-solving. The gaps identified were inadequate knowledge and skills on the use of IPT among health care workers, lack of awareness of IPT by patients, inadequate monitoring and evaluation tools, and poor quantification and forecasting of IPT commodities. In response, Afya Jijini trained over 300 health care workers on the administration of IPT, supported patient education, supported quantification and forecasting of IPT commodities, and provided IPT data collection tools to help facilities monitor their performance. The facility QI teams conducted monthly meetings to monitor progress on implementation of IPT and took corrective action when necessary. IPT uptake improved from 31.8% to 61.2% during the second year of the Afya Jijini project and improved to 80.1% during the third year of the project’s support. Use of QI teams and root cause analysis to identify and address service delivery gaps, in addition to targeted program interventions and continual performance reviews, can be successful in increasing TB related service delivery uptake at health facilities.

Keywords: isoniazid, quality, health care workers, people leaving with HIV

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539 Enhancing of Antibacterial Activity of Essential Oil by Rotating Magnetic Field

Authors: Tomasz Borowski, Dawid Sołoducha, Agata Markowska-Szczupak, Aneta Wesołowska, Marian Kordas, Rafał Rakoczy

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Essential oils (EOs) are fragrant volatile oils obtained from plants. These are used for cooking (for flavor and aroma), cleaning, beauty (e.g., rosemary essential oil is used to promote hair growth), health (e.g. thyme essential oil cures arthritis, normalizes blood pressure, reduces stress on the heart, cures chest infection and cough) and in the food industry as preservatives and antioxidants. Rosemary and thyme essential oils are considered the most eminent herbs based on their history and medicinal properties. They possess a wide range of activity against different types of bacteria and fungi compared with the other oils in both in vitro and in vivo studies. However, traditional uses of EOs are limited due to rosemary and thyme oils in high concentrations can be toxic. In light of the accessible data, the following hypothesis was put forward: Low frequency rotating magnetic field (RMF) increases the antimicrobial potential of EOs. The aim of this work was to investigate the antimicrobial activity of commercial Salvia Rosmarinus L. and Thymus vulgaris L. essential oil from Polish company Avicenna-Oil under Rotating Magnetic Field (RMF) at f = 25 Hz. The self-constructed reactor (MAP) was applied for this study. The chemical composition of oils was determined by gas chromatography coupled with mass spectrometry (GC-MS). Model bacteria Escherichia coli K12 (ATCC 25922) was used. Minimum inhibitory concentrations (MIC) against E. coli were determined for the essential oils. Tested oils in very small concentrations were prepared (from 1 to 3 drops of essential oils per 3 mL working suspensions). From the results of disc diffusion assay and MIC tests, it can be concluded that thyme oil had the highest antibacterial activity against E. coli. Moreover, the study indicates the exposition to the RMF, as compared to the unexposed controls causing an increase in the efficacy of antibacterial properties of tested oils. The extended radiation exposure to RMF at the frequency f= 25 Hz beyond 160 minutes resulted in a significant increase in antibacterial potential against E. coli. Bacteria were killed within 40 minutes in thyme oil in lower tested concentration (1 drop of essential oils per 3 mL working suspension). Rapid decrease (>3 log) of bacteria number was observed with rosemary oil within 100 minutes (in concentration 3 drops of essential oils per 3 mL working suspension). Thus, a method for improving the antimicrobial performance of essential oil in low concentrations was developed. However, it still remains to be investigated how bacteria get killed by the EOs treated by an electromagnetic field. The possible mechanisms relies on alteration in the permeability of ionic channels in ionic channels in the bacterial cell walls that transport in the cells was proposed. For further studies, it is proposed to examine other types of essential oils and other antibiotic-resistant bacteria (ARB), which are causing a serious concern throughout the world.

Keywords: rotating magnetic field, rosemary, thyme, essential oils, Escherichia coli

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538 Frailty and Quality of Life among Older Adults: A Study of Six LMICs Using SAGE Data

Authors: Mamta Jat

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Background: The increased longevity has resulted in the increase in the percentage of the global population aged 60 years or over. With this “demographic transition” towards ageing, “epidemiologic transition” is also taking place characterised by growing share of non-communicable diseases in the overall disease burden. So, many of the older adults are ageing with chronic disease and high levels of frailty which often results in lower levels of quality of life. Although frailty may be increasingly common in older adults, prevention or, at least, delay the onset of late-life adverse health outcomes and disability is necessary to maintain the health and functional status of the ageing population. This is an effort using SAGE data to assess levels of frailty and its socio-demographic correlates and its relation with quality of life in LMICs of India, China, Ghana, Mexico, Russia and South Africa in a comparative perspective. Methods: The data comes from multi-country Study on Global AGEing and Adult Health (SAGE), consists of nationally representative samples of older adults in six low and middle-income countries (LMICs): China, Ghana, India, Mexico, the Russian Federation and South Africa. For our study purpose, we will consider only 50+ year’s respondents. The logistic regression model has been used to assess the correlates of frailty. Multinomial logistic regression has been used to study the effect of frailty on QOL (quality of life), controlling for the effect of socio-economic and demographic correlates. Results: Among all the countries India is having highest mean frailty in males (0.22) and females (0.26) and China with the lowest mean frailty in males (0.12) and females (0.14). The odds of being frail are more likely with the increase in age across all the countries. In India, China and Russia the chances of frailty are more among rural older adults; whereas, in Ghana, South Africa and Mexico rural residence is protecting against frailty. Among all countries china has high percentage (71.46) of frail people in low QOL; whereas Mexico has lowest percentage (36.13) of frail people in low QOL.s The risk of having low and middle QOL is significantly (p<0.001) higher among frail elderly as compared to non–frail elderly across all countries with controlling socio-demographic correlates. Conclusion: Women and older age groups are having higher frailty levels than men and younger aged adults in LMICs. The mean frailty scores demonstrated a strong inverse relationship with education and income gradients, while lower levels of education and wealth are showing higher levels of frailty. These patterns are consistent across all LMICs. These data support a significant role of frailty with all other influences controlled, in having low QOL as measured by WHOQOL index. Future research needs to be built on this evolving concept of frailty in an effort to improve quality of life for frail elderly population, in LMICs setting.

Keywords: Keywords: Ageing, elderly, frailty, quality of life

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537 Guard@Lis: Birdwatching Augmented Reality Mobile Application

Authors: Jose A. C. Venancio, Alexandrino J. M. Goncalves, Anabela Marto, Nuno C. S. Rodrigues, Rita M. T. Ascenso

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Nowadays, it is common to find people who are concerned about getting away from the everyday life routine, looking forward to outcome well-being and pleasant emotions. Trying to disconnect themselves from the usual places of work and residence, they pursue different places, such as tourist destinations, aiming to have unexpected experiences. In order to make this exploration process easier, cities and tourism agencies seek new opportunities and solutions, creating routes with diverse cultural landmarks, including natural landscapes and historic buildings. These offers frequently aspire to the preservation of the local patrimony. In nature and wildlife, birdwatching is an activity that has been increasing, both in cities and in the countryside. This activity seeks to find, observe and identify the diversity of birds that live permanently or temporarily in these places, and it is usually supported by birdwatching guides. Leiria (Portugal) is a well-known city, presenting several historical and natural landmarks, like the Lis river and the castle where King D. Dinis lived in the 13th century. Along the Lis River, a conservation process was carried out and a pedestrian route was created (Polis project). This is considered an excellent spot for birdwatching, especially for the gray heron (Ardea cinerea) and for the kingfisher (Alcedo atthis). There is also a route through the city, from the riverside to the castle, which encloses a characterized variety of species, such as the barn swallow (Hirundo rustica), known for passing through different seasons of the year. Birdwatching is sometimes a difficult task since it is not always possible to see all bird species that inhabit a given place. For this reason, a need to create a technological solution was found to ease this activity. This project aims to encourage people to learn about the various species of birds that live along the Lis River and to promote the preservation of nature in a conscious way. This work is being conducted in collaboration with Leiria Municipal Council and with the Environmental Interpretation Centre. It intends to show the majesty of the Lis River, a place visited daily by several people, such as children and families, who use it for didactic and recreational activities. We are developing a mobile multi-platform application (Guard@Lis) that allows bird species to be observed along a given route, using representative digital 3D models through the integration of augmented reality technologies. Guard@Lis displays a route with points of interest for birdwatching and a list of species for each point of interest, along with scientific information, images and sounds for every species. For some birds, to ensure their observation, the user can watch them in loco, in their real and natural environment, with their mobile device by means of augmented reality, giving the sensation of presence of these birds, even if they cannot be seen in that place at that moment. The augmented reality feature is being developed with Vuforia SDK, using a hybrid approach to recognition and tracking processes, combining marks and geolocation techniques. This application proposes routes and notifies users with alerts for the possibility of viewing models of augmented reality birds. The final Guard@Lis prototype will be tested by volunteers in-situ.

Keywords: augmented reality, birdwatching route, mobile application, nature tourism, watch birds using augmented reality

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536 Implementing the WHO Air Quality Guideline for PM2.5 Worldwide can Prevent Millions of Premature Deaths Per Year

Authors: Despina Giannadaki, Jos Lelieveld, Andrea Pozzer, John Evans

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Outdoor air pollution by fine particles ranks among the top ten global health risk factors that can lead to premature mortality. Epidemiological cohort studies, mainly conducted in United States and Europe, have shown that the long-term exposure to PM2.5 (particles with an aerodynamic diameter less than 2.5μm) is associated with increased mortality from cardiovascular, respiratory diseases and lung cancer. Fine particulates can cause health impacts even at very low concentrations. Previously, no concentration level has been defined below which health damage can be fully prevented. The World Health Organization ambient air quality guidelines suggest an annual mean PM2.5 concentration limit of 10μg/m3. Populations in large parts of the world, especially in East and Southeast Asia, and in the Middle East, are exposed to high levels of fine particulate pollution that by far exceeds the World Health Organization guidelines. The aim of this work is to evaluate the implementation of recent air quality standards for PM2.5 in the EU, the US and other countries worldwide and estimate what measures will be needed to substantially reduce premature mortality. We investigated premature mortality attributed to fine particulate matter (PM2.5) under adults ≥ 30yrs and children < 5yrs, applying a high-resolution global atmospheric chemistry model combined with epidemiological concentration-response functions. The latter are based on the methodology of the Global Burden of Disease for 2010, assuming a ‘safe’ annual mean PM2.5 threshold of 7.3μg/m3. We estimate the global premature mortality by PM2.5 at 3.15 million/year in 2010. China is the leading country with about 1.33 million, followed by India with 575 thousand and Pakistan with 105 thousand. For the European Union (EU) we estimate 173 thousand and the United States (US) 52 thousand in 2010. Based on sensitivity calculations we tested the gains from PM2.5 control by applying the air quality guidelines (AQG) and standards of the World Health Organization (WHO), the EU, the US and other countries. To estimate potential reductions in mortality rates we take into consideration the deaths that cannot be avoided after the implementation of PM2.5 upper limits, due to the contribution of natural sources to total PM2.5 and therefore to mortality (mainly airborne desert dust). The annual mean EU limit of 25μg/m3 would reduce global premature mortality by 18%, while within the EU the effect is negligible, indicating that the standard is largely met and that stricter limits are needed. The new US standard of 12μg/m3 would reduce premature mortality by 46% worldwide, 4% in the US and 20% in the EU. Implementing the AQG by the WHO of 10μg/m3 would reduce global premature mortality by 54%, 76% in China and 59% in India. In the EU and US, the mortality would be reduced by 36% and 14%, respectively. Hence, following the WHO guideline will prevent 1.7 million premature deaths per year. Sensitivity calculations indicate that even small changes at the lower PM2.5 standards can have major impacts on global mortality rates.

Keywords: air quality guidelines, outdoor air pollution, particulate matter, premature mortality

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535 Overview of Research Contexts about XR Technologies in Architectural Practice

Authors: Adeline Stals

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The transformation of architectural design practices has been underway for almost forty years due to the development and democratization of computer technology. New and more efficient tools are constantly being proposed to architects, amplifying a technological wave that sometimes stimulates them, sometimes overwhelms them, depending essentially on their digital culture and the context (socio-economic, structural, organizational) in which they work on a daily basis. Our focus is on VR, AR, and MR technologies dedicated to architecture. The commercialization of affordable headsets like the Oculus Rift, the HTC Vive or more low-tech like the Google CardBoard, makes it more accessible to benefit from these technologies. In that regard, researchers report the growing interest of these tools for architects, given the new perspectives they open up in terms of workflow, representation, collaboration, and client’s involvement. However, studies rarely mention the consequences of the sample studied on results. Our research provides an overview of VR, AR, and MR researches among a corpus of papers selected from conferences and journals. A closer look at the sample of these research projects highlights the necessity to take into consideration the context of studies in order to develop tools truly dedicated to the real practices of specific architect profiles. This literature review formalizes milestones for future challenges to address. The methodology applied is based on a systematic review of two sources of publications. The first one is the Cumincad database, which regroups publications from conferences exclusively about digital in architecture. Additionally, the second part of the corpus is based on journal publications. Journals have been selected considering their ranking on Scimago. Among the journals in the predefined category ‘architecture’ and in Quartile 1 for 2018 (last update when consulted), we have retained the ones related to the architectural design process: Design Studies, CoDesign, Architectural Science Review, Frontiers of Architectural Research and Archnet-IJAR. Beside those journals, IJAC, not classified in the ‘architecture’ category, is selected by the author for its adequacy with architecture and computing. For all requests, the search terms were ‘virtual reality’, ‘augmented reality’, and ‘mixed reality’ in title and/or keywords for papers published between 2015 and 2019 (included). This frame time is defined considering the fast evolution of these technologies in the past few years. Accordingly, the systematic review covers 202 publications. The literature review on studies about XR technologies establishes the state of the art of the current situation. It highlights that studies are mostly based on experimental contexts with controlled conditions (pedagogical, e.g.) or on practices established in large architectural offices of international renown. However, few studies focus on the strategies and practices developed by offices of smaller size, which represent the largest part of the market. Indeed, a European survey studying the architectural profession in Europe in 2018 reveals that 99% of offices are composed of less than ten people, and 71% of only one person. The study also showed that the number of medium-sized offices is continuously decreasing in favour of smaller structures. In doing so, a frontier seems to remain between the worlds of research and practice, especially for the majority of small architectural practices having a modest use of technology. This paper constitutes a reference for the next step of the research and for further worldwide researches by facilitating their contextualization.

Keywords: architectural design, literature review, SME, XR technologies

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534 Analysing the Stability of Electrical Grid for Increased Renewable Energy Penetration by Focussing on LI-Ion Battery Storage Technology

Authors: Hemendra Singh Rathod

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Frequency is, among other factors, one of the governing parameters for maintaining electrical grid stability. The quality of an electrical transmission and supply system is mainly described by the stability of the grid frequency. Over the past few decades, energy generation by intermittent sustainable sources like wind and solar has seen a significant increase globally. Consequently, controlling the associated deviations in grid frequency within safe limits has been gaining momentum so that the balance between demand and supply can be maintained. Lithium-ion battery energy storage system (Li-Ion BESS) has been a promising technology to tackle the challenges associated with grid instability. BESS is, therefore, an effective response to the ongoing debate whether it is feasible to have an electrical grid constantly functioning on a hundred percent renewable power in the near future. In recent years, large-scale manufacturing and capital investment into battery production processes have made the Li-ion battery systems cost-effective and increasingly efficient. The Li-ion systems require very low maintenance and are also independent of geographical constraints while being easily scalable. The paper highlights the use of stationary and moving BESS for balancing electrical energy, thereby maintaining grid frequency at a rapid rate. Moving BESS technology, as implemented in the selected railway network in Germany, is here considered as an exemplary concept for demonstrating the same functionality in the electrical grid system. Further, using certain applications of Li-ion batteries, such as self-consumption of wind and solar parks or their ancillary services, wind and solar energy storage during low demand, black start, island operation, residential home storage, etc. offers a solution to effectively integrate the renewables and support Europe’s future smart grid. EMT software tool DIgSILENT PowerFactory has been utilised to model an electrical transmission system with 100% renewable energy penetration. The stability of such a transmission system has been evaluated together with BESS within a defined frequency band. The transmission system operators (TSO) have the superordinate responsibility for system stability and must also coordinate with the other European transmission system operators. Frequency control is implemented by TSO by maintaining a balance between electricity generation and consumption. Li-ion battery systems are here seen as flexible, controllable loads and flexible, controllable generation for balancing energy pools. Thus using Li-ion battery storage solution, frequency-dependent load shedding, i.e., automatic gradual disconnection of loads from the grid, and frequency-dependent electricity generation, i.e., automatic gradual connection of BESS to the grid, is used as a perfect security measure to maintain grid stability in any case scenario. The paper emphasizes the use of stationary and moving Li-ion battery storage for meeting the demands of maintaining grid frequency and stability for near future operations.

Keywords: frequency control, grid stability, li-ion battery storage, smart grid

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533 Central Nervous System Lesion Differentiation in the Emergency Radiology Department

Authors: Angelis P. Barlampas

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An 89 years old woman came to the emergency department complaining of long-lasting headaches and nausea. A CT examination was performed, and a homogeneous midline anterior cranial fossa lesion was revealed, which was situated near the base and measured 2,4 cm in diameter. The patient was allergic, and an i.v.c injection could not be done on the spot, and neither could an MRI exam because of metallic implants. How could someone narrow down the differential diagnosis? The interhemispheric meningioma is usually a silent midline lesion with no edema, and most often presents as a homogeneous, solid type, isodense, or slightly hyperdense mass ( usually the smallest lesions as this one ). Of them, 20-30% have some calcifications. Hyperostosis is typical for meningiomas that abut the base of the skull but is absent in the current case, presumably of a more cephalad location that is borderline away from the bone. Because further investigation could not be done, as the patient was allergic to the contrast media, some other differential options should be considered. Regarding the site of the lesion, the most common other entities to keep in mind are the following: Metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma, giant aneurysm of the anterior cerebral artery, midline lesion. Appearance will depend on whether the aneurysm is non-thrombosed, or partially, or completely thrombosed. Non-contrast: slightly hyperdense, well-defined round extra-axial mass, may demonstrate a peripheral calcified rim, olfactory neuroblastoma, midline lesion. The mass is of soft tissue attenuation and is relatively homogeneous. Focal calcifications are occasionally present. When an intracranial extension is present, peritumoral cysts between it and the overlying brain are often present. Final diagnosis interhemispheric meningioma (Known from the previous patient’s history). Meningiomas come from the meningocytes or the arachnoid cells of the meninges. They are usually found incidentally, have an indolent course, and their most common location is extra-axial, parasagittal, and supratentorial. Other locations include the sphenoid ridge, olfactory groove, juxtasellar, infratentorial, intraventricular, pineal gland area, and optic nerve meningioma. They are clinically silent entities, except for large ones, which can present with headaches, changes in personality status, paresis, or symptomatology according to their specific site and may cause edema of the surrounding brain tissue. Imaging findings include the presence of calcifications, the CSF cleft sign, hyperostosis of adjacent bone, dural tail, and white matter buckling sign. After i.v.c. injection, they enhance brightly and homogenously, except for large ones, which may exhibit necrotic areas or may be heavily calcified. Malignant or cystic variants demonstrate more heterogeneity and less intense enhancement. Sometimes, it is inevitable that the needed CT protocol cannot be performed, especially in the emergency department. In these cases, the radiologist must focus on the characteristic imaging features of the unenhanced lesion, as well as in previous examinations or a known lesion history, in order to come to the right report conclusion.

Keywords: computed tomography, emergency radiology, metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma

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532 The Location-Routing Problem with Pickup Facilities and Heterogeneous Demand: Formulation and Heuristics Approach

Authors: Mao Zhaofang, Xu Yida, Fang Kan, Fu Enyuan, Zhao Zhao

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Nowadays, last-mile distribution plays an increasingly important role in the whole industrial chain delivery link and accounts for a large proportion of the whole distribution process cost. Promoting the upgrading of logistics networks and improving the layout of final distribution points has become one of the trends in the development of modern logistics. Due to the discrete and heterogeneous needs and spatial distribution of customer demand, which will lead to a higher delivery failure rate and lower vehicle utilization, last-mile delivery has become a time-consuming and uncertain process. As a result, courier companies have introduced a range of innovative parcel storage facilities, including pick-up points and lockers. The introduction of pick-up points and lockers has not only improved the users’ experience but has also helped logistics and courier companies achieve large-scale economy. Against the backdrop of the COVID-19 of the previous period, contactless delivery has become a new hotspot, which has also created new opportunities for the development of collection services. Therefore, a key issue for logistics companies is how to design/redesign their last-mile distribution network systems to create integrated logistics and distribution networks that consider pick-up points and lockers. This paper focuses on the introduction of self-pickup facilities in new logistics and distribution scenarios and the heterogeneous demands of customers. In this paper, we consider two types of demand, including ordinary products and refrigerated products, as well as corresponding transportation vehicles. We consider the constraints associated with self-pickup points and lockers and then address the location-routing problem with self-pickup facilities and heterogeneous demands (LRP-PFHD). To solve this challenging problem, we propose a mixed integer linear programming (MILP) model that aims to minimize the total cost, which includes the facility opening cost, the variable transport cost, and the fixed transport cost. Due to the NP-hardness of the problem, we propose a hybrid adaptive large-neighbourhood search algorithm to solve LRP-PFHD. We evaluate the effectiveness and efficiency of the proposed algorithm by using instances generated based on benchmark instances. The results demonstrate that the hybrid adaptive large neighbourhood search algorithm is more efficient than MILP solvers such as Gurobi for LRP-PFHD, especially for large-scale instances. In addition, we made a comprehensive analysis of some important parameters (e.g., facility opening cost and transportation cost) to explore their impacts on the results and suggested helpful managerial insights for courier companies.

Keywords: city logistics, last-mile delivery, location-routing, adaptive large neighborhood search

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531 Foreseen the Future: Human Factors Integration in European Horizon Projects

Authors: José Manuel Palma, Paula Pereira, Margarida Tomás

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Foreseen the future: Human factors integration in European Horizon Projects The development of new technology as artificial intelligence, smart sensing, robotics, cobotics or intelligent machinery must integrate human factors to address the need to optimize systems and processes, thereby contributing to the creation of a safe and accident-free work environment. Human Factors Integration (HFI) consistently pose a challenge for organizations when applied to daily operations. AGILEHAND and FORTIS projects are grounded in the development of cutting-edge technology - industry 4.0 and 5.0. AGILEHAND aims to create advanced technologies for autonomously sort, handle, and package soft and deformable products, whereas FORTIS focuses on developing a comprehensive Human-Robot Interaction (HRI) solution. Both projects employ different approaches to explore HFI. AGILEHAND is mainly empirical, involving a comparison between the current and future work conditions reality, coupled with an understanding of best practices and the enhancement of safety aspects, primarily through management. FORTIS applies HFI throughout the project, developing a human-centric approach that includes understanding human behavior, perceiving activities, and facilitating contextual human-robot information exchange. it intervention is holistic, merging technology with the physical and social contexts, based on a total safety culture model. In AGILEHAND we will identify safety emergent risks, challenges, their causes and how to overcome them by resorting to interviews, questionnaires, literature review and case studies. Findings and results will be presented in “Strategies for Workers’ Skills Development, Health and Safety, Communication and Engagement” Handbook. The FORTIS project will implement continuous monitoring and guidance of activities, with a critical focus on early detection and elimination (or mitigation) of risks associated with the new technology, as well as guidance to adhere correctly with European Union safety and privacy regulations, ensuring HFI, thereby contributing to an optimized safe work environment. To achieve this, we will embed safety by design, and apply questionnaires, perform site visits, provide risk assessments, and closely track progress while suggesting and recommending best practices. The outcomes of these measures will be compiled in the project deliverable titled “Human Safety and Privacy Measures”. These projects received funding from European Union’s Horizon 2020/Horizon Europe research and innovation program under grant agreement No101092043 (AGILEHAND) and No 101135707 (FORTIS).

Keywords: human factors integration, automation, digitalization, human robot interaction, industry 4.0 and 5.0

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530 The Vanishing Treasure: An Anthropological Study on Changing Social Relationships, Values, Belief System and Language Pattern of the Limbus in Kalimpong Sub-Division of the Darjeeling District in West Bengal, India

Authors: Biva Samadder, Samita Manna

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India is a melting pot of races, tribes, castes and communities. The population of India can be roughly branched into the huge majority of “Civilized” Indians of the Plains and the minority of Tribal population of the hill area and the forest who constituting almost 16 percent of total population of India. The Kirat community composed of four ethnic tribes: Limbu, Lepcha, Dhimal, and Rai. These Kirat people were found to be rich in indigenous knowledge, skill and practices especially for the use on medicinal plants and livelihood purposes. The “Mundhum" is the oral scripture or the “Bible of the Limbus” which serves as the canon of the codes of the Limbu socialization, their moral values and the very orientation of their lifestyle. From birth till death the Limbus are disciplined in the life with full of religious rituals, traditions and culture governed by community norms with a rich legacy of indigenous knowledge and traditional practices. The present study has been conducted using both secondary as well as primary data by applying social methodology consisting of the social survey, questionnaire, interviews and observations in the Kalimpong Block-I of Darjeeling District of west Bengal of India, which is a heterogeneous zone in terms of its ethnic composition and where the Limbus are pre-dominantly concentrated. Due to their close contact with other caste and communities Limbus are now adjusted with the changing situation by borrowing some cultural traits from the other communities and changes that have taken place in their cultural practices, religious beliefs, economic aspects, languages and in social roles and relationships which is bringing the change in their material culture. Limbu language is placed in the Tibeto- Burman Language category. But due to the political and cultural domination of educationally sound and numerically dominant Bengali race, the different communities in this area forced to come under the one umbrella of the Nepali or Gorkhali nation (nation-people). Their respective identities had to be submerged in order to constitute as a strong force to resist Nepali domination and ensure their common survival. As Nepali is a lingua-franca of the area knowing and speaking Nepali language helps them in procuring economic and occupational facilities. Ironically, present day younger generation does not feel comfortable speaking in their own Limbu tongue. The traditional knowledge about medicinal plants, healing, and health culture is found to be wear away due to the lack of interest of young generation. Not only poverty, along with exclusion due to policies they are in the phase of extinction, but their capabilities are ignored and not documented and preserved especially in the case of Limbus who having a great cultural heritage of an oral tradition. Attempts have been made to discuss the persistence and changes in socioeconomic pattern of life in relation to the social structure, material culture, cultural practices, social relationships, indigenous technology, ethos and their values and belief system.

Keywords: changing social relationship, cultural transition, identity, indigenous knowledge, language

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529 Assessment and Forecasting of the Impact of Negative Environmental Factors on Public Health

Authors: Nurlan Smagulov, Aiman Konkabayeva, Akerke Sadykova, Arailym Serik

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Introduction. Adverse environmental factors do not immediately lead to pathological changes in the body. They can exert the growth of pre-pathology characterized by shifts in physiological, biochemical, immunological and other indicators of the body state. These disorders are unstable, reversible and indicative of body reactions. There is an opportunity to objectively judge the internal structure of the adaptive body reactions at the level of individual organs and systems. In order to obtain a stable response of the body to the chronic effects of unfavorable environmental factors of low intensity (compared to production environment factors), a time called the «lag time» is needed. The obtained results without considering this factor distort reality and, for the most part, cannot be a reliable statement of the main conclusions in any work. A technique is needed to reduce methodological errors and combine mathematical logic using statistical methods and a medical point of view, which ultimately will affect the obtained results and avoid a false correlation. Objective. Development of a methodology for assessing and predicting the environmental factors impact on the population health considering the «lag time.» Methods. Research objects: environmental and population morbidity indicators. The database on the environmental state was compiled from the monthly newsletters of Kazhydromet. Data on population morbidity were obtained from regional statistical yearbooks. When processing static data, a time interval (lag) was determined for each «argument-function» pair. That is the required interval, after which the harmful factor effect (argument) will fully manifest itself in the indicators of the organism's state (function). The lag value was determined by cross-correlation functions of arguments (environmental indicators) with functions (morbidity). Correlation coefficients (r) and their reliability (t), Fisher's criterion (F) and the influence share (R2) of the main factor (argument) per indicator (function) were calculated as a percentage. Results. The ecological situation of an industrially developed region has an impact on health indicators, but it has some nuances. Fundamentally opposite results were obtained in the mathematical data processing, considering the «lag time». Namely, an expressed correlation was revealed after two databases (ecology-morbidity) shifted. For example, the lag period was 4 years for dust concentration, general morbidity, and 3 years – for childhood morbidity. These periods accounted for the maximum values of the correlation coefficients and the largest percentage of the influencing factor. Similar results were observed in relation to the concentration of soot, dioxide, etc. The comprehensive statistical processing using multiple correlation-regression variance analysis confirms the correctness of the above statement. This method provided the integrated approach to predicting the degree of pollution of the main environmental components to identify the most dangerous combinations of concentrations of leading negative environmental factors. Conclusion. The method of assessing the «environment-public health» system (considering the «lag time») is qualitatively different from the traditional (without considering the «lag time»). The results significantly differ and are more amenable to a logical explanation of the obtained dependencies. The method allows presenting the quantitative and qualitative dependence in a different way within the «environment-public health» system.

Keywords: ecology, morbidity, population, lag time

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528 Hospital Malnutrition and its Impact on 30-day Mortality in Hospitalized General Medicine Patients in a Tertiary Hospital in South India

Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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527 2,7-Diazaindole as a Photophysical Probe for Excited State Hydrogen/Proton Transfer

Authors: Simran Baweja, Bhavika Kalal, Surajit Maity

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Photoinduced tautomerization reactions have been the centre of attention among the scientific community over the past several decades because of their significance in various biological systems. 7-azaindole (7AI) is considered a model system for DNA base pairing and to understand the role of such tautomerization reactions in mutations. To the best of our knowledge, extensive studies have been carried out on 7-azaindole and its solvent clusters exhibiting proton/ hydrogen transfer in both solution as well as gas phases. Derivatives of the above molecule, like 2,7- and 2,6-diazaindoles are proposed to have even better photophysical properties due to the presence of -aza group on the 2nd position. However, there are studies in the solution phase that suggest the relevance of these molecules, but there are no experimental studies reported in the gas phase yet. In our current investigation, we present the first gas phase spectroscopic data of 2,7-diazaindole (2,7-DAI) and its solvent cluster (2,7-DAI-H2O). In this, we have employed state-of-the-art laser spectroscopic methods such as fluorescence excitation (LIF), dispersed fluorescence (DF), resonant two-photon ionization-time of flight mass spectrometry (2C-R2PI), photoionization efficiency spectroscopy (PIE), IR-UV double resonance spectroscopy, i.e., fluorescence-dip infrared spectroscopy (FDIR) and resonant ion-dip infrared spectroscopy (IDIR) to understand the electronic structure of the molecule. The origin band corresponding to the S1 ← S0 transition of the bare 2,7-DAI is found to be positioned at 33910 cm-1, whereas the origin band corresponding to S1 ← S0 transition of the 2,7-DAI-H2O is positioned at 33074 cm-1. The red-shifted transition in the case of solvent cluster suggests the enhanced feasibility of excited state hydrogen/ proton transfer. The ionization potential for the 2,7-DAI molecule is found to be 8.92 eV which is significantly higher than the previously reported 7AI (8.11 eV) molecule, making it a comparatively complex molecule to study. The ionization potential is reduced by 0.14 eV in the case of 2,7-DAI-H2O (8.78 eV) cluster compared to that of 2,7-DAI. Moreover, on comparison with the available literature values of 7AI, we found the origin band of 2,7-DAI and 2,7-DAI-H2O to be red-shifted by -729 and -280 cm-1 respectively. The ground and excited state N-H stretching frequencies of the 27DAI molecule were determined using fluorescence-dip infrared spectra (FDIR) and resonant ion dip infrared spectroscopy (IDIR), obtained at 3523 and 3467 cm-1, respectively. The lower value of vNH in the electronically excited state of 27DAI implies the higher acidity of the group compared to the ground state. Moreover, we have done extensive computational analysis, which suggests that the energy barrier in the excited state reduces significantly as we increase the number of catalytic solvent molecules (S= H2O, NH3) as well as the polarity of solvent molecules. We found that the ammonia molecule is a better candidate for hydrogen transfer compared to water because of its higher gas-phase basicity. Further studies are underway to understand the excited state dynamics and photochemistry of such N-rich chromophores.

Keywords: excited state hydrogen transfer, supersonic expansion, gas phase spectroscopy, IR-UV double resonance spectroscopy, laser induced fluorescence, photoionization efficiency spectroscopy

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526 Anesthesia for Spinal Stabilization Using Neuromuscular Blocking Agents in Dog: Case Report

Authors: Agata Migdalska, Joanna Berczynska, Ewa Bieniek, Jacek Sterna

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Muscle relaxation is considered important during general anesthesia for spine stabilization. In a presented case peripherally acting muscle relaxant was applied during general anesthesia for spine stabilization surgery. The patient was a dog, 11-years old, 26 kg, male, mix breed. Spine fracture was situated between Th13-L1-L2, probably due to the car accident. Preanesthetic physical examination revealed no sign underlying health issues. The dog was premedicated with midazolam 0.2 mg IM and butorphanol 2.4 mg IM. General anesthesia was induced with propofol IV. After the induction, the dog was intubated with an endotracheal tube and connected to an open-ended rebreathing system and maintained with the use of inhalation anesthesia with isoflurane in oxygen. 0,5 mg/ kg of rocuronium was given IV. Use of muscle relaxant was accompanied by an assessment of the degree of neuromuscular blockade by peripheral nerve stimulator. Electrodes were attached to the skin overlying at the peroneal nerve at the lateral cranial tibia. Four electrical pulses were applied to the nerve over a 2 second period. When satisfying nerve block was detected dog was prepared for the surgery. No further monitoring of the effectiveness of blockade was performed during surgery. Mechanical ventilation was kept during anesthesia. During surgery dog maintain stable, and no anesthesiological complication occur. Intraoperatively surgeon claimed that neuromuscular blockade results in a better approach to the spine and easier muscle manipulation which was helpful in order to see the fracture and replace bone fragments. Finally, euthanasia was performed intraoperatively as a result of vast myelomalacia process of the spinal cord. This prevented examination of the recovering process. Neuromuscular blocking agents act at the neuromuscular junction to provide profound muscle relaxation throughout the body. Muscle blocking agents are neither anesthetic nor analgesic; therefore inappropriately used may cause paralysis in fully conscious and feeling pain patient. They cause paralysis of all skeletal muscles, also diaphragm and intercostal muscles when given in higher doses. Intraoperative management includes maintaining stable physiological conditions, which involves adjusting hemodynamic parameters, ensuring proper ventilation, avoiding variations in temperature, maintain normal blood flow to promote proper oxygen exchange. Neuromuscular blocking agent can cause many side effects like residual paralysis, anaphylactic or anaphylactoid reactions, delayed recovery from anesthesia, histamine release, recurarization. Therefore reverse drug like neostigmine (with glikopyrolat) or edrofonium (with atropine) should be used in case of a life-threatening situation. Another useful drug is sugammadex, although the cost of this drug strongly limits its use. Muscle relaxant improves surgical conditions during spinal surgery, especially in heavily muscled individuals. They are also used to facilitate the replacement of dislocated joints as they improve conditions during fracture reduction. It is important to emphasize that in a patient with muscle weakness neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. This should not appear in patients with recent spine fracture or luxation. Therefore it is believed that neuromuscular blockers could be useful during spine stabilization procedures.

Keywords: anesthesia, dog, neuromuscular block, spine surgery

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525 Screening Tools and Its Accuracy for Common Soccer Injuries: A Systematic Review

Authors: R. Christopher, C. Brandt, N. Damons

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Background: The sequence of prevention model states that by constant assessment of injury, injury mechanisms and risk factors are identified, highlighting that collecting and recording of data is a core approach for preventing injuries. Several screening tools are available for use in the clinical setting. These screening techniques only recently received research attention, hence there is a dearth of inconsistent and controversial data regarding their applicability, validity, and reliability. Several systematic reviews related to common soccer injuries have been conducted; however, none of them addressed the screening tools for common soccer injuries. Objectives: The purpose of this study was to conduct a review of screening tools and their accuracy for common injuries in soccer. Methods: A systematic scoping review was performed based on the Joanna Briggs Institute procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed, and grey literature were used to access suitable studies. Some of the key search terms included: injury screening, screening, screening tool accuracy, injury prevalence, injury prediction, accuracy, validity, specificity, reliability, sensitivity. All types of English studies dating back to the year 2000 were included. Two blind independent reviewers selected and appraised articles on a 9-point scale for inclusion as well as for the risk of bias with the ACROBAT-NRSI tool. Data were extracted and summarized in tables. Plot data analysis was done, and sensitivity and specificity were analyzed with their respective 95% confidence intervals. I² statistic was used to determine the proportion of variation across studies. Results: The initial search yielded 95 studies, of which 21 were duplicates, and 54 excluded. A total of 10 observational studies were included for the analysis: 3 studies were analysed quantitatively while the remaining 7 were analysed qualitatively. Seven studies were graded low and three studies high risk of bias. Only high methodological studies (score > 9) were included for analysis. The pooled studies investigated tools such as the Functional Movement Screening (FMS™), the Landing Error Scoring System (LESS), the Tuck Jump Assessment, the Soccer Injury Movement Screening (SIMS), and the conventional hamstrings to quadriceps ratio. The accuracy of screening tools was of high reliability, sensitivity and specificity (calculated as ICC 0.68, 95% CI: 52-0.84; and 0.64, 95% CI: 0.61-0.66 respectively; I² = 13.2%, P=0.316). Conclusion: Based on the pooled results from the included studies, the FMS™ has a good inter-rater and intra-rater reliability. FMS™ is a screening tool capable of screening for common soccer injuries, and individual FMS™ scores are a better determinant of performance in comparison with the overall FMS™ score. Although meta-analysis could not be done for all the included screening tools, qualitative analysis also indicated good sensitivity and specificity of the individual tools. Higher levels of evidence are, however, needed for implication in evidence-based practice.

Keywords: accuracy, screening tools, sensitivity, soccer injuries, specificity

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524 Stochastic Approach for Technical-Economic Viability Analysis of Electricity Generation Projects with Natural Gas Pressure Reduction Turbines

Authors: Roberto M. G. Velásquez, Jonas R. Gazoli, Nelson Ponce Jr, Valério L. Borges, Alessandro Sete, Fernanda M. C. Tomé, Julian D. Hunt, Heitor C. Lira, Cristiano L. de Souza, Fabio T. Bindemann, Wilmar Wounnsoscky

Abstract:

Nowadays, society is working toward reducing energy losses and greenhouse gas emissions, as well as seeking clean energy sources, as a result of the constant increase in energy demand and emissions. Energy loss occurs in the gas pressure reduction stations at the delivery points in natural gas distribution systems (city gates). Installing pressure reduction turbines (PRT) parallel to the static reduction valves at the city gates enhances the energy efficiency of the system by recovering the enthalpy of the pressurized natural gas, obtaining in the pressure-lowering process shaft work and generating electrical power. Currently, the Brazilian natural gas transportation network has 9,409 km in extension, while the system has 16 national and 3 international natural gas processing plants, including more than 143 delivery points to final consumers. Thus, the potential of installing PRT in Brazil is 66 MW of power, which could yearly avoid the emission of 235,800 tons of CO2 and generate 333 GWh/year of electricity. On the other hand, an economic viability analysis of these energy efficiency projects is commonly carried out based on estimates of the project's cash flow obtained from several variables forecast. Usually, the cash flow analysis is performed using representative values of these variables, obtaining a deterministic set of financial indicators associated with the project. However, in most cases, these variables cannot be predicted with sufficient accuracy, resulting in the need to consider, to a greater or lesser degree, the risk associated with the calculated financial return. This paper presents an approach applied to the technical-economic viability analysis of PRTs projects that explicitly considers the uncertainties associated with the input parameters for the financial model, such as gas pressure at the delivery point, amount of energy generated by TRP, the future price of energy, among others, using sensitivity analysis techniques, scenario analysis, and Monte Carlo methods. In the latter case, estimates of several financial risk indicators, as well as their empirical probability distributions, can be obtained. This is a methodology for the financial risk analysis of PRT projects. The results of this paper allow a more accurate assessment of the potential PRT project's financial feasibility in Brazil. This methodology will be tested at the Cuiabá thermoelectric plant, located in the state of Mato Grosso, Brazil, and can be applied to study the potential in other countries.

Keywords: pressure reduction turbine, natural gas pressure drop station, energy efficiency, electricity generation, monte carlo methods

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523 Benefits of Environmental Aids to Chronobiology Management and Its Impact on Depressive Mood in an Operational Setting

Authors: M. Trousselard, D. Steiler, C. Drogou, P. van-Beers, G. Lamour, S. N. Crosnier, O. Bouilland, P. Dubost, M. Chennaoui, D. Léger

Abstract:

According to published data, undersea navigation for long periods (nuclear-powered ballistic missile submarine, SSBN) constitutes an extreme environment in which crews are subjected to multiple stresses, including the absence of natural light, illuminance below 1,000 lux, and watch schedules that do not respect natural chronobiological rhythms, for a period of 60-80 days. These stresses seem clearly detrimental to the submariners’ sleep, with consequences for their affective (seasonal affective disorder-like) and cognitive functioning. In the long term, there are abundant publications regarding the consequences of sleep disruption for the occurrence of organic cardiovascular, metabolic, immunological or malignant diseases. It seems essential to propose countermeasures for the duration of the patrol in order to reduce the negative physiological effects on the sleep and mood of submariners. Light therapy, the preferred treatment for dysfunctions of the internal biological clock and the resulting seasonal depression, cannot be used without data to assist knowledge of submariners’ chronobiology (melatonin secretion curve) during patrols, given the unusual characteristics of their working environment. These data are not available in the literature. The aim of this project was to assess, in the course of two studies, the benefits of two environmental techniques for managing chronobiological stress: techniques for optimizing potential (TOP; study 1)3, an existing programme to help in the psychophysiological regulation of stress and sleep in the armed forces, and dawn and dusk simulators (DDS, study 2). For each experiment, psychological, physiological (sleep) or biological (melatonin secretion) data were collected on D20 and D50 of patrol. In the first experiment, we studied sleep and depressive distress in 19 submariners in an operational setting on board an SSBM during a first patrol, and assessed the impact of TOP on the quality of sleep and depressive distress in these same submariners over the course of a second patrol. The submariners were trained in TOP between the two patrols for a 2-month period, at a rate of 1 h of training per week, and assigned daily informal exercises. Results show moderate disruptions in sleep pattern and duration associated with the intensity of depressive distress. The use of TOP during the following patrol improved sleep and depressive mood only in submariners who regularly practiced the techniques. In light of these limited benefits, we assessed, in a second experiment, the benefits of DDS on chronobiology (daily secretion of melatonin) and depressive distress. Ninety submariners were randomly allocated to two groups, group 1 using DDS daily, and group 2 constituting the control group. Although the placebo effect was not controlled, results showed a beneficial effect on chronobiology and depressive mood for submariners with a morning chronotype. Conclusions: These findings demonstrate the difficulty of practicing the tools of psychophysiological management in real life. They raise the question of the subjects’ autonomy with respect to using aids that involve regular practice. It seems important to study autonomy in future studies, as a cognitive resource resulting from the interaction between internal positive resources and “coping” resources, to gain a better understanding of compliance problems.

Keywords: chronobiology, light therapy, seasonal affective disorder, sleep, stress, stress management, submarine

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522 Study of Elastic-Plastic Fatigue Crack in Functionally Graded Materials

Authors: Somnath Bhattacharya, Kamal Sharma, Vaibhav Sonkar

Abstract:

Composite materials emerged in the middle of the 20th century as a promising class of engineering materials providing new prospects for modern technology. Recently, a new class of composite materials known as functionally graded materials (FGMs) has drawn considerable attention of the scientific community. In general, FGMs are defined as composite materials in which the composition or microstructure or both are locally varied so that a certain variation of the local material properties is achieved. This gradual change in composition and microstructure of material is suitable to get gradient of properties and performances. FGMs are synthesized in such a way that they possess continuous spatial variations in volume fractions of their constituents to yield a predetermined composition. These variations lead to the formation of a non-homogeneous macrostructure with continuously varying mechanical and / or thermal properties in one or more than one direction. Lightweight functionally graded composites with high strength to weight and stiffness to weight ratios have been used successfully in aircraft industry and other engineering applications like in electronics industry and in thermal barrier coatings. In the present work, elastic-plastic crack growth problems (using Ramberg-Osgood Model) in an FGM plate under cyclic load has been explored by extended finite element method. Both edge and centre crack problems have been solved by taking additionally holes, inclusions and minor cracks under plane stress conditions. Both soft and hard inclusions have been implemented in the problems. The validity of linear elastic fracture mechanics theory is limited to the brittle materials. A rectangular plate of functionally graded material of length 100 mm and height 200 mm with 100% copper-nickel alloy on left side and 100% ceramic (alumina) on right side is considered in the problem. Exponential gradation in property is imparted in x-direction. A uniform traction of 100 MPa is applied to the top edge of the rectangular domain along y direction. In some problems, domain contains major crack along with minor cracks or / and holes or / and inclusions. Major crack is located the centre of the left edge or the centre of the domain. The discontinuities, such as minor cracks, holes, and inclusions are added either singly or in combination with each other. On the basis of this study, it is found that effect of minor crack in the domain’s failure crack length is minimum whereas soft inclusions have moderate effect and the effect of holes have maximum effect. It is observed that the crack growth is more before the failure in each case when hard inclusions are present in place of soft inclusions.

Keywords: elastic-plastic, fatigue crack, functionally graded materials, extended finite element method (XFEM)

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521 Application of 2D Electrical Resistivity Tomographic Imaging Technique to Study Climate Induced Landslide and Slope Stability through the Analysis of Factor of Safety: A Case Study in Ooty Area, Tamil Nadu, India

Authors: S. Maniruzzaman, N. Ramanujam, Qazi Akhter Rasool, Swapan Kumar Biswas, P. Prasad, Chandrakanta Ojha

Abstract:

Landslide is one of the major natural disasters in South Asian countries. Applying 2D Electrical Resistivity Tomographic Imaging estimation of geometry, thickness, and depth of failure zone of the landslide can be made. Landslide is a pertinent problem in Nilgris plateau next to Himalaya. Nilgris range consists of hard Archean metamorphic rocks. Intense weathering prevailed during the Pre-Cambrian time had deformed the rocks up to 45m depth. The landslides are dominant in the southern and eastern part of plateau of is comparatively smaller than the northern drainage basins, as it has low density of drainage; coarse texture permitted the more of infiltration of rainwater, whereas in the northern part of the plateau entombed with high density of drainage pattern and fine texture with less infiltration than run off, and low to the susceptible to landslide. To get comprehensive information about the landslide zone 2D Electrical Resistivity Tomographic imaging study with CRM 500 Resistivity meter are used in Coonoor– Mettupalyam sector of Nilgiris plateau. To calculate Factor of Safety the infinite slope model of Brunsden and Prior is used. Factor of Safety can be expressed (FS) as the ratio of resisting forces to disturbing forces. If FS < 1 disturbing forces are larger than resisting forces and failure may occur. The geotechnical parameters of soil samples are calculated on the basis upon the apparent resistivity values for litho units of measured from 2D ERT image of the landslide zone. Relationship between friction angles for various soil properties is established by simple regression analysis from apparent resistivity data. Increase of water content in slide zone reduces the effectiveness of the shearing resistance and increase the sliding movement. Time-lapse resistivity changes to slope failure is determined through geophysical Factor of Safety which depends on resistivity and site topography. This ERT technique infers soil property at variable depths in wider areas. This approach to retrieve the soil property and overcomes the limit of the point of information provided by rain gauges and porous probes. Monitoring of slope stability without altering soil structure through the ERT technique is non-invasive with low cost. In landslide prone area an automated Electrical Resistivity Tomographic Imaging system should be installed permanently with electrode networks to monitor the hydraulic precursors to monitor landslide movement.

Keywords: 2D ERT, landslide, safety factor, slope stability

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520 A Biophysical Study of the Dynamic Properties of Glucagon Granules in α Cells by Imaging-Derived Mean Square Displacement and Single Particle Tracking Approaches

Authors: Samuele Ghignoli, Valentina de Lorenzi, Gianmarco Ferri, Stefano Luin, Francesco Cardarelli

Abstract:

Insulin and glucagon are the two essential hormones for maintaining proper blood glucose homeostasis, which is disrupted in Diabetes. A constantly growing research interest has been focused on the study of the subcellular structures involved in hormone secretion, namely insulin- and glucagon-containing granules, and on the mechanisms regulating their behaviour. Yet, while several successful attempts were reported describing the dynamic properties of insulin granules, little is known about their counterparts in α cells, the glucagon-containing granules. To fill this gap, we used αTC1 clone 9 cells as a model of α cells and ZIGIR as a fluorescent Zinc chelator for granule labelling. We started by using spatiotemporal fluorescence correlation spectroscopy in the form of imaging-derived mean square displacement (iMSD) analysis. This afforded quantitative information on the average dynamical and structural properties of glucagon granules having insulin granules as a benchmark. Interestingly, the iMSD sensitivity to average granule size allowed us to confirm that glucagon granules are smaller than insulin ones (~1.4 folds, further validated by STORM imaging). To investigate possible heterogeneities in granule dynamic properties, we moved from correlation spectroscopy to single particle tracking (SPT). We developed a MATLAB script to localize and track single granules with high spatial resolution. This enabled us to classify the glucagon granules, based on their dynamic properties, as ‘blocked’ (i.e., trajectories corresponding to immobile granules), ‘confined/diffusive’ (i.e., trajectories corresponding to slowly moving granules in a defined region of the cell), or ‘drifted’ (i.e., trajectories corresponding to fast-moving granules). In cell-culturing control conditions, results show this average distribution: 32.9 ± 9.3% blocked, 59.6 ± 9.3% conf/diff, and 7.4 ± 3.2% drifted. This benchmarking provided us with a foundation for investigating selected experimental conditions of interest, such as the glucagon-granule relationship with the cytoskeleton. For instance, if Nocodazole (10 μM) is used for microtubule depolymerization, the percentage of drifted motion collapses to 3.5 ± 1.7% while immobile granules increase to 56.0 ± 10.7% (remaining 40.4 ± 10.2% of conf/diff). This result confirms the clear link between glucagon-granule motion and cytoskeleton structures, a first step towards understanding the intracellular behaviour of this subcellular compartment. The information collected might now serve to support future investigations on glucagon granules in physiology and disease. Acknowledgment: This work has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 866127, project CAPTUR3D).

Keywords: glucagon granules, single particle tracking, correlation spectroscopy, ZIGIR

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519 Mental Health of Caregivers in Public Hospital Intensive Care Department: A Multicentric Cross-Sectional Study

Authors: Lamia Bouzgarrou, Amira Omrane, Naima Bouatay, Chaima Harrathi, Samia Machroughl, Ahmed Mhalla

Abstract:

Background and Aims: Professionals of health care sector are exposed to psychosocial constraints like stress, harassment, violence, which can lead to many mental health problems such as, depression, addictive behavior, and burn-out. Moreover, it’s well established that caregivers affected to intensive care units are more likely to experience such constraints and mental health problems. For these caregivers, the mental health state may affect care quality and patient’s safety. This study aims either to identify occupational psychosocial constraints and their mental health consequences among paramedical and medical caregivers affected to intensive units in Tunisian public hospital. Methods: An exhaustive three months cross-sectional study conducted among medical and paramedical staffs of intensive care units in three Tunisian university hospitals. After informed consent collection, we evaluated work-related stress, workplace harassment, depression, anxious troubles, addictive behavior, and self-esteems through an anonymous self-completed inquiry form. Five validated questionnaires and scales were included in this form: Karasek's Job Content Questionnaire, Negative Acts Questionnaire, Rosenberg, Beck depression inventory and Hamilton Anxiety scale. Results: We included 129 intensive unit caregivers; with a mean age of 36.1 ± 1.1 years and a sex ratio of 0.58. Among these caregivers, 30% were specialist or under-specialization doctors. The average seniority in the intensive care was 6.1 ± 1.2 (extremes=1 to 40 years). Atypical working schedules were noted among 36.7% of the subjects with an imposed choice in 52.4% of cases. During the last 12 months preceding the survey, 51.7% of care workers were absent from work because of a health problem with stops exceeding 15 days in 11.7%. Job strain was objective among 15% of caregivers and 38.33% of them were victims of moral harassment. A low or very low self-esteem was noted among 40% of respondents. Moreover, active smoking was reported by 20% subjects, alcohol consumption by 13.3% and psychotropic substance use by 1.7% of them. According to Beck inventory and Hamilton Anxiety scale, we concluded that 61.7% of intensive care providers were depressed, with 'severe' depression in 13.3% of cases and 49.9% of them present anxious disorders. Multivariate analysis objective that, job strain was correlated with young age (p=0.005) and shorter work seniority (p=0.001). Workplace and moral harassment was more prevalent among females (p=0.009), under-specialization doctor (p=0.021), those affected to atypical schedules (p=0.008). Concerning depression, it was more prevalent among staff in job strain situation (p = 0.004), among smokers caregivers (p = 0.048), and those with no leisure activity (p < 0.001). Anxious disorders were positively correlated to chronic diseases history (p = 0.001) and work-bullying exposure (p = 0.004). Conclusions: Our findings reflected a high frequency of caregivers who are under stress at work and those who are victims of moral harassment. These health professionals were at increased risk for developing psychiatric illness such depressive and anxious disorders and addictive behavior. Our results suggest the necessity of preventive strategies of occupational psychosocial constraints in order to preserve professional’s mental health and maximize patient safety and quality of care.

Keywords: health care sector, intensive care units, mental health, psychosocial constraints

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518 SME Internationalisation and Its Financing: An Exploratory Study That Analyses Government Support and Funding Mechanisms for Irish and Scottish International SMEs

Authors: L. Spencer, S. O’ Donohoe

Abstract:

Much of the research to date on internationalisation relates to large firms with much less known about how small and medium-sized enterprises (SMEs) engage in internationalisation. Given the crucial role of SMEs in contributing to economic growth, there is now an emphasis on the need for SMEs internationalise. Yet little is known about how SMEs undertake and finance such expansion and whether or not internationalisation actually hinders or helps them in securing finance. The purpose of this research is to explore the internationalisation process for SMEs, the sources of funding used in financing this expansion and support received from the state agencies in assisting their overseas expansion. A conceptual framework has been devised which marries the two strands of literature together (internationalisation and financing the firm). The exploratory nature of this research dictates that the most appropriate methodology was to use semi-structured interviews with SME owners; bank representatives and support agencies. In essence, a triangulated approach to the research problem facilitates assessment of the perceptions and experiences from firms, the state and the financial institutions. Our sample is drawn from SMEs operating in Ireland and Scotland, two small but very open economies where SMEs are the dominant form of organisation. The sample includes a range of industry sectors. Key findings to date suggest some SMEs are born global; others are born again global whilst a significant cohort can be classed as traditional internationalisers. Unsurprisingly there is a strong industry effect with firms in the high tech sector more likely to be faster internationalisers in contrast to those in the traditional manufacturing sectors. Owner manager’s own funds are deemed key to financing initial internationalisation lending support for the financial growth life cycle model albeit more important for the faster internationalisers in contrast to the slower cohort who are more likely to deploy external sources especially bank finance. Retained earnings remain the predominant source of on-going financing for internationalising firms but trade credit is often used and invoice discounting is utilised quite frequently. In terms of lending, asset based lending backed by personal guarantees appears paramount for securing bank finance. Whilst the lack of diversified sources of funding for internationalising SMEs was found in both jurisdictions there appears no evidence to suggest that internationalisation impedes firms in securing finance. Finally state supports were cited as important to the internationalisation process, in particular those provided by Enterprise Ireland were deemed very valuable. Considering the paucity of studies to date on SME internationalisation and in particular the funding mechanisms deployed by them; this study seeks to contribute to the body of knowledge in both the international business and finance disciplines.

Keywords: funding, government support, international pathways, modes of entry

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