Search results for: Christina Irene D. Mejia

Authors: Christina Van Wingerden

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This paper focuses on a sense of belonging, isolation, and the use of a learning management system as a “third space” for connection and community. Given student use of learning management systems (LMS) for courses on campuses, moderate to high use of social media and hand-held devices, the author explores the possibilities of LMS as a third space. The COVID-19 pandemic has exacerbated student experiences of isolation, and research indicates that students who experience a sense of belonging have a greater likelihood for academic retention and success. The impacts on students of an LMS designed for student employee orientation and training were examined through a mixed methods approach, including a survey, individual interviews, and focus groups. The sample involved 250-450 undergraduate student employees at a US northwestern university. The goal of the study was to find out the efficiency and effectiveness of the orientation information for a wide range of student employees from multiple student affairs departments. And unexpected finding emerged within the study in 2015 and was noted again as a finding in the 2017 study. Students reported feeling like they individually connected to the department, and further to the university because of the LMS orientation. They stated they could see themselves as part of the university community and like they belonged. The orientation, through the LMS, was designed for and occurred online (asynchronous), prior to students traveling and beginning university life for the academic year. The students indicated connection and belonging resulting from some of the design features. With the onset of COVID-19 and prolonged sheltering in place in North America, as well as other parts of the world, students have been precluded from physically gathering to educate and learn. COVID-19 essentially paused face-to-face education in 2020. Media, governments, and higher education outlets have been reporting on widespread college student stress, isolation, loneliness, and sadness. In this context, the author conducted a current mixed methods study (online survey, online interviews) of students in advanced degree programs, like Ph.D. and Ed.D. specifically investigating isolation and sense of belonging. As a part of the study a prototype of a Canvas site was experienced by student interviewees for their reaction of this Canvas site prototype as a “third” space. Some preliminary findings of this study are presented. Doctoral students in the study affirmed the potential of LMS as a third space for community and social academic connection.

Keywords: COVID-19, isolation, learning management system, sense of belonging

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Authors: Clara Tramuta, Floris Irene, Daniela Manila Bianchi, Monica Pitti, Giulia Federica Cazzaniga, Lucia Decastelli

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This work presents the results obtained by the Regional Reference Centre for Salmonella Typing (CeRTiS) in a retrospective study aimed to investigate, through Pulsed-field Gel Electrophoresis (PFGE) analysis, the genetic relatedness of emerging Salmonella serotypes of human origin circulating in North-West of Italy. Furthermore, the goal of this work was to create a Regional database to facilitate foodborne outbreak investigation and to monitor them at an earlier stage. A total of 112 strains, isolated from 2016 to 2018 in hospital laboratories, were included in this study. The isolates were previously identified as Salmonella according to standard microbiological techniques and serotyping was performed according to ISO 6579-3 and the Kaufmann-White scheme using O and H antisera (Statens Serum Institut®). All strains were characterized by PFGE: analysis was conducted according to a standardized PulseNet protocol. The restriction enzyme XbaI was used to generate several distinguishable genomic fragments on the agarose gel. PFGE was performed on a CHEF Mapper system, separating large fragments and generating comparable genetic patterns. The agarose gel was then stained with GelRed® and photographed under ultraviolet transillumination. The PFGE patterns obtained from the 112 strains were compared using Bionumerics version 7.6 software with the Dice coefficient with 2% band tolerance and 2% optimization. For each serotype, the data obtained with the PFGE were compared according to the geographical origin and the year in which they were isolated. Salmonella strains were identified as follow: S. Derby n. 34; S. Infantis n. 38; S. Napoli n. 40. All the isolates had appreciable restricted digestion patterns ranging from approximately 40 to 1100 kb. In general, a fairly heterogeneous distribution of pulsotypes has emerged in the different provinces. Cluster analysis indicated high genetic similarity (≥ 83%) among strains of S. Derby (n. 30; 88%), S. Infantis (n. 36; 95%) and S. Napoli (n. 38; 95%) circulating in north-western Italy. The study underlines the genomic similarities shared by the emerging Salmonella strains in Northwest Italy and allowed to create a database to detect outbreaks in an early stage. Therefore, the results confirmed that PFGE is a powerful and discriminatory tool to investigate the genetic relationships among strains in order to monitoring and control Salmonellosis outbreak spread. Pulsed-field gel electrophoresis (PFGE) still represents one of the most suitable approaches to characterize strains, in particular for the laboratories for which NGS techniques are not available.

Keywords: emerging Salmonella serotypes, genetic characterization, human strains, PFGE

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Authors: Jannis Kountouras, Nikolaos Kapetanakis, Stergios A. Polyzos, Apostolis Papaeftymiou, Panagiotis Katsinelos, Ioannis Venizelos, Christina Nikolaidou, Christos Zavos, Iordanis Romiopoulos, Elena Tsiaousi, Evangelos Kazakos, Michael Doulberis

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Background & Aims: Helicobacter pylori infection (Hp-I) has been recognized as a substantial risk agent involved in gastrointestinal (GI) tract oncogenesis by stimulating cancer stem cells (CSCs), oncogenes, immune surveillance processes, and triggering GI microbiota dysbiosis. We aimed to investigate the possible involvement of active Hp-I in the sequence: chronic inflammation–adenoma–colorectal cancer (CRC) development. Methods: Four pillars were investigated: (i) endoscopic and conventional histological examinations of patients with CRC, colorectal adenomas (CRA) versus controls to detect the presence of active Hp-I; (ii) immunohistochemical determination of the presence of Hp; expression of CD44, an indicator of CSCs and/or bone marrow-derived stem cells (BMDSCs); expressions of oncogene Ki67 and anti-apoptotic Bcl-2 protein; (iii) expression of CD45, indicator of immune surveillance locally (assessing mainly T and B lymphocytes locally); and (iv) correlation of the studied parameters with the presence or absence of Hp-I. Results: Among 50 patients with CRC, 25 with CRA, and 10 controls, a significantly higher presence of Hp-I in the CRA (68%) and CRC group (84%) were found compared with controls (30%). The presence of Hp-I with accompanying immunohistochemical expression of CD44 in biopsy specimens was revealed in a high proportion of patients with CRA associated with moderate/severe dysplasia (88%) and CRC patients with moderate/severe degree of malignancy (91%). Comparable results were also obtained for Ki67, Bcl-2, and CD45 immunohistochemical expressions. Concluding Remarks: Hp-I seems to be involved in the sequence: CRA – dysplasia – CRC, similarly to the upper GI tract oncogenesis, by several pathways such as the following: Beyond Hp-I associated insulin resistance, the major underlying mechanism responsible for the metabolic syndrome (MetS) that increase the risk of colorectal neoplasms, as implied by other Hp-I related MetS pathologies, such as non-alcoholic fatty liver disease and upper GI cancer, the disturbance of the normal GI microbiota (i.e., dysbiosis) and the formation of an irritative biofilm could contribute to a perpetual inflammatory upper GIT and colon mucosal damage, stimulating CSCs or recruiting BMDSCs and affecting oncogenes and immune surveillance processes. Further large-scale relative studies with a pathophysiological perspective are necessary to demonstrate in-depth this relationship.

Keywords: Helicobacter pylori, colorectal cancer, colorectal adenomas, gastrointestinal oncogenesis

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Authors: Sofia Mariani, Irene Leo

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The objective of the present study is to define the mediating role of attitudes that objectify and devalue women (hostile sexism, benevolent sexism, and sexual objectification of women) in the indirect correlation between exposure to televised sports and acceptance of rape myths. A second goal is to contribute to research on the topic by defining the role of mediators in exposure to different types of sports, following the traditional gender classification of sports. Data collection was carried out by means of an online questionnaire, measuring television sport exposure, sport type, hostile sexism, benevolent sexism, and sexual objectification of women. Data analysis was carried out using IBM SPSS software. The model used was created using Ordinary Least Squares (OLS) regression path analysis. The predictor variable in the model was television sports exposure, the outcome was rape myths acceptance, and the mediators were (1) hostile sexism, (2) benevolent sexism, and (3) sexual objectification of women. Correlation analyses were carried out dividing by sport type and controlling for the participants’ gender. As seen in existing literature, television sports exposure was found to be indirectly and positively related to rape myth acceptance through the mediating role of: (1) hostile sexism, (2) benevolent sexism, and (3) sexual objectification of women. The type of sport watched influenced the role of the mediators: hostile sexism was found to be the common mediator to all sports type, exposure to traditionally considered feminine or neutral sports showed the additional mediation effect of sexual objectification of women. In line with existing literature, controlling for gender showed that the only significant mediators were hostile sexism for male participants and benevolent sexism for female participants. Given the prevalence of men among the viewers of traditionally considered masculine sports, the correlation between television sports exposure and rape myth acceptance through the mediation of hostile sexism is likely due to the gender of the participants. However, this does not apply to the viewers of traditionally considered feminine and neutral sports, as this group is balanced in terms of gender and shows a unique mediation: the correlation between television sports exposure and rape myth acceptance is mediated by both hostile sexism and sexual objectification. Given that hostile sexism is defined as hostility towards women who oppose or fail to conform to traditional gender roles, these findings confirm that sport is perceived as a non-traditional activity for women. Additionally, these results imply that the portrayal of women in traditionally considered feminine and neutral sports - which are defined as such because of their aesthetic characteristics - may have a strong component of sexual objectification of women. The present research contributes to defining the association between sports exposure and rape myth acceptance through the mediation effects of sexist attitudes and sexual objectification of women. The results of this study have practical implications, such as supporting the feminine sports teams who ask for more practical and less revealing uniforms, more similar to their male colleagues and therefore less objectifying.

Keywords: television exposure, sport, rape myths, objectification, sexism

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Authors: Irene Capecchi, Tommaso Borghini, Iacopo Bernetti

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One of the most common pieces of equipment still used today for pruning, felling, and processing trees is the chainsaw in forestry. However, chainsaw use highlights dangers and one of the highest rates of accidents in both professional and non-professional work. Felling is proportionally the most dangerous phase, both in severity and frequency, because of the risk of being hit by the plant the operator wants to cut down. To avoid this, a correct sequence of chainsaw cuts must be taught concerning the different conditions of the tree. Virtual reality (VR) makes it possible to virtually simulate chainsaw use without danger of injury. The limitations of the existing applications are as follow. The existing platforms are not symmetrical collaborative because the trainee is only in virtual reality, and the trainer can only see the virtual environment on a laptop or PC, and this results in an inefficient teacher-learner relationship. Therefore, most applications only involve the use of a virtual chainsaw, and the trainee thus cannot feel the real weight and inertia of a real chainsaw. Finally, existing applications simulate only a few cases of tree felling. The objectives of this research were to implement and test a symmetrical collaborative training application based on VR and mixed reality (MR) with the overlap between real and virtual chainsaws in MR. The research and training platform was developed for the Meta quest 2 head-mounted display. The research and training platform application is based on the Unity 3D engine, and Present Platform Interaction SDK (PPI-SDK) developed by Meta. PPI-SDK avoids the use of controllers and enables hand tracking and MR. With the combination of these two technologies, it was possible to overlay a virtual chainsaw with a real chainsaw in MR and synchronize their movements in VR. This ensures that the user feels the weight of the actual chainsaw, tightens the muscles, and performs the appropriate movements during the test allowing the user to learn the correct body posture. The chainsaw works only if the right sequence of cuts is made to felling the tree. Contact detection is done by Unity's physics system, which allows the interaction of objects that simulate real-world behavior. Each cut of the chainsaw is defined by a so-called collider, and the felling of the tree can only occur if the colliders are activated in the right order simulating a safe technique felling. In this way, the user can learn how to use the chainsaw safely. The system is also multiplayer, so the student and the instructor can experience VR together in a symmetrical and collaborative way. The platform simulates the following tree-felling situations with safe techniques: cutting the tree tilted forward, cutting the medium-sized tree tilted backward, cutting the large tree tilted backward, sectioning the trunk on the ground, and cutting branches. The application is being evaluated on a sample of university students through a special questionnaire. The results are expected to test both the increase in learning compared to a theoretical lecture and the immersive and telepresence of the platform.

Keywords: chainsaw, collaborative symmetric virtual reality, mixed reality, operator training

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Authors: T. S. Terence Ma, Irene T. Ho

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Conducting adequate assessment of the challenges students with ASD (Autism Spectrum Disorder) face and the support they need is imperative for promoting their school adjustment. Students with ASD often show deficits in communication, social interaction, emotional regulation, and self-management in learning. While targeting these areas in intervention is often helpful, we argue that not enough attention has been paid to weak self-regulation being a key factor underlying their manifest difficulty in all these areas. Self-regulation refers to one’s ability to moderate their behavioral or affective responses without assistance from others. Especially for students with high functioning autism, who often show problems not so much in acquiring the needed skills but rather in applying those skills appropriately in everyday problem-solving, self-regulation becomes a key to successful adjustment in daily life. Therefore, a greater understanding of the construct of self-regulation, its relationship with other daily skills, and its role in school functioning for students with ASD would generate insights on how students’ school adjustment could be promoted more effectively. There were two focuses in this study. Firstly, we examined the extent to which self-regulation is a distinct construct that is differentiable from other daily skills and the most salient indicators of this construct. Then we tested a model of relationships between self-regulation and other daily school skills as well as their relative and combined effects on school adjustment. A total of 1,345 Grade1 to Grade 6 students with ASD attending mainstream schools in Hong Kong participated in the research. In the first stage of the study, teachers filled out a questionnaire consisting of 136 items assessing a wide range of student skills in social, emotional and learning areas. Results from exploratory factor analysis (EFA) with 673 participants and subsequent confirmatory factor analysis (CFA) with another group of 672 participants showed that there were five distinct factors of school skills, namely (1) communication skills, (2) pro-social behavior, (3) emotional skills, (4) learning management, and (5) self-regulation. Five scales representing these skill dimensions were generated. In the second stage of the study, a model postulating the mediating role of self-regulation for the effects of the other four types of skills on school adjustment was tested with structural equation modeling (SEM). School adjustment was defined in terms of the extent to which the student is accepted well in school, with high engagement in school life and self-esteem as well as good interpersonal relationships. A 5-item scale was used to assess these aspects of school adjustment. Results showed that communication skills, pro-social behavior, emotional skills and learning management had significant effects on school adjustment only indirectly through self-regulation, and their total effects were found to be not high. The results indicate that support rendered to students with ASD focusing only on the training of well-defined skills is not adequate for promoting their inclusion in school. More attention should be paid to the training of self-management with an emphasis on the application of skills backed by self-regulation. Also, other non-skill factors are important in promoting inclusive education.

Keywords: autism, assessment, factor analysis, self-regulation, school adjustment

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Authors: Cheyenne Johnson, Samantha Robinson, Christina Chant, Ann M. Mitchell, Carol Price, Carmel Clancy, Adam Searby, Deborah S. Finnell

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Introduction: Substance use along the continuum from at-risk use to a substance use disorder (SUD) contributes substantially to the burden of disease and related harms worldwide. There is a growing body of literature that highlights the lack of substance use related content in nursing curricula. Furthermore, there is also a lack of consensus on key competencies necessary for entry-level nurses. Globally, there is a lack of established nursing competencies related to prevention, health promotion, harm reduction and treatment of at-risk substance use and SUDs. At a critical time in public health, this gap in nursing curricula contributes to a lack of preparation for entry-level nurses to support people along the continuum of substance use. Thus, in practice, early opportunities for screening, support, and interventions may be missed. To address this gap, an international committee was convened to develop international entry-level nursing competencies specifying the knowledge, skills, and abilities that all nurses should possess in order to address the continuum of substance use. Methodology: An international steering committee, including representation from Canada, United States, United Kingdom, and Australia was established to lead this work over a one-year time period. The steering committee conducted a scoping review, undertaken to examine nursing competency frameworks, and to inform a competency structure that would guide this work. The next steps were to outline key competency areas and establish leaders for working groups to develop the competencies. In addition, a larger international committee was gathered to contribute to competency working groups, review the collective work and concur on the final document. Findings: A comprehensive framework was developed with competencies covering a wide spectrum of substance use across the lifespan and in the context of prevention, health promotion, harm reduction and treatment, including special populations. The development of this competency-based framework meets an identified need to provide guidance for universities, health authorities, policy makers, nursing regulators and other organizations that provide and support nursing education which focuses on care for patients and families with at-risk substance use and SUDs. Conclusion: Utilizing these global competencies as expected outcomes of an educational and skill building curricula for entry-level nurses holds great promise for incorporating evidence-informed training in the care and management of people across the continuum of substance use.

Keywords: addiction nursing, addiction nursing curriculum, competencies, substance use

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Authors: Velitchko G. Tzatchkov, Petronilo E. Cortes-Mejia, J. Manuel Rodriguez-Varela, Jesus Figueroa-Vazquez

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Hydraulic headloss, expressed by the values of friction factor f and Manning’s coefficient n, is an important parameter in designing drainage pipes. Their values normally are taken from manufacturer recommendations, many times without sufficient experimental support. To our knowledge, currently there is no standard procedure for hydraulically testing such pipes. As a result of research carried out at the Mexican Institute of Water Technology, a laboratory testing procedure was proposed and applied on 6 and 12 inches diameter polyvinyl chloride (PVC) and high-density dual wall polyethylene pipe (HDPE) drainage pipes. While the PVC pipe is characterized by naturally smooth interior and exterior walls, the dual wall HDPE pipe has corrugated exterior wall and, although considered smooth, a slightly wavy interior wall. The pipes were tested at full and partially full pipe flow conditions. The tests for full pipe flow were carried out on a 31.47 m long pipe at flow velocities between 0.11 and 4.61 m/s. Water was supplied by gravity from a 10 m-high tank in some of the tests, and from a 3.20 m-high tank in the rest of the tests. Pressure was measured independently with piezometer readings and pressure transducers. The flow rate was measured by an ultrasonic meter. For the partially full pipe flow the pipe was placed inside an existing 49.63 m long zero slope (horizontal) channel. The flow depth was measured by piezometers located along the pipe, for flow rates between 2.84 and 35.65 L/s, measured by a rectangular weir. The observed flow profiles were then compared to computer generated theoretical gradually varied flow profiles for different Manning’s n values. It was found that Manning’s n, that normally is assumed constant for a given pipe material, is in fact dependent on flow velocity and pipe diameter for full pipe flow, and on flow depth for partially full pipe flow. Contrary to the expected higher values of n and f for the HDPE pipe, virtually the same values were obtained for the smooth interior wall PVC pipe and the slightly wavy interior wall HDPE pipe. The explanation of this fact was found in Henry Morris’ theory for smooth turbulent conduit flow over isolated roughness elements. Following Morris, three categories of the flow regimes are possible in a rough conduit: isolated roughness (or semi smooth turbulent) flow, wake interference (or hyper turbulent) flow, and skimming (or quasi-smooth) flow. Isolated roughness flow is characterized by friction drag turbulence over the wall between the roughness elements, independent vortex generation, and dissipation around each roughness element. In this regime, the wake and vortex generation zones at each element develop and dissipate before attaining the next element. The longitudinal spacing of the roughness elements and their height are important influencing agents. Given the slightly wavy form of the HDPE pipe interior wall, the flow for this type of pipe belongs to this category. Based on that theory, an equation for the hydraulic friction factor was obtained. The obtained coefficient values are going to be used in the Mexican design standards.

Keywords: drainage plastic pipes, hydraulic headloss, hydraulic friction factor, Manning’s n

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Authors: Katie Dolaghan, Christina Tran, Kim Hamilton, Amanda Beresford, Vicky Adams, Jamie Toole, John Marley

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During the Covid 19 pandemic routine outpatient appointments were not possible face to face. That resulted in many branches of healthcare starting virtual clinics. These clinics have continued following the return to face to face patient appointments. With these new types of clinic it is important to ensure that a high standard of patient care is maintained. In order to improve patient and clinician experience of the telephone clinics a quality improvement project was carried out to ensure the patient and clinician experience of these clinics was enhanced whilst remaining a safe, effective and an efficient use of resources. The project began by developing a process map for the consultation process and agreed on the design of a driver diagram and tests of change. In plan do study act (PDSA) cycle1 a single consultant completed an online survey after every patient encounter over a 5 week period. Baseline patient responses were collected using a follow-up telephone survey for each patient. Piloting led to several iterations of both survey designs. Salient results of PDSA1 included; patients not receiving appointment letters, patients feeling more anxious about a virtual appointment and many would prefer a face to face appointment. The initial clinician data showed a positive response with a provisional diagnosis being reached in 96.4% of encounters. PDSA cycle 2 included provision of a patient information sheet and information leaflets relevant to the patients’ conditions were developed and sent following new patient telephone clinics with follow-up survey analysis as before to monitor for signals of change. We also introduced the ability for patients to send an images of their lesion prior to the consultation. Following the changes implemented we noted an improvement in patient satisfaction and, in fact, many patients preferring virtual clinics as it lead to less disruption of their working lives. The extra reading material both before and after the appointments eased patients’ anxiety around virtual clinics and helped them to prepare for their appointment. Following the patient feedback virtual clinics are now used for review patients as well, with all four consultants within the department continuing to utilise virtual clinics. During this presentation the progression of these clinics and the reasons that these clinics are still operating following the return to face to face appointments will be explored. The lessons that have been gained using a QI approach have helped to deliver an optimal service that is valid and reliable as well as being safe, effective and efficient for the patient along with helping reduce the pressures from ever increasing waiting lists. In summary our work in improving the quality of virtual clinics has resulted in improved patient satisfaction along with reduced pressures on the facilities of the health trust.

Keywords: clinic, satisfaction, telephone, virtual

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Authors: Christina Klippel, Lucia Pezzi, Silvio Neto, Rafael Bertani, Priscila Mendes, Flavio Machado, Aline Szeliga, Maria Cosendey, Adilson Mariz, Raquel Santos, Lys Bendett, Pedro Velasco, Thalita Rolleigh, Bruna Bellote, Daria Coelho, Bruna Martins, Julia Almeida, Juliana Cerqueira

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This project presents a framework for teaching intracranial pressure monitoring (ICP) concepts using a low-cost experimental model in a neurointensive care education program. Data concerning ICP monitoring contribute to the patient's clinical assessment and may dictate the course of action of a health team (nursing, medical staff) and influence decisions to determine the appropriate intervention. This study aims to present a safe method for teaching ICP monitoring to medical students in a Simulation Center. Methodology: Medical school teachers, along with students from the 4th year, built an experimental model for teaching ICP measurement. The model consists of a mannequin's head with a plastic bag inside simulating the cerebral ventricle and an inserted ventricular catheter connected to the ICP monitoring system. The bag simulating the ventricle can also be changed for others containing bloody or infected simulated cerebrospinal fluid. On the mannequin's ear, there is a blue point indicating the right place to set the "zero point" for accurate pressure reading. The educational program includes four steps: 1st - Students receive a script on ICP measurement for reading before training; 2nd - Students watch a video about the subject created in the Simulation Center demonstrating each step of the ICP monitoring and the proper care, such as: correct positioning of the patient, anatomical structures to establish the zero point for ICP measurement and a secure range of ICP; 3rd - Students train the procedure in the model. Teachers help students during training; 4th - Student assessment based on a checklist form. Feedback and correction of wrong actions. Results: Students expressed interest in learning ICP monitoring. Tests concerning the hit rate are still being performed. ICP's final results and video will be shown at the event. Conclusion: The study of intracranial pressure measurement based on an experimental model consists of an effective and controlled method of learning and research, more appropriate for teaching neurointensive care practices. Assessment based on a checklist form helps teachers keep track of student learning progress. This project offers medical students a safe method to develop intensive neurological monitoring skills for clinical assessment of patients with neurological disorders.

Keywords: neurology, intracranial pressure, medical education, simulation

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Authors: Andrea Pietrelli, Vincenzo Ferrara, Bruno Allard, Francois Buret, Irene Bavasso, Nicola Lovecchio, Francesca Costantini, Firas Khaled

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This paper aims to show some applications of microbial fuel cells (MFCs), an energy harvesting technique, as clean power source to supply low power device for application like wireless sensor network (WSN) for environmental monitoring. Furthermore, MFC can be used directly as biosensor to analyse parameters like pH and temperature or arranged in form of cluster devices in order to use as small power plant. An MFC is a bioreactor that converts energy stored in chemical bonds of organic matter into electrical energy, through a series of reactions catalysed by microorganisms. We have developed a lab-scale terrestrial microbial fuel cell (TMFC), based on soil that acts as source of bacteria and flow of nutrient and a lab-scale waste water microbial fuel cell (WWMFC), where waste water acts as flow of nutrient and bacteria. We performed large series of tests to exploit the capability as biosensor. The pH value has strong influence on the open circuit voltage (OCV) delivered from TMFCs. We analyzed three condition: test A and B were filled with same soil but changing pH from 6 to 6.63, test C was prepared using a different soil with a pH value of 6.3. Experimental results clearly show how with higher pH value a higher OCV was produced; indeed reactors are influenced by different values of pH which increases the voltage in case of a higher pH value until the best pH value of 7 is achieved. The influence of pH on OCV of lab-scales WWMFC was analyzed at pH value of 6.5, 7, 7.2, 7.5 and 8. WWMFCs are influenced from temperature more than TMFCs. We tested the power performance of WWMFCs considering four imposed values of ambient temperature. Results show how power performance increase proportionally with higher temperature values, doubling the output power from 20° to 40°. The best value of power produced from our lab-scale TMFC was equal to 310 μW using peaty soil, at 1KΩ, corresponding to a current of 0.5 mA. A TMFC can supply proper energy to low power devices of a WSN by means of the design of three stages scheme of an energy management system, which adapts voltage level of TMFC to those required by a WSN node, as 3.3V. Using a commercial DC/DC boost converter, that needs an input voltage of 700 mV, the current source of 0.5 mA, charges a capacitor of 6.8 mF until it will have accumulated an amount of charge equal to 700 mV in a time of 10 s. The output stage includes an output switch that close the circuit after a time of 10s + 1.5ms because the converter can boost the voltage from 0.7V to 3.3V in 1.5 ms. Furthermore, we tested in form of clusters connected in series up to 20 WWMFCs, we have obtained a high voltage value as output, around 10V, but low current value. MFC can be considered a suitable clean energy source to be used to supply low power devices as a WSN node or to be used directly as biosensor.

Keywords: energy harvesting, low power electronics, microbial fuel cell, terrestrial microbial fuel cell, waste-water microbial fuel cell, wireless sensor network

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Authors: Sandra Christina Gressler

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Resting is essentially the physical and mental relaxation. So, can behaviors that go beyond the merely physical relaxation to some extent be understood as a behavior of restoration? Studies on restorative environments emphasize the physical, mental and social benefits that some environments can provide and suggest that activities in natural environments reduce the stress of daily lives, promoting recovery against the daily wear. These studies, though specific in their results, do not unify the different possibilities of restoration. Considering the importance of restorative environments by promoting well-being, this research aims to verify the applicability of the theory on restorative environments in a Brazilian context, inquiring about the environment/behavior of rest. The research sought to achieve its goals by; a) identifying daily ways of how participants interact/connect with nature; b) identifying the resting environments/behavior; c) verifying if rest strategies match the restorative environments suggested by restorative studies; and d) verifying different rest strategies related to time. Workers from different companies in which certain functions require focused attention, and high school students from different schools, participated in this study. An interview was used to collect data and information. The data obtained were compared with studies of attention restoration theory and stress recovery. The collected data were analyzed through the basic descriptive inductive statistics and the use of the software ALCESTE® (Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte). The open questions investigate perception of nature on a daily basis – analysis using ALCESTE; rest periods – daily, weekends and holidays – analysis using ALCESTE with tri-croisé; and resting environments and activities – analysis using a simple descriptive statistics. According to the results, environments with natural characteristics that are compatible with personal desires (physical aspects and distance) and residential environments when they fulfill the characteristics of refuge, safety, and self-expression, characteristics of primary territory, meet the requirements of restoration. Analyzes suggest that the perception of nature has a wide range that goes beyond the objects nearby and possible to be touched, as well as observation and contemplation of details. The restoration processes described in the studies of attention restoration theory occur gradually (hierarchically), starting with being away, following compatibility, fascination, and extent. They are also associated with the time that is available for rest. The relation between rest behaviors and the bio-demographic characteristics of the participants are noted. It reinforces, in studies of restoration, the need to insert not only investigations regarding the physical characteristics of the environment but also behavior, social relationship, subjective reactions, distance and time available. The complexity of the theme indicates the necessity for multimethod studies. Practical contributions provide subsidies for developing strategies to promote the welfare of the population.

Keywords: attention restoration theory, environmental psychology, rest behavior, restorative environments

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Authors: Christian Andrä, Luisa Zimmermann, Christina Müller

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Introduction: The positive relation between physical activity and cognition is commonly known. Relevant studies show that in everyday school life active breaks can lead to improvement in certain abilities (e.g. attention and concentration). A beneficial effect is in particular attributed to moderate activity. It is still unclear whether active breaks are beneficial after relatively short phases of cognitive load and whether the postulated effects of activity really have an immediate impact. The objective of this study was to verify whether an active break after 18 minutes of cognitive load leads to enhanced attention/concentration performance, compared to inactive breaks with voluntary mobile phone activity. Methodology: For this quasi-experimental study, 36 students [age: 14.0 (mean value) ± 0.3 (standard deviation); male/female: 21/15] of a secondary school were tested. In week 1, every student’s maximum heart rate (Hfmax) was determined through maximum effort tests conducted during physical education classes. The task was to run 3 laps of 300 m with increasing subjective effort (lap 1: 60%, lap 2: 80%, lap 3: 100% of the maximum performance capacity). Furthermore, first attention/concentration tests (D2-R) took place (pretest). The groups were matched on the basis of the pretest results. During week 2 and 3, crossover testing was conducted, comprising of 18 minutes of cognitive preload (test for concentration performance, KLT-R), a break and an attention/concentration test after a 2-minutes transition. Different 10-minutes breaks (active break: moderate physical activity with 65% Hfmax or inactive break: mobile phone activity) took place between preloading and transition. Major findings: In general, there was no impact of the different break interventions on the concentration test results (symbols processed after physical activity: 185.2 ± 31.3 / after inactive break: 184.4 ± 31.6; errors after physical activity: 5.7 ± 6.3 / after inactive break: 7.0. ± 7.2). There was, however, a noticeable development of the values over the testing periods. Although no difference in the number of processed symbols was detected (active/inactive break: period 1: 49.3 ± 8.8/46.9 ± 9.0; period 2: 47.0 ± 7.7/47.3 ± 8.4; period 3: 45.1 ± 8.3/45.6 ± 8.0; period 4: 43.8 ± 7.8/44.6 ± 8.0), error rates decreased successively after physical activity and increased gradually after an inactive break (active/inactive break: period 1: 1.9 ± 2.4/1.2 ± 1.4; period 2: 1.7 ± 1.8/ 1.5 ± 2.0, period 3: 1.2 ± 1.6/1.8 ± 2.1; period 4: 0.9 ± 1.5/2.5 ± 2.6; p= .012). Conclusion: Taking into consideration only the study’s overall results, the hypothesis must be dismissed. However, more differentiated evaluation shows that the error rates decreased after active breaks and increased after inactive breaks. Obviously, the effects of active intervention occur with a delay. The 2-minutes transition (regeneration time) used for this study seems to be insufficient due to the longer adaptation time of the cardio-vascular system in untrained individuals, which might initially affect the concentration capacity. To use the positive effects of physical activity for teaching and learning processes, physiological characteristics must also be considered. Only this will ensure optimum ability to perform.

Keywords: active breaks, attention/concentration test, cognitive performance capacity, heart rate, physical activity

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Authors: Ioanna Garefi, Irene Kalemaki

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Education is not solely about preparing young people for the world of work but also about equipping them with competences that will enable them to become socially proactive, empowered, responsible, and engaged citizens who will collectively contribute to and benefit from an inclusive and sustainable future. Hence, progress assessment towards competence development is an ongoing process where continuous efforts are needed. This paper abstract presents the work of the H2020 NEMESIS project that aims to investigate, experiment and co-create together with schools a model for introducing and embedding social innovation education (SIE henceforth) in European primary and secondary schools. All in all, during the 2018-2019 academic year, 8 schools from 5 European countries involving 56 teachers, 1030 students, and 80 external stakeholders, experimented with different methodologies for embedding SIE in their contexts. This paper captures briefly the impact of these efforts towards the cultivation and progression of students’ social innovation (SI henceforth) competences. As part of the model, 14 SI competences, whose progress was evaluated, have been introduced falling under 3 interrelated categories: competences for identifying opportunities for social and collective value creation, competences for developing collaborations and building meaningful relations and competences for taking action both on an individual and collective level. Methodologically wise, the evaluation strategy employed was informed by a realist approach, enabling the researchers to go beyond synthesizing 'what happened' and towards understanding 'why it happened', delving into ‘what works, for whom and in what circumstances’. The reason for choosing such an approach was because it goes beyond attempting to answer the basic yes or no question of evaluation and focus on an ‘explanatory quest’ tracing the limits of when and where intervention is effective. A rich mix of sources of evidence have been employed, from focus groups with 80 people from the 5 EU countries to an online survey to 206 students, classroom observations, students’ narratives granting them with the opportunity to freely express their opinions, short stories letting students express their feelings through their imagination and also, drawings so that younger children can express their perception of reality. All these evidences offered insights on the impact of SIE on the development of students’ competences. Research findings showed that students progressed in all 14 SI competences through their involvement in the different activities. This positive progression is attributed to the model’s three core principles: 1) the student-centered approach, rendering students active and self-determined producers of their own learning, 2) the co-creation process fostering intergenerational interactions, empowering thus students by making their voices heard and valued and also, 3) the transformative social action whereby through their projects, students are able to witness the impact they are bringing about with their actions. Concluding, these initial findings, together with the forthcoming evaluation research to a pool of 30 schools around Europe, have the potential to raise the dynamics of the under-investigated field of SIE and encourage its embeddedness in more schools around Europe.

Keywords: competence development, education, social innovation, students

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Authors: Claudio Di Benedetto, Irene Bengo

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The objective of the paper is to study how large European companies develop social business (SB) at the base of the economic pyramid (BoP). BoP markets are defined as the four billions people living with an annual income below $3,260 in local purchasing power. Despite they are heterogeneous in terms of geographic range they present some common characteristics: the presence of significant unmet (social) needs, high level of informal economy and the so-called ‘poverty penalty’. As a result, most people living at BoP are excluded from the value created by the global market economy. But it is worth noting, that BoP population with an aggregate purchasing power of around $5 trillion a year, represent a huge opportunity for companies that want to enhance their long-term profitability perspective. We suggest that in this context, the development of SB is, for companies, an innovative and promising way to satisfy unmet social needs and to experience new forms of value creation. Indeed, SB can be considered a strategic model to develop CSR programs that fully integrate the social dimension into the business to create economic and social value simultaneously. Despite in literature many studies have been conducted on social business, only few have explicitly analyzed such phenomenon from a company perspective and their role in the development of such initiatives remains understudied with fragmented results. To fill this gap the paper analyzes the key characteristics of the social business initiatives developed by European companies at BoP. The study was performed analyzing 1475 European companies participating in the United Nation Global Compact, the world’s leading corporate social responsibility program. Through the analysis of the corporate websites the study identifies companies that actually do SB at BoP. For SB initiatives identified, information were collected according to a framework adapted from the SB model developed by preliminary results show that more than one hundred European companies have already implemented social businesses at BoP accounting for the 6,5% of the total. This percentage increases to 15% if the focus is on companies with more than 10.440 employees. In terms of geographic distribution 80% of companies doing SB at BoP are located in western and southern Europe. The companies more active in promoting SB belong to financial sector (20%), energy sector (17%) and food and beverage sector (12%). In terms of social needs addressed almost 30% of the companies develop SB to provide access to energy and WASH, 25% of companies develop SB to reduce local unemployment or to promote local entrepreneurship and 21% of companies develop SB to promote financial inclusion of poor. In developing SB companies implement different social business configurations ranging from forms of outsourcing to internal development models. The study identifies seven main configurations through which company develops social business and each configuration present distinguishing characteristics respect to the involvement of the company in the management, the resources provided and the benefits achieved. By performing different analysis on data collected the paper provides detailed insights on how European companies develop SB at BoP.

Keywords: base of the economic pyramid, corporate social responsibility, social business, social enterprise

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Authors: Christina Y. P. Ting

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Migration is a global phenomenon with movements of migrants from developed and developing countries to the host societies. Migrants have changed the host countries’ demography – its population structure and also its ethnic cultural diversity. Acculturation of migrants in terms of their adoption of the host culture is seen as important to ensure that they ‘fit into’ their adopted country so as to participate in everyday public life. However, this research found that the increase of the China-born migrants’ post-migration consumption level had impact on Australia’s environment reflected not only because of their adoption of elements of the host culture, but also retention of aspects of Chinese culture – indicating that the influence of bi-culturalism was in operation. This research, which was based on the face-to-face interview with 61 China-born migrants in the suburb of Box Hill, Melbourne, investigated the pattern of change in the migrants’ consumption upon their settlement in Australia. Using an ecological footprint calculator, their post-migration footprints were found to be larger than pre-migration footprint. The uniquely-derived CALD (Culturally and Linguistically Diverse) Index was used to measure individuals’ strength of connectedness to ethnic culture. Multi-variant analysis was carried out to understand which independent factors that influence consumption best explain the change in footprint (which is the difference between pre-and post-migration footprints, as a dependent factor). These independent factors ranged from socio-economic and demographics to the cultural context, that is, the CALD Index and indicators of acculturation. The major findings from the analysis were: Chinese culture (as measured by the CALD Index) and indicators of acculturation such as length of residency and using English in communications besides the traditional factors such as age, income and education level made significant contributions to the large increase in the China-born group’s post-migration consumption level. This paper as part of a larger study found that younger migrants’ large change in their footprint were related to high income and low level of education. This group of migrants also practiced bi-cultural consumption in retaining ethnic culture and adopting the host culture. These findings have importantly highlighted that for a host society to tackle environmental crisis, governments need not only to understand the relationship between age and consumption behaviour, but also to understand and embrace the migrants’ ethnic cultures, which may act as bridges and/or fences in relationships. In conclusion, for governments to deal with national issues such as environmental crisis within a cultural diverse population, it necessitates an understanding of age and aspects of ethnic culture that may act as bridges and fences. This understanding can aid in putting in place policies that enable the co-existence of a hybrid of the ethnic and host cultures in order to create and maintain a harmonious and secured living environment for population groups.

Keywords: bicultural consumer, CALD index, consumption, ethnic culture, migrants

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Authors: Irene Kalemaki, Ioanna Garefi

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Social Innovation Education (SIE) is a new educational approach that aims to empower students to take action for a more democratic and sustainable society. Conceptually and pedagogically wise, it is situated at the intersection of Enterprise Education and Citizenship Education as it aspires to i) combine action with activism, ii) personal development with collective efficacy, iii) entrepreneurial mindsets with democratic values and iv) individual competences with collective competences. This paper abstract presents the work of the NEMESIS project, funded by H2020, that aims to design, test and validate the first consolidated approach for embedding Social Innovation Education in schools of primary and secondary education. During the academic year 2018-2019, eight schools from five European countries experimented with different approaches and methodologies to incorporate SIE in their settings. This paper reports briefly on these attempts and discusses the wider educational philosophy underlying these interventions with a particular focus on analyzing the learning outcomes and impact on students. That said, this paper doesn’t only report on the theoretical and practical underpinnings of SIE, but most importantly, it provides evidence on the impact of SIE on students. In terms of methodology, the study took place from September 2018 to July 2019 in eight schools from Greece, Spain, Portugal, France, and the UK involving directly 56 teachers, 1030 students and 69 community stakeholders. Focus groups, semi-structured interviews, classroom observations as well as students' written narratives were used to extract data on the impact of SIE on students. The overall design of the evaluation activities was informed by a realist approach, which enabled us to go beyond “what happened” and towards understanding “why it happened”. Research findings suggested that SIE can benefit students in terms of their emotional, cognitive, behavioral and agentic engagement. Specifically, the emotional engagement of students was increased because through SIE interventions; students voice was heard, valued, and acted upon. This made students feel important to their school, increasing their sense of belonging, confidence and level of autonomy. As regards cognitive engagement, both students and teachers reported positive outcomes as SIE enabled students to take ownership of their ideas to drive their projects forward and thus felt more motivated to perform in class because it felt personal, important and relevant to them. In terms of behavioral engagement, the inclusive environment and the collective relationships that were reinforced through the SIE interventions had a direct positive impact on behaviors among peers. Finally, with regard to agentic engagement, it has been observed that students became very proactive which was connected to the strong sense of ownership and enthusiasm developed during collective efforts to deliver real-life social innovations. Concluding, from a practical and policy point of view these research findings could encourage the inclusion of SIE in schools, while from a research point of view, they could contribute to the scientific discourse providing evidence and clarity on the emergent field of SIE.

Keywords: education, engagement, social innovation, students

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Authors: Irene Capecchi, Tommaso Borghini, Iacopo Bernetti

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An important tool for the enhancement of cultural sites is serious games (SG), i.e., games designed for educational purposes; SG is applied in cultural sites through trivia, puzzles, and mini-games for participation in interactive exhibitions, mobile applications, and simulations of past events. The combination of Augmented Reality (AR) and digital cultural content has also produced examples of cultural heritage recovery and revitalization around the world. Through AR, the user perceives the information of the visited place in a more real and interactive way. Another interesting technological development for the revitalization of cultural sites is the combination of AR and Global Positioning System (GPS), which integrated have the ability to enhance the user's perception of reality by providing historical and architectural information linked to specific locations organized on a route. To the author’s best knowledge, there are currently no applications that combine GPS AR and SG for cultural heritage revitalization. The present research focused on the development of an SG based on GPS and AR. The study area is the village of Caldana in Tuscany, Italy. Caldana is a fortified Renaissance village; the most important architectures are the walls, the church of San Biagio, the rectory, and the marquis' palace. The historical information is derived from extensive research by the Department of Architecture at the University of Florence. The storyboard of the SG is based on the history of the three characters who built the village: marquis Marcello Agostini, who was commissioned by Cosimo I de Medici, Grand Duke of Tuscany, to build the village, his son Ippolito and his architect Lorenzo Pomarelli. The three historical characters were modeled in 3D using the freeware MakeHuman and imported into Blender and Mixamo to associate a skeleton and blend shapes to have gestural animations and reproduce lip movement during speech. The Unity Rhubarb Lip Syncer plugin was used for the lip sync animation. The historical costumes were created by Marvelous Designer. The application was developed using the Unity 3D graphics and game engine. The AR+GPS Location plugin was used to position the 3D historical characters based on GPS coordinates. The ARFoundation library was used to display AR content. The SG is available in two versions: for children and adults. the children's version consists of finding a digital treasure consisting of valuable items and historical rarities. Players must find 9 village locations where 3D AR models of historical figures explaining the history of the village provide clues. To stimulate players, there are 3 levels of rewards for every 3 clues discovered. The rewards consist of AR masks for archaeologist, professor, and explorer. At the adult level, the SG consists of finding the 16 historical landmarks in the village, and learning historical and architectural information interactively and engagingly. The application is being tested on a sample of adults and children. Test subjects will be surveyed on a Likert scale to find out their perceptions of using the app and the learning experience between the guided tour and interaction with the app.

Keywords: augmented reality, cultural heritage, GPS, serious game

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Authors: Christos E. Lampropoulos, Maria Konsta, Vicky Dradaki, Irini Dri, Tamta Sirbilatze, Ifigenia Apostolou, Christina Kordali, Konstantina Panouria, Kostas Argyros, Georgios Mavras

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Malnutrition in hospitalized patients is related to increased morbidity and mortality. Purpose of our study was to assess nutritional status of hospitalized, elderly patients with various nutritional scores and to detect unfavorable prognostic factors, related to increased mortality and extended duration of admission. Methods: 150 patients (78 men, 72 women, mean age 80±8.2) were included in this cross-sectional study. Nutritional status was assessed by Mini Nutritional Assessment (MNA full, short-form), Malnutrition Universal Screening Tool (MUST) and short Nutritional Appetite Questionnaire (sNAQ). The following data were incorporated in analysis: Anthropometric and laboratory data, physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, dietary habits and mediterranean diet (assessed by MedDiet score), cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were the mortality (from admission until 6 months afterwards) and duration of admission, compared to national guidelines for closed consolidated medical expenses. Mann-Whitney two-sample statistics or t-test was used for group comparisons and Spearman or Pearson coefficients for testing correlation between variables. Results: Normal nutrition was assessed in 54/150 (36%), 92/150 (61.3%) and in 106/150 (70.7%) of patients, according to full MNA, MUST and sNAQ questionnaires respectively. Mortality rate was 20.7% (31/150 patients). The patients who died until 6 months after admission had lower BMI (24±4.4 vs 26±4.8, p=0.04) and albumin levels (2.9±0.7 vs 3.4±0.7, p=0.002), significantly lower full MNA (14.5±7.3 vs 20.7±6, p<0.0001) and short-form MNA scores (7.3±4.2 vs 10.5±3.4, p=0.0002) compared to non-dead one. In contrast, the aforementioned patients had higher MUST (2.5±1.8 vs 0.5±1.02, p=<0.0001) and sNAQ scores (2.9±2.4 vs 1.1±1.3, p<0.0001). Additionally, they showed significantly lower MedDiet (23.5±4.3 vs 31.1±5.6, p<0.0001) and IPAQ scores (37.2±156.2 vs 516.5±1241.7, p<0.0001) compared to remaining one. These patients had extended hospitalization [5 (0-13) days vs 0 (-1-3) days, p=0.001]. Patients who admitted due to cancer depicted higher mortality rate (10/13, 77%), compared to those who admitted due to infections (12/73, 18%), stroke (4/15, 27%) or other causes (4/49, 8%) (p<0.0001). Extension of hospitalization was negatively correlated to both full (Spearman r=-0.35, p<0.0001) and short-form MNA (Spearman r=-0.33, p<0.0001) and positively correlated to MUST (Spearman r=0.34, p<0.0001) and sNAQ (Spearman r=0.3, p=0.0002). Additionally, the extension was inversely related to MedDiet score (Spearman r=-0.35, p<0.0001), IPAQ score (Spearman r=-0.34, p<0.0001), albumin levels (Pearson r=-0.36, p<0.0001), Ht (Pearson r=-0.2, p=0.02) and Hb (Pearson r=-0.18, p=0.02). Conclusion: A great proportion of elderly, hospitalized patients are malnourished or at risk of malnutrition. All nutritional scores, physical activity and albumin are significantly related to mortality and increased hospitalization.

Keywords: dietary habits, duration of admission, malnutrition, prognostic factors for mortality

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Authors: Irene T. Ho

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Students with Autism Spectrum Disorder (ASD) studying in mainstream schools often face difficulties adjusting to school life and teachers often find it challenging to meet the needs of these students. The Hong Kong Jockey Club Autism Support Network (JC A-Connect) is an initiative launched in 2015 to enhance support for students with ASD as well as their families and schools. The School Support Programme of the Project aims at building the capacity of schools to provide quality education for these students. The present report provides a summary of the main features of the support model and the related evaluation results. The school support model was conceptualized in response to four observed needs: (1) inadequate teacher expertise in dealing with the related challenges, (2) the need to promote evidence-based practices in schools, (3) less than satisfactory home-school collaboration and whole-school participation, and (4) lack of concerted effort by different parties involved in providing support to schools. The resulting model had partnership and capacity building as two guiding tenets for the School Support Programme. There were two levels of partnership promoted in the project. At the programme support level, a platform that enables effective collaboration among major stakeholders was established, including the funding body that provides the necessary resources, the Education Bureau that helps to engage schools, university experts who provide professional leadership and research support, as well as non-governmental organization (NGO) professionals who provide services to the schools. At the programme implementation level, tripartite collaboration among teachers, parents and professionals was emphasized. This notion of partnership permeated efforts at capacity building targeting students with ASD, school personnel, parents and peers. During 2015 to 2018, school-based programmes were implemented in over 400 primary and secondary schools with the following features: (1) spiral Tier 2 (group) training for students with ASD to enhance their adaptive skills, led by professionals but with strong teacher involvement to promote transfer of knowledge and skills; (2) supplementary programmes for teachers, parents and peers to enhance their capability to support students with ASD; and (3) efforts at promoting continuing or transfer of learning, on the part of both students and teachers, to Tier 1 (classroom practice) and Tier 3 (individual training) contexts. Over 5,000 students participated in the Programme, representing about 50% of students diagnosed with ASD in mainstream public sector schools in Hong Kong. Results showed that the Programme was effective in helping students improve to various extents at three levels: achievement of specific training goals, improvement in adaptive skills in school, and change in ASD symptoms. The sense of competence of teachers and parents in dealing with ASD-related issues, measured by self-report rating scales, was also significantly enhanced. Moreover, effects on enhancing the school system to provide support for students with ASD, assessed according to indicators of inclusive education, were seen. The process and results of this Programme illustrate how obstacles to inclusive education for students with ASD could be overcome by strengthening the necessary partnerships and building the required capabilities of all parties concerned.

Keywords: autism, school support, skills training, teacher development, three-tier model

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Authors: Christina Drosou, Konstantina E. Kyriakopoulou, Andreas Bimpilas, Dimitrios Tsimogiannis, Magdalini C. Krokida

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Rationale: Agiorgitiko is one of the most widely-grown and commercially well-established red wine varieties in Greece. Each year viticulture industry produces a large amount of waste consisting of grape skins and seeds (pomace) during a short period. Grapes contain polyphenolic compounds which are partially transferred to wine during winemaking. Therefore, winery wastes could be an alternative cheap source for obtaining such compounds with important antioxidant activity. Specifically, red grape waste contains anthocyanins and flavonols which are characterized by multiple biological activities, including cardioprotective, anti-inflammatory, anti-carcinogenic, antiviral and antibacterial properties attributed mainly to their antioxidant activity. Ultrasound assisted extraction (UAE) is considered an effective way to recover phenolic compounds, since it combines the advantage of mechanical effect with low temperature. Moreover, green solvents can be used in order to recover extracts intended for used in the food and nutraceutical industry. Apart from the extraction, pre-treatment process like drying can play an important role on the preservation of the grape pomace and the enhancement of its antioxidant capacity. Objective: The aim of this study is to recover natural extracts from winery waste with high antioxidant capacity using green solvents so they can be exploited and utilized as enhancers in food or nutraceuticals. Methods: Agiorgitiko grape pomace was dehydrated by air drying (AD) and accelerated solar drying (ASD) in order to explore the effect of the pre-treatment on the recovery of bioactive compounds. UAE was applied in untreated and dried samples using water and water: ethanol (1:1) as solvents. The total antioxidant potential and phenolic content of the extracts was determined using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay and Folin-Ciocalteu method, respectively. Finally, the profile of anthocyanins and flavonols was specified using HPLC-DAD analysis. The efficiency of processes was determined in terms of extraction yield, antioxidant activity, phenolic content and the anthocyanins and flavovols profile. Results & Discussion: The experiments indicated that the pre-treatment was essential for the recovery of highly nutritious compounds from the pomace as long as the extracts samples showed higher phenolic content and antioxidant capacity. Water: ethanol (1:1) was considered a more effective solvent on the recovery of phenolic compounds. Moreover, ASD grape pomace extracted with the solvent system exhibited the highest antioxidant activity (IC50=0.36±0.01mg/mL) and phenolic content (TPC=172.68±0.01mgGAE/g dry extract), followed by AD and untreated pomace. The major compounds recovered were malvidin3-O-glucoside and quercetin3-O-glucoside according to the HPLC analysis. Conclusions: Winery waste can be exploited for the recovery of nutritious compounds using green solvents such as water or ethanol. The pretreatment of the pomace can significantly affect the concentration of phenolic compounds, while UAE is considered a highly effective extraction process.

Keywords: agiorgitico grape pomace, antioxidants, phenolic compounds, ultrasound assisted extraction

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Authors: Sawang Saenghirunvattana, Chao Saenghirunvattana, Maria Christina Gonzales, Wilai Srimuk, Chitchamai Siangpro, Kritsana Sutthisri

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Introduction: Thailand is one of the fastest growing countries in Asia. It has emerged from agricultural to industrialized economy. Work places have shifted from farms to factories, offices and streets were employees are exposed to certain chemicals and pollutants causing occupational diseases particularly asthma. Work-related diseases are major concern and many studies have been published to demonstrate certain professions and their exposures that elevate the risk of asthma. Workers who exhibit coughing, wheezing and difficulty of breathing are brought to a health care setting where Pulmonary Function Test (PFT) is performed and based from results, they are then diagnosed of asthma. These patients, known to have occupational asthma eventually get well when removed from the exposure of the environment. Our study, focused on performing PFT or specific challenge test in diagnosing workers of occupational asthma with them executing the test within their workplace, maintaining the environment and their daily exposure to certain levels of chemicals and pollutants. This has provided us with an understanding and reliable diagnosis of occupational asthma. Objective: To identify the prevalence of Thai workers who develop asthma caused by exposure to pollutants and chemicals from their working environment by conducting interview and performing PFT or specific challenge test in their work places. Materials and Methods: This study was performed from January-March 2015 in Bangkok, Thailand. The percentage of abnormal symptoms of 940 workers in 5 different areas (factories of plastic, fertilizer, animal food, office and streets) were collected through a questionnaire. The demographic information, occupational history, and the state of health were determined using a questionnaire and checklists. PFT was executed in their work places and results were measured and evaluated. Results: Pulmonary Function test was performed by 940 participants. The specific challenge test was done in factories of plastic, fertilizer, animal food, office environment and on the streets of Thailand. Of the 100 participants working in the plastic industry, 65% complained of having respiratory symptoms. None of them had an abnormal PFT. From the participants who worked with fertilizers and are exposed to sulfur dioxide, out of 200 participants, 20% complained of having symptoms and 8% had abnormal PFT. The 300 subjects working with animal food reported that 45% complained of respiratory symptoms and 15% had abnormal PFT results. From the office environment where there is indoor pollution, Out of 140 subjects, 7% had symptoms and 4% had abnormal PFT. The 200 workers exposed to traffic pollution, 24% reported respiratory symptoms and 12% had abnormal PFT. Conclusion: We were able to identify and diagnose participants of occupational asthma through their abnormal lung function test done at their work places. The chemical agents and exposures were determined therefore effective management of workers with occupational asthma were advised to avoid further exposure for better chances of recovery. Further studies identifying the risk factors and causative agents of asthma in workplaces should be developed to encourage interventional strategies and programs that will prevent occupation related diseases particularly asthma.

Keywords: occupational asthma, pulmonary function test, specific challenge test, Thailand

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Authors: Irene Carmagnola, Valeria Chiono, Sandra Pacharra, Jochen Salber, Sean McMahon, Chris Lovell, Pooja Basnett, Barbara Lukasiewicz, Ipsita Roy, Xiang Zhang, Gianluca Ciardelli

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Thrombosis and restenosis after stenting procedure can be prevented by promoting fast stent wall endothelialisation. It is well known that surface functionalisation with antifouling molecules combining with extracellular matrix proteins is a promising strategy to design biomimetic surfaces able to promote fast endothelialization. In particular, REDV has gained much attention for the ability to enhance rapid endothelialization due to its specific affinity with endothelial cells (ECs). In this work, a two-step plasma treatment was performed to polymerize a thin layer of acrylic acid, used to subsequently graft PEGylated-REDV and polyethylene glycol (PEG) at different molar ratio with the aim to selectively promote endothelial cell adhesion avoiding platelet activation. PEGylate-REDV was provided by Biomatik and it is formed by 6 PEG monomer repetitions (Chempep Inc.), with an NH2 terminal group. PEG polymers were purchased from Chempep Inc. with two different chain lengths: m-PEG6-NH2 (295.4 Da) with 6 monomer repetitions and m-PEG12-NH2 (559.7 Da) with 12 monomer repetitions. Plasma activation was obtained by operating at 50W power, 5 min of treatment and at an Ar flow rate of 20 sccm. Pure acrylic acid (99%, AAc) vapors were diluted in Ar (flow = 20 sccm) and polymerized by a pulsed plasma discharge applying a discharge RF power of 200 W, a duty cycle of 10% (on time = 10 ms, off time = 90 ms) for 10 min. After plasma treatment, samples were dipped into an 1-(3-dimethylaminopropyl)-3- ethylcarbodiimide (EDC)/N-hydroxysuccinimide (NHS) solution (ratio 4:1, pH 5.5) for 1 h at 4°C and subsequently dipped in PEGylate-REDV and PEGylate-REDV:PEG solutions at different molar ratio (100 μg/mL in PBS) for 20 h at room temperature. Surface modification was characterized through physico-chemical analyses and in vitro cell tests. PEGylated-REDV peptide and PEG were successfully bound to the carboxylic groups that are formed on the polymer surface after plasma reaction. FTIR-ATR spectroscopy, X -ray Photoelectron Spectroscopy (XPS) and contact angle measurement gave a clear indication of the presence of the grafted molecules. The use of PEG as a spacer allowed for an increase in wettability of the surface, and the effect was more evident by increasing the amount of PEG. Endothelial cells adhered and spread well on the surfaces functionalized with the REDV sequence. In conclusion, a selective coating able to promote a new endothelial cell layer on polymeric stent surface was developed. In particular, a thin AAc film was polymerised on the polymeric surface in order to expose –COOH groups, and PEGylate-REDV and PEG were successful grafted on the polymeric substrates. The REDV peptide demonstrated to encourage cell adhesion with a consequent, expected improvement of the hemocompatibility of these polymeric surfaces in vivo. Acknowledgements— This work was funded by the European Commission 7th Framework Programme under grant agreement number 604251- ReBioStent (Reinforced Bioresorbable Biomaterials for Therapeutic Drug Eluting Stents). The authors thank all the ReBioStent partners for their support in this work.

Keywords: endothelialisation, plasma treatment, stent, surface functionalisation

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Authors: Christina Largent, Tazley Hobbs

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Objective: A literature review was performed to examine the existing research on COVID-19 lockdown as it relates to ADHD child/adolescent individuals, media use, and impact on educational performance/learning. It was surmised that with the COVID-19 shut-down and transition to remote learning, a less structured learning environment, increased screen time, in addition to potential difficulty accessing school resources would impair ADHD individuals’ performance and learning. A resulting increase in the number of youths diagnosed and treated for ADHD would be expected. As of yet, there has been little to no published data on the incidence of ADHD as it relates to COVID-19 outside of reports from several nonprofit agencies such as CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder ), who reported an increased number of calls to their helpline, The New York based Child Mind Institute, who reported an increased number of appointments to discuss medications, and research released from Athenahealth showing an increase in the number of patients receiving new diagnosis of ADHD and new prescriptions for ADHD medications. Methods: A literature search for articles published between 2020 and 2021 from Pubmed, Google Scholar, PsychInfo, was performed. Search phrases and keywords included “covid, adhd, child, impact, remote learning, media, screen”. Results: Studies primarily utilized parental reports, with very few from the perspective of the ADHD individuals themselves. Most findings thus far show that with the COVID-19 quarantine and transition to online learning, ADHD individuals’ experienced decreased ability to keep focused or adhere to the daily routine, as well as increased inattention-related problems, such as careless mistakes or lack of completion in homework, which in turn translated into overall more difficulty with remote learning. To add further injury, one study showed (just on evaluation of two different sites within the US) that school based services for these individuals decreased with the shift to online-learning. Increased screen time, television, social media, and gaming were noted amongst ADHD individuals. One study further differentiated the degree of digital media, identifying individuals with “problematic “ or “non-problematic” use. ADHD children with problematic digital media use suffered from more severe core symptoms of ADHD, negative emotions, executive function deficits, damage to family environment, pressure from life events, and a lower motivation to learn. Conclusions and Future Considerations: Studies found not only was online learning difficult for ADHD individuals but it, in addition to greater use of digital media, was associated with worsening ADHD symptoms impairing schoolwork, in addition to secondary findings of worsening mood and behavior. Currently, data on the number of new ADHD cases, in addition to data on the prescription and usage of stimulants during COVID-19, has not been well documented or studied; this would be well-warranted out of concern for over diagnosing or over-prescribing our youth. It would also be well-worth studying how reversible or long-lasting these negative impacts may be.

Keywords: COVID-19, remote learning, media use, ADHD, child, adolescent

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Authors: Emma J. Dale, Christina D. Buesching, Kevin R. Theis, David W. Macdonald

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This study investigates the oral and intestinal microbiomes of wild-living European badgers (Meles meles) and will relate inter-individual differences to social contact networks, somatic and reproductive fitness, varying susceptibility to bovine tuberculous (bTB) and to the olfactory advertisement. Badgers are an interesting model for this research, as they have great variation in body condition, despite living in complex social networks and having access to the same resources. This variation in somatic fitness, in turn, affects breeding success, particularly in females. We postulate that microbiota have a central role to play in determining the successfulness of an individual. Our preliminary results, characterising the microbiota of individual badgers, indicate unique compositions of microbiota communities within social groups of badgers. This basal information will inform further questions related to the extent microbiota influence fitness. Hitherto, the potential role of microbiota has not been considered in determining host condition, but also other key fitness variables, namely; communication and resistance to disease. Badgers deposit their faeces in communal latrines, which play an important role in olfactory communication. Odour profiles of anal and subcaudal gland secretions are highly individual-specific and encode information about group-membership and fitness-relevant parameters, and their chemical composition is strongly dependent on symbiotic microbiota. As badgers sniff/ lick (using their Vomeronasal organ) and over-mark faecal deposits of conspecifics, these microbial communities can be expected to vary with social contact networks. However, this is particularly important in the context of bTB, where badgers are assumed to transmit bTB to cattle as well as conspecifics. Interestingly, we have found that some individuals are more susceptible to bTB than are others. As acquired immunity and thus potential susceptibility to infectious diseases are known to depend also on symbiotic microbiota in other members of the mustelids, a role of particularly oral microbiota can currently not be ruled out as a potential explanation for inter-individual differences in infection susceptibility of bTB in badgers. Tri annually badgers are caught in the context of a long-term population study that began in 1987. As all badgers receive an individual tattoo upon first capture, age, natal as well as previous and current social group-membership and other life history parameters are known for all animals. Swabs (subcaudal ‘scent gland’, anal, genital, nose, mouth and ear) and fecal samples will be taken from all individuals, stored at -80oC until processing. Microbial samples will be processed and identified at Wayne State University’s Theis (Host-Microbe Interactions) Lab, using High Throughput Sequencing (16S rRNA-encoding gene amplification and sequencing). Acknowledgments: Gas-Chromatography/ Mass-spectrometry (in the context of olfactory communication) analyses will be performed through an established collaboration with Dr. Veronica Tinnesand at Telemark University, Norway.

Keywords: communication, energetics, fitness, free-ranging animals, immunology

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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Authors: M. Reza Hashemi, Chris Small, Scott Hayward

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The Northeast Coast of the US faces damaging effects of coastal flooding and winds due to Atlantic tropical and extratropical storms each year. Historically, several large storm events have produced substantial levels of damage to the region; most notably of which were the Great Atlantic Hurricane of 1938, Hurricane Carol, Hurricane Bob, and recently Hurricane Sandy (2012). The objective of this study was to develop an integrated modeling system that could be used as a forecasting/hindcasting tool to evaluate and communicate the risk coastal communities face from these coastal storms. This modeling system utilizes the ADvanced CIRCulation (ADCIRC) model for storm surge predictions and the Simulating Waves Nearshore (SWAN) model for the wave environment. These models were coupled, passing information to each other and computing over the same unstructured domain, allowing for the most accurate representation of the physical storm processes. The coupled SWAN-ADCIRC model was validated and has been set up to perform real-time forecast simulations (as well as hindcast). Modeled storm parameters were then passed to a coastal risk assessment tool. This tool, which is generic and universally applicable, generates spatial structural damage estimate maps on an individual structure basis for an area of interest. The required inputs for the coastal risk model included a detailed information about the individual structures, inundation levels, and wave heights for the selected region. Additionally, calculation of wind damage to structures was incorporated. The integrated coastal risk assessment system was then tested and applied to Charlestown, a small vulnerable coastal town along the southern shore of Rhode Island. The modeling system was applied to Hurricane Sandy and a synthetic storm. In both storm cases, effect of natural dunes on coastal risk was investigated. The resulting damage maps for the area (Charlestown) clearly showed that the dune eroded scenarios affected more structures, and increased the estimated damage. The system was also tested in forecast mode for a large Nor’Easters: Stella (March 2017). The results showed a good performance of the coupled model in forecast mode when compared to observations. Finally, a nearshore model XBeach was then nested within this regional grid (ADCIRC-SWAN) to simulate nearshore sediment transport processes and coastal erosion. Hurricane Irene (2011) was used to validate XBeach, on the basis of a unique beach profile dataset at the region. XBeach showed a relatively good performance, being able to estimate eroded volumes along the beach transects with a mean error of 16%. The validated model was then used to analyze the effectiveness of several erosion mitigation methods that were recommended in a recent study of coastal erosion in New England: beach nourishment, coastal bank (engineered core), and submerged breakwater as well as artificial surfing reef. It was shown that beach nourishment and coastal banks perform better to mitigate shoreline retreat and coastal erosion.

Keywords: ADCIRC, coastal flooding, storm surge, coastal risk assessment, living shorelines

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Authors: Ainura Tursunalieva, Irene Hudson

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Continuous improvement of both the quality and safety of health care is an important goal in Australia and internationally. The intensive care unit (ICU) receives patients with a wide variety of and severity of illnesses. Accurately identifying patients at risk of developing complications or dying is crucial to increasing healthcare efficiency. Thus, it is essential for clinicians and researchers to have a robust framework capable of evaluating the risk profile of a patient. ICU scoring systems provide such a framework. The Acute Physiology and Chronic Health Evaluation III and the Simplified Acute Physiology Score II are ICU scoring systems frequently used for assessing the severity of acute illness. These scoring systems collect multiple risk factors for each patient including physiological measurements then render the assessment outcomes of individual risk factors into a single numerical value. A higher score is related to a more severe patient condition. Furthermore, the Mortality Probability Model II uses logistic regression based on independent risk factors to predict a patient’s probability of mortality. An important overlooked limitation of SAPS II and MPM II is that they do not, to date, include interaction terms between a patient’s vital signs. This is a prominent oversight as it is likely there is an interplay among vital signs. The co-existence of certain conditions may pose a greater health risk than when these conditions exist independently. One barrier to including such interaction terms in predictive models is the dimensionality issue as it becomes difficult to use variable selection. We propose an innovative scoring system which takes into account a dependence structure among patient’s vital signs, such as systolic and diastolic blood pressures, heart rate, pulse interval, and peripheral oxygen saturation. Copulas will capture the dependence among normally distributed and skewed variables as some of the vital sign distributions are skewed. The estimated dependence parameter will then be incorporated into the traditional scoring systems to adjust the points allocated for the individual vital sign measurements. The same dependence parameter will also be used to create an alternative copula-based model for predicting a patient’s probability of mortality. The new copula-based approach will accommodate not only a patient’s trajectories of vital signs but also the joint dependence probabilities among the vital signs. We hypothesise that this approach will produce more stable assessments and lead to more time efficient and accurate predictions. We will use two data sets: (1) 250 ICU patients admitted once to the Chui Regional Hospital (Kyrgyzstan) and (2) 37 ICU patients’ agitation-sedation profiles collected by the Hunter Medical Research Institute (Australia). Both the traditional scoring approach and our copula-based approach will be evaluated using the Brier score to indicate overall model performance, the concordance (or c) statistic to indicate the discriminative ability (or area under the receiver operating characteristic (ROC) curve), and goodness-of-fit statistics for calibration. We will also report discrimination and calibration values and establish visualization of the copulas and high dimensional regions of risk interrelating two or three vital signs in so-called higher dimensional ROCs.

Keywords: copula, intensive unit scoring system, ROC curves, vital sign dependence

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Authors: Kyriaki Hatziagapiou, Konstantinos Bethanis, Olti Nikola, Elias Christoforides, Eleni Koniari, Eleni Kakouri, George Lambrou, Christina Kanaka-Gantenbein

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Glioblastoma multiforme (GBM) remains a serious health challenge, as current therapeutic modalities continue to yield unsatisfactory results, with the average survival rarely exceeding 1-2 years. Natural compounds still provide some of the most promising approaches for discovering new drugs. The non-psychotropic cannabidiol (CBD) deriving from Cannabis sativa L. provides such promise. CBD is endowed with anticancer, antioxidant, and genoprotective properties as established in vitro and in in vivo experiments. CBD’s selectivity towards cancer cells and its safe profile suggest its usage in cancer therapies. However, the bioavailability of oral CBD is low due to poor aqueous solubility, erratic gastrointestinal absorption, and significant first-pass metabolism, hampering its therapeutic potential and resulting in a variable pharmacokinetic profile. In this context, CBD can take great advantage of nanomedicine-based formulation strategies. Cyclodextrins (CDs) are cyclic oligosaccharides used in the pharmaceutical industry to incorporate apolar molecules inside their hydrophobic cavity, increasing their stability, water solubility, and bioavailability or decreasing their side effects. CBD-inclusion complexes with CDs could be a good strategy to improve its properties, like solubility and stability to harness its full therapeutic potential. The current research aims to study the potential cytotoxic effect of CBD and CBD-CDs complexes CBD-RMβCD (randomly methylated β-cyclodextrin) and CBD-HPβCD (hydroxypropyl-b-CD) on the A172 glioblastoma cell line. CBD is diluted in 10% DMSO, and CBD/CDs solutions are prepared by mixing solid CBD, solid CDs, and dH2O. For the biological assays, A172 cells are incubated at a range of concentrations of CBD, CBD-RMβCD and CBD-HPβCD, RMβCD, and HPβCD (0,03125-4 mg/ml) at 24, 48, and 72 hours. Analysis of cell viability after incubation with the compounds is performed with Alamar Blue viability assay. CBD’s dilution to DMSO 10% was inadequate, as crystals are observed; thus cytotoxicity experiments are not assessed. CBD’s solubility is enhanced in the presence of both CDs. CBD/CDs exert significant cytotoxicity in a dose and time-dependent manner (p < 0.005 for exposed cells to any concentration at 48, 72, and 96 hours versus cells not exposed); as their concentration and time of exposure increases, the reduction of resazurin to resofurin decreases, indicating a reduction in cell viability. The cytotoxic effect is more pronounced in cells exposed to CBD-HPβCD for all concentrations and time-points. RMβCD and HPβCD at the highest concentration of 4 mg/ml also exerted antitumor action per se since manifesting cell growth inhibition. The results of our study could afford the basis of research regarding the use of natural products and their inclusion complexes as anticancer agents and the shift to targeted therapy with higher efficacy and limited toxicity. Acknowledgments: The research is partly funded by ΙΚΥ (State Scholarships Foundation) – Post-doc Scholarships-Partnership Agreement 2014-2020.

Keywords: cannabidiol, cyclodextrins, glioblastoma, hydroxypropyl-b-Cyclodextrin, randomly-methylated-β-cyclodextrin

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Authors: Petra Gergelova, Sofia Ioannidou, Davide Arcella, Alexandra Tard, Polly E. Boon, Oliver Lindtner, Christina Tlustos, Jean-Charles Leblanc

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Objectives: To assess chronic dietary exposure to food additives in different European countries and population groups. Method and Design: The European Food Safety Authority’s (EFSA) Panel on Food Additives and Nutrient Sources added to Food (ANS) estimates chronic dietary exposure to food additives with the purpose of re-evaluating food additives that were previously authorized in Europe. For this, EFSA uses concentration values (usage and/or analytical occurrence data) reported through regular public calls for data by food industry and European countries. These are combined, at individual level, with national food consumption data from the EFSA Comprehensive European Food Consumption Database including data from 33 dietary surveys from 19 European countries and considering six different population groups (infants, toddlers, children, adolescents, adults and the elderly). EFSA ANS Panel estimates dietary exposure for each individual in the EFSA Comprehensive Database by combining the occurrence levels per food group with their corresponding consumption amount per kg body weight. An individual average exposure per day is calculated, resulting in distributions of individual exposures per survey and population group. Based on these distributions, the average and 95th percentile of exposure is calculated per survey and per population group. Dietary exposure is assessed based on two different sets of data: (a) Maximum permitted levels (MPLs) of use set down in the EU legislation (defined as regulatory maximum level exposure assessment scenario) and (b) usage levels and/or analytical occurrence data (defined as refined exposure assessment scenario). The refined exposure assessment scenario is sub-divided into the brand-loyal consumer scenario and the non-brand-loyal consumer scenario. For the brand-loyal consumer scenario, the consumer is considered to be exposed on long-term basis to the highest reported usage/analytical level for one food group, and at the mean level for the remaining food groups. For the non-brand-loyal consumer scenario, the consumer is considered to be exposed on long-term basis to the mean reported usage/analytical level for all food groups. An additional exposure from sources other than direct addition of food additives (i.e. natural presence, contaminants, and carriers of food additives) is also estimated, as appropriate. Results: Since 2014, this methodology has been applied in about 30 food additive exposure assessments conducted as part of scientific opinions of the EFSA ANS Panel. For example, under the non-brand-loyal scenario, the highest 95th percentile of exposure to α-tocopherol (E 307) and ammonium phosphatides (E 442) was estimated in toddlers up to 5.9 and 8.7 mg/kg body weight/day, respectively. The same estimates under the brand-loyal scenario in toddlers resulted in exposures of 8.1 and 20.7 mg/kg body weight/day, respectively. For the regulatory maximum level exposure assessment scenario, the highest 95th percentile of exposure to α-tocopherol (E 307) and ammonium phosphatides (E 442) was estimated in toddlers up to 11.9 and 30.3 mg/kg body weight/day, respectively. Conclusions: Detailed and up-to-date information on food additive concentration values (usage and/or analytical occurrence data) and food consumption data enable the assessment of chronic dietary exposure to food additives to more realistic levels.

Keywords: α-tocopherol, ammonium phosphatides, dietary exposure assessment, European Food Safety Authority, food additives, food consumption data

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