Search results for: comprehensive examination result

Authors: Sharon Millen, Sarah Miller, Laura Dunne, Clare McGeady, Laura Neeson

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This paper presents the findings from a randomised controlled trial (RCT) and process evaluation of the Lifestart parenting programme. Lifestart is a structured child-centred programme of information and practical activity for parents of children aged from birth to five years of age. It is delivered to parents in their own homes by trained, paid family visitors and it is offered to parents regardless of their social, economic or other circumstances. The RCT evaluated the effectiveness of the programme and the process evaluation documented programme delivery and included a qualitative exploration of parent and child outcomes. 424 parents and children participated in the RCT: 216 in the intervention group and 208 in the control group across the island of Ireland. Parent outcomes included: parental knowledge of child development, parental efficacy, stress, social support, parenting skills and embeddedness in the community. Child outcomes included cognitive, language and motor development and social-emotional and behavioural development. Both groups were tested at baseline (when children were less than 1 year old), mid-point (aged 3) and at post-test (aged 5). Data were collected during a home visit, which took two hours. The process evaluation consisted of interviews with parents (n=16 at baseline and end-point), and focus groups with Lifestart Coordinators (n=9) and Family Visitors (n=24). Quantitative findings from the RCT indicated that, compared to the control group, parents who received the Lifestart programme reported reduced parenting-related stress, increased knowledge of their child’s development, and improved confidence in their parenting role. These changes were statistically significant and consistent with the hypothesised pathway of change depicted in the logic model. There was no evidence of any change in parents’ embeddedness in the community. Although four of the five child outcomes showed small positive change for children who took part in the programme, these were not statistically significant and there is no evidence that the programme improves child cognitive and non-cognitive skills by immediate post-test. The qualitative process evaluation highlighted important challenges related to conducting trials of this magnitude and design in the general population. Parents reported that a key incentive to take part in study was receiving feedback from the developmental assessment, which formed part of the data collection. This highlights the potential importance of appropriate incentives in relation to recruitment and retention of participants. The interviews with intervention parents indicated that one of the first changes they experienced as a result of the Lifestart programme was increased knowledge and confidence in their parenting ability. The outcomes and pathways perceived by parents and described in the interviews are also consistent with the findings of the RCT and the theory of change underpinning the programme. This hypothesises that improvement in parental outcomes, arising as a consequence of the programme, mediate the change in child outcomes. Parents receiving the Lifestart programme reported great satisfaction with and commitment to the programme, with the role of the Family Visitor being identified as one of the key components of the programme.

Keywords: parent-child relationship, parental self-efficacy, parental stress, school readiness

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Authors: Harriet Bothwell, Lowri Evans, Kevin Jones

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Background: The University of Bristol provides all medical students the opportunity to undertake student selected components (SSCs) at multiple stages of the undergraduate programme. SSCs enable students to explore areas of interest that are not necessarily covered by the curriculum. Students are required to produce a written report and most use SSCs as an opportunity to undertake an audit or small research project. In 2013 Swindon Academy, based at the Great Western Hospital, offered eight students the opportunity of a global health SSC which included a two week trip to rural hospital in Uganda. This SSC has since expanded and in 2017 a total of 20 students had the opportunity to undertake small research projects at two hospitals in rural Uganda. 'Tomorrows Doctors' highlights the importance of understanding healthcare from a 'global perspective' and student feedback from previous SSCs suggests that self-assessed knowledge of global health increases as a result of this SSC. Through the most recent version of this SSC students had the opportunity to undertake projects in a wide range of specialties including paediatrics, palliative care, surgery and medical education. Methods: An anonymous online questionnaire was made available to students following the SSC. There was a response rate of 80% representing 16 out of the 20 students. This questionnaire surveyed students’ satisfaction and experience of the SSC including the level of academic, project and spiritual support provided as well as perceived challenges in completing the project and barriers to healthcare delivery in the low resource setting. This survey had multiple open questions allowing the collection of qualitative data. Further qualitative data was collected from the students’ project report. The suggested format included a reflection and all students completed these. All qualitative data underwent thematic analysis. Results: All respondents rated the overall experience of the SSC as 'good' or 'excellent'. Preliminary data suggest that students’ confidence in their knowledge of global health, diagnosis of tropical diseases and management of tropical diseases improved after completing this SSC. Thematic analysis of students' reflection is ongoing but suggests that students gain far more than improved knowledge of tropical diseases. Students reflect positively on having the opportunity to research in a low resource setting and feel that by completing these projects they will be 'useful' to the hospital. Several students reflect the stark contrast to healthcare delivery in the UK and recognise the 'privilege' of having a healthcare system that is free at the point of access. Some students noted the different approaches that clinicians in Uganda had to train in 'taking ownership' of their own learning. Conclusions: Students completing this SSC report increased knowledge of global health and tropical medicine. However, their reflections reveal much broader learning outcomes and demonstrate considerable insight in multiple topics including conducting research in the low resource setting, training and healthcare inequality.

Keywords: global health, medical education, student feedback, undergraduate

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Authors: Adriana Pereira Arteaga

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In many Latin American countries the transition towards legal pluralism - has developed as part of what is called Latin-American-Constitutionalism over the last thirty years. The aim of this paper is to discuss how legal pluralism in its current form in Bolivia may produce exclusion and violence. Legal sources and discourse analysis - as an approach to examine written language on discourse documentation- will be used to develop this paper. With the constitution of 2009, Bolivia was symbolically "re-founded" into a multi-nation state. This shift goes hand in hand with the "indigenista" and "decolonisation" ideologies developing since the early 20th century. Discourses based on these ideologies reflect the rejection of liberal and western premises on which the Bolivian republic was originally built after independence. According to the "indigenista" movements, the liberal nation-state generates institutions corresponding to a homogenous society. These liberal institutions not only ignore the Bolivian multi-nation reality, but also maintain the social structures originating form the colony times, based on prejudices against the indigenous. The described statements were elaborated through the image: the indigenous people humiliated by a cruel western system as highlighted by the constitution's preamble. This narrative had a considerable impact on the sensitivity of people and received great social support. Therefore the proposal for changing structures of the nation-state, is charged with an emancipatory message of restoring even the pre-Columbian order. An order at times romantically described as the perfect order. Legally this connotes a rejection of the positivistic national legal system based on individual rights and the promotion of constitutional recognition of indigenous justice administration. The pluralistic Constitution is supposed to promote tolerance and a peaceful coexistence among nations, so that the unity and integrity of the country could be maintained. In its current form, legal pluralism in Bolivia is justified on pre-existing rights contained for example in the International - Labour - Organization - Convention 169, but it is more developed on the described discursive constructions. Over time these discursive constructions created inconsistencies in terms of putting indigenous justice administration into practice: First, because legal pluralism has been more developed on level of political discourse, so a real interaction between the national and the indigenous jurisdiction cannot be observed. There are no clear coordination and cooperation mechanisms. Second, since the recently reformed constitution is based on deep sensitive experiences, little is said about the general legal principles on which a pluralistic administration of justice in Bolivia should be based. Third, basic rights, liberties, and constitutional guarantees are also affected by the antagonized image of the national justice administration. As a result, fundamental rights could be violated on a large scale because many indigenous justice administration practices run counter to these constitutional rules. These problems are not merely Bolivian but may also be encountered in other regional countries with similar backgrounds, like Ecuador.

Keywords: discourse, indigenous justice, legal pluralism, multi-nation

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Authors: Özgür Bahadir, Meltem Kurtuncu

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The study was designed as quasi-experimental and conducted to determine the effect of music therapy on anxiety, fear and pain management in 6-12-year-old children undergoing surgery. The present study was carried out between 01.01.2016 and 19.08.2016 in BEU. Application and Research Center. The children aged 6 -12 who applied for surgery between the mentioned dates constituted the universe of the study. In the quasi-experimental study that was conducted in the clinics where children received operational treatment, two groups were formed: experimental group (the children who received musical therapy before the surgery) and control group (the children who were administered surveys and the surgery service routines only). Each group consisted of 30 children, and the participants of the study were 60 children in total. Necessary permissions were obtained from the parents of the children hospitalized before the beginning of the implementation. The data was collected through Child Anxiety Sensitivity Index (CASI), “Fear In Medical Treatment Scale”, Face, Legs, Activity, Cry, Consolability Scale (FLACC), Visual Analog Scale (VAS) and Participant Information Form. In the analysis of the data, Kolmogorov-Smirnov distribution scale was used to examine the normality of the distribution along with descriptive statistics methods (Frequency, Percentage, Mean, Standard Deviation). Data was presented in the tables in numbers and percentages. Means were demonstrated along with the standard deviations. The research compared children received; case and control groups include socio-demographic perspective, non-significant difference statistically among similar groups are intertwined. The general level of fear regarding the medical processes before returning to service after the operation and 30 minutes before getting discharged was found to be significantly low in the experimental group compared to control group (p<0.05). No statistically significant difference was found between experimental and control groups in terms of general level of fear regarding the medical processes before the operation, during the operation day and in the recovery room after the operation (p>0.05). Total CASI AD (anxiety sensitivity) levels before the operation, day of the operation and 30 minutes before the discharge for patients in experimental group was found to be significantly higher than the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in the total CASI AD levels for the post-operative recovery room and for returning to the service room after the operation (p>0.05). VAS levels for patients in the experimental group in the post-operative recovery room was significantly higher than the control group (p>0.05). There was no statistically significant difference between the groups in terms of VAS findings in returning to service room after the operation and in 30 minutes before the discharge (p>0.05). As a result of the research; applied children music therapy in the experimental group anxiety, fear, and pain of the scales, their scores average, is lower than the control group children in this situation an increase in the satisfaction of children and parents was observed. In line with this, music therapy preoperative anxiety, fear, and can be used as an effective method of decreasing postoperative pain clinics is suggested.

Keywords: anxiety, children, fear, music therapy, pain

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Authors: Marielcio Lacerda, Angelo Paulino, Elcio Shiguemori, Alvaro Damiao, Lamartine Guimaraes, Camila Anjos

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Accurate information about the terrain is extremely important in disaster management activities or conflict. This paper proposes the use of the Unmanned Aircraft Systems (UAS) at the identification of Airdrop Zones (AZs) and Helicopter Landing Zones (HLZs). In this paper we consider the AZs the zones where troops or supplies are dropped by parachute, and HLZs areas where victims can be rescued. The use of digital image processing enables the automatic generation of an orthorectified mosaic and an actual Digital Surface Model (DSM). This methodology allows obtaining this fundamental information to the terrain’s comprehension post-disaster in a short amount of time and with good accuracy. In order to get the identification and classification of AZs and HLZs images from DJI drone, model Phantom 4 have been used. The images were obtained with the knowledge and authorization of the responsible sectors and were duly registered in the control agencies. The flight was performed on May 24, 2017, and approximately 1,300 images were obtained during approximately 1 hour of flight. Afterward, new attributes were generated by Feature Extraction (FE) from the original images. The use of multispectral images and complementary attributes generated independently from them increases the accuracy of classification. The attributes of this work include the Declivity Map and Principal Component Analysis (PCA). For the classification four distinct classes were considered: HLZ 1 – small size (18m x 18m); HLZ 2 – medium size (23m x 23m); HLZ 3 – large size (28m x 28m); AZ (100m x 100m). The Decision Tree method Random Forest (RF) was used in this work. RF is a classification method that uses a large collection of de-correlated decision trees. Different random sets of samples are used as sampled objects. The results of classification from each tree and for each object is called a class vote. The resulting classification is decided by a majority of class votes. In this case, we used 200 trees for the execution of RF in the software WEKA 3.8. The classification result was visualized on QGIS Desktop 2.12.3. Through the methodology used, it was possible to classify in the study area: 6 areas as HLZ 1, 6 areas as HLZ 2, 4 areas as HLZ 3; and 2 areas as AZ. It should be noted that an area classified as AZ covers the classifications of the other classes, and may be used as AZ, HLZ of large size (HLZ3), medium size (HLZ2) and small size helicopters (HLZ1). Likewise, an area classified as HLZ for large rotary wing aircraft (HLZ3) covers the smaller area classifications, and so on. It was concluded that images obtained through small UAV are of great use in calamity situations since they can provide data with high accuracy, with low cost, low risk and ease and agility in obtaining aerial photographs. This allows the generation, in a short time, of information about the features of the terrain in order to serve as an important decision support tool.

Keywords: disaster management, unmanned aircraft systems, helicopter landing zones, airdrop zones, random forest

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Authors: Nanadcha Sinjindawong

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This article discusses the design process of a community mall called Castle of The Mall-dern. The concept behind this mall is to combine elements of a medieval castle with modern architecture. The author aims to create a building that fits into the surroundings while also providing users with the vibes of the ancient era. The total area used for the mall is 4,000 square meters, with three floors. The first floor is 1,500 square meters, the second floor is 1,750 square meters, and the third floor is 750 square meters. Research Aim: The aim of this research is to design a community mall that sells ancient clothes and accessories, and to combine sustainable architectural design with the ideas of ancient architecture in an urban area with convenient transportation. Methodology: The research utilizes qualitative research methods in architectural design. The process begins with calculating the given area and dividing it into different zones. The author then sketches and draws the plan of each floor, adding the necessary rooms based on the floor areas mentioned earlier. The program "SketchUp" is used to create an online 3D model of the community mall, and a physical model is built for presentation purposes on A1 paper, explaining all the details. Findings: The result of this research is a community mall with various amenities. The first floor includes retail shops, clothing stores, a food center, and a service zone. Additionally, there is an indoor garden with a fountain and a tree for relaxation. The second and third floors feature a void in the middle, with a few stores, cafes, restaurants, and studios on the second floor. The third floor is home to the administration and security control room, as well as a community gathering area designed as a public library with a café inside. Theoretical Importance: This research contributes to the field of sustainable architectural design by combining ancient architectural ideas with modern elements. It showcases the potential for creating buildings that blend historical aesthetics with contemporary functionality. Data Collection and Analysis Procedures: The data for this research is collected through a combination of area calculation, sketching, and building a 3D model. The analysis involves evaluating the design based on the allocated area, zoning, and functional requirements for a community mall. Question Addressed: The research addresses the question of how to design a community mall with a theme of ancient Medieval and Victorian eras. It explores how to combine sustainable architectural design principles with historical aesthetics to create a functional and visually appealing space. Conclusion: In conclusion, this research successfully designs a community mall called “Castle of The Mall-dern” that incorporates elements of Medieval and Victorian architecture. The building encompasses various zones, including retail shops, restaurants, community gathering areas, and service zones. It also features an interior garden and a public library within the mall. The research contributes to the field of sustainable architectural design by showcasing the potential for combining ancient architectural ideas with modern elements in an urban setting.

Keywords: 3D model, community mall, modern architecture, medieval architecture

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Authors: Ho Yin Wickson Cheung, Liora Malki-Epshtein

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Outdoor air pollution presents a significant challenge for public health globally, especially in urban areas, with road traffic acting as the primary contributor to air pollution. Several studies have documented the antagonistic relation between traffic-related air pollution (TRAP) and the impact on health, especially to the vulnerable group of population, particularly young pupils. Generally, TRAP could cause damage to their brain, restricting the ability of children to learn and, more importantly, causing detrimental respiratory issues in later life. Butlittle is known about the specific exposure of children at school during the school day and the impact this may have on their overall exposure to pollution at a crucial time in their development. This project has set out to examine the air quality across primary schools in South-East London and assesses the variability of data found based on their geographic location and surroundings. Nitrogen dioxide, PM contaminants, and carbon dioxide were collected with diffusion tubes and portable monitoring equipment for eight schools across three local areas, that are Greenwich, Lewisham, and Tower Hamlets. This study first examines the geographical features of the schools surrounding (E.g., coverage of urban road structure and green infrastructure), then utilize three different methods to capture pollutants data. Moreover, comparing the obtained results with existing data from monitoring stations to understand the differences in air quality before and during the pandemic. Furthermore, most studies in this field have unfortunately neglected human exposure to pollutants and calculated based on values from fixed monitoring stations. Therefore, this paper introduces an alternative approach by calculating human exposure to air pollution from real-time data obtained when commuting within related areas (Driving routes and field walking). It is found that schools located highly close to motorways are generally not suffering from the most air pollution contaminants. Instead, one with the worst traffic congested routes nearby might also result in poor air quality. Monitored results also indicate that the annual air pollution values have slightly decreased during the pandemic. However, the majority of the data is currently still exceeding the WHO guidelines. Finally, the total human exposures for NO2 during commuting in the two selected routes were calculated. Results illustrated the total exposure for route 1 were 21,730 μm/m3 and 28,378.32 μm/m3, and for route 2 were 30,672 μm/m3 and 16,473 μm/m3. The variance that occurred might be due to the difference in traffic volume that requires further research. Exposure for NO2 during commuting was plotted with detailed timesteps that have shown their peak usually occurred while commuting. These have consolidated the initial assumption to the extremeness of TRAP. To conclude, this paper has yielded significant benefits to understanding air quality across schools in London with the new approach of capturing human exposure (Driving routes). Confirming the severity of air pollution and promoting the necessity of considering environmental sustainability for policymakers during decision making to protect society's future pillars.

Keywords: air pollution, schools, pupils, congestion

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Authors: A. Kourou, A. Ioakeimidou, S. Hadjiefthymiades, V. Abramea

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During the last decades, the task of engaging governments, communities and citizens to reduce risk and vulnerability of the populations has made variable progress. Experience has demonstrated that lack of awareness, education and preparedness may result in significant material and other losses both on the onset of the disaster. Schools play a vital role in the community and are important elements of values and culture of the society. A proper school education not only teaches children, but also is a key factor in the promotion of a safety culture into the wider community. In Greece School Earthquake Safety Initiative has been undertaken by Earthquake Planning and Protection Ogranization with specific actions (seminars, lectures, guidelines, educational material, campaigns, national or EU projects, drills etc.). The objective of this initiative is to develop disaster-resilient school communities through awareness, self-help, cooperation and education. School preparedness requires the participation of Principals, teachers, students, parents, and competent authorities. Preparation and earthquake readiness involves: a) learning what should be done before, during, and after earthquake; b) doing or preparing to do these things now, before the next earthquake; and c) developing teachers’ and students’ skills to cope efficiently in case of an earthquake. In the above given framework this paper presents the results of a survey aimed to identify the level of education and preparedness of school community in Greece. More specifically, the survey questionnaire investigates issues regarding earthquake protection actions, appropriate attitudes and behaviors during an earthquake and existence of contingency plans at elementary and secondary schools. The questionnaires were administered to Principals and teachers from different regions of the country that attend the EPPO national training project 'Earthquake Safety at Schools'. A closed-form questionnaire was developed for the survey, which contained questions regarding the following: a) knowledge of self protective actions b) existence of emergency planning at home and c) existence of emergency planning at school (hazard mitigation actions, evacuation plan, and performance of drills). Survey results revealed that a high percentage of teachers have taken the appropriate preparedness measures concerning non-structural hazards at schools, emergency school plan and simulation drills every year. In order to improve the action-planning for ongoing school disaster risk reduction, the implementation of earthquake drills, the involvement of students with disabilities and the evaluation of school emergency plans, EPPO participates in E-PreS project. The main objective of this project is to create smart tools which define, simulate and evaluate all hazards emergency steps customized to the unique district and school. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The project is supported by EU Civil Protection Financial Instrument with a duration of two years. Coordinator is the Kapodistrian University of Athens and partners are from four countries; Greece, Italy, Romania and Bulgaria.

Keywords: drills, earthquake, emergency plans, E-PreS project

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Authors: Alan Walsh, Peter Walker

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Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

Keywords: western consultants in megaprojects, national culture impacts on GCC megaprojects, significant risk factors in megaprojects, professional culture in megaprojects

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Authors: Andrzej Szewczak

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Study of the effect of high temperatures on polymer coatings represents an important field of research of their properties. Polymers, as materials with numerous features (chemical resistance, ease of processing and recycling, corrosion resistance, low density and weight) are currently the most widely used modern building materials, among others in the resin concrete, plastic parts, and hydrophobic coatings. Unfortunately, the polymers have also disadvantages, one of which decides about their usage - low resistance to high temperatures and brittleness. This applies in particular thin and flexible polymeric coatings applied to other materials, such a steel and concrete, which degrade under varying thermal conditions. Research about improvement of this state includes methods of modification of the polymer composition, structure, conditioning conditions, and the polymerization reaction. At present, ways are sought to reflect the actual environmental conditions, in which the coating will be operating after it has been applied to other material. These studies are difficult because of the need for adopting a proper model of the polymer operation and the determination of phenomena occurring at the time of temperature fluctuations. For this reason, alternative methods are being developed, taking into account the rapid modeling and the simulation of the actual operating conditions of polymeric coating’s materials in real conditions. The nature of a duration is typical for the temperature influence in the environment. Studies typically involve the measurement of variation one or more physical and mechanical properties of such coating in time. Based on these results it is possible to determine the effects of temperature loading and develop methods affecting in the improvement of coatings’ properties. This paper contains a description of the stability studies of silicone coatings deposited on the surface of a ceramic brick. The brick’s surface was hydrophobized by two types of inorganic polymers: nano-polymer preparation based on dialkyl siloxanes (Series 1 - 5) and an aqueous solution of the silicon (series 6 - 10). In order to enhance the stability of the film formed on the brick’s surface and immunize it to variable temperature and humidity loading, the nano silica was added to the polymer. The right combination of the polymer liquid phase and the solid phase of nano silica was obtained by disintegration of the mixture by the sonification. The changes of viscosity and surface tension of polymers were defined, which are the basic rheological parameters affecting the state and the durability of the polymer coating. The coatings created on the brick’s surfaces were then subjected to a temperature loading of 100° C and moisture by total immersion in water, in order to determine any water absorption changes caused by damages and the degradation of the polymer film. The effect of moisture and temperature was determined by measurement (at specified number of cycles) of changes in the surface hardness (using a Vickers’ method) and the absorption of individual samples. As a result, on the basis of the obtained results, the degradation process of polymer coatings related to their durability changes in time was determined.

Keywords: silicones, siloxanes, surface hardness, temperature, water absorption

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

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Authors: Izabela P. Vatanabe, Rafaela Peron, Patricia Manzine, Marcia R. Cominetti

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Introduction: Considering the increase in life expectancy of world population, there is an emerging concern in health services to allocate better care and care to elderly, through promotion, prevention and treatment of health. It has been observed that frailty syndrome is prevalent in elderly people worldwide and this complex and heterogeneous clinical syndrome consist of the presence of physical frailty associated with cognitive dysfunction, though in absence of dementia. This can be characterized by exhaustion, unintentional weight loss, decreased walking speed, weakness and low level of physical activity, in addition, each of these symptoms may be a predictor of adverse outcomes such as hospitalization, falls, functional decline, institutionalization, and death. Cognitive frailty is a recent concept in literature, which is defined as the presence of physical frailty associated with mild cognitive impairment (MCI) however in absence of dementia. This new concept has been considered as a subtype of frailty, which along with aging process and its interaction with physical frailty, accelerates functional declines and can result in poor quality of life of the elderly. MCI represents a risk factor for Alzheimer's disease (AD) in view of high conversion rate for this disease. Comorbidities and physical frailty are frequently found in AD patients and are closely related to heterogeneity and clinical manifestations of the disease. The decreased platelets ADAM10 levels in AD patients, compared to cognitively healthy subjects, matched by sex, age and education. Objective: Based on these previous results, this study aims to evaluate whether ADAM10 platelet levels of could act as a biomarker of cognitive frailty. Methods: The study was approved by Ethics Committee of Federal University of São Carlos (UFSCar) and conducted in the municipality of São Carlos, headquarters of Federal University of São Carlos (UFSCar). Biological samples of subjects were collected, analyzed and then stored in a biorepository. ADAM10 platelet levels were analyzed by western blotting technique in subjects with MCI and compared to subjects without cognitive impairment, both with and without presence of frailty. Statistical tests of association, regression and diagnostic accuracy were performed. Results: The results have shown that ADAM10/β-actin ratio is decreased in elderly individuals with cognitive frailty compared to non-frail and cognitively healthy controls. Previous studies performed by this research group, already mentioned above, demonstrated that this reduction is still higher in AD patients. Therefore, the ADAM10/β-actin ratio appears to be a potential biomarker for cognitive frailty. The results bring important contributions to an accurate diagnosis of cognitive frailty from the perspective of ADAM10 as a biomarker for this condition, however, more experiments are being conducted, using a high number of subjects, and will help to understand the role of ADAM10 as biomarker of cognitive frailty and contribute to the implementation of tools that work in the diagnosis of cognitive frailty. Such tools can be used in public policies for the diagnosis of cognitive frailty in the elderly, resulting in a more adequate planning for health teams and better quality of life for the elderly.

Keywords: ADAM10, biomarkers, cognitive frailty, elderly

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Sarah Elshahat, Tina Moffat

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Suboptimal mental health is a considerable global public health challenge that leads to considerable inequalities worldwide. Newcomers are at elevated risk for developing mental health issues as a result of social exclusion, stigmatization, racism, unequal employment opportunities, and discrimination. The problem can be especially serious amongst Arabic-speaking immigrants and refugees (ASIR) whose mental wellness may have already been affected by exposure to political violence, persecution, hunger or war in their countries of origin. A scoping review was conducted to investigate pre- and post-migration mental health determinants amongst ASIR in North America (the U.S. and Canada), who are a rapidly growing population in both regions. Pertinent peer-reviewed papers and grey literature were located through a systematic search of five electronic databases (Medline, Embase, PsycINFO, Anthropology Plus, and Sociology Database). A stakeholder consultation was implemented to validate the analyzed findings of the included 44 studies. About 80% of the studies were carried out in the US, underscoring a lack of Canadian ASIR-mental health research. A gap in qualitative, mixed-method, and longitudinal research was detected, where approximately two-thirds of the studies adopted a cross-sectional method. Pre-migration determinants of mental health were related to the political unrest, violence and armed conflict in the Arab world, increasing post-traumatic stress disorder and psychological distress levels among ASIR. English language illiteracy and generational variations in acculturation patterns were major post-migration mental health triggering factors. Exposure to domestic violence, stigmatization, poverty, racialization, and harassment were significant post-migration mental health determinants that stem from social inequalities, triggering depression, and distress amongst ASIR. Family conflicts linked to child-rearing and gendered norms were considered as both pre- and post-migration mental health triggering factors. Most post-migration mental health protective factors were socio-culturally related and included the maintenance of positive ethnic identity, faith, family support, and community cohesion. Individual resilience, articulated as self-esteem and hope, was a significant negative predictor of depression and psychological distress among ASIR. Community-engaged, mixed-methods, and longitudinal studies are required to address the current gap in mental health research among ASIR in North America. A more thorough determination of potential mental health triggers and protective factors would help inform the development of mental wellness and resilience-promoting programs that are culturally sensitive to ASIR. On the policy level, the Health in All Policies framework of the World Health Organization can be potentially useful for addressing social and health inequalities among ASIR, reducing mental health challenges.

Keywords: depression, post-traumatic stress disorder, psychological distress, resilience

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Authors: Md. Afroz Ansari

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The Bengal basin is a spectacular example of a peripheral foreland basin formed by the convergence of the Indian plate beneath the Eurasian and Burmese plates. The basin is embraced on three sides; north, west and east by different fault-controlled tectonic features whereas released in the south where the rivers are drained into the Bay of Bengal. The Bengal basin in the eastern part of the Indian subcontinent constitutes the largest fluvio-deltaic to shallow marine sedimentary basin in the world today. This continental basin coupled with the offshore Bengal Fan under the Bay of Bengal forms the biggest sediment dispersal system. The continental basin is continuously receiving the sediments by the two major rivers Ganga and Brahmaputra (known as Jamuna in Bengal), and Meghna (emerging from the point of conflux of the Ganga and Brahmaputra) and large number of rain-fed, small tributaries originating from the eastern Indian Shield. The drained sediments are ultimately delivered into the Bengal fan. The significance of the present study is to delineate the variations in thicknesses of the sediments, different crustal structures, and the mantle lithosphere throughout the onshore-offshore Bengal basin. In the present study, the different crustal/geological units and the shallower mantle lithosphere were delineated by analyzing the Bouguer Gravity Anomaly (BGA) data along two long traverses South-North (running from Bengal fan cutting across the transition offshore-onshore of the Bengal basin and intersecting the Main Frontal Thrust of India-Himalaya collision zone in Sikkim-Bhutan Himalaya) and West-East (running from the Peninsular Indian Shield across the Bengal basin to the Chittagong–Tripura Fold Belt). The BGA map was derived from the analysis of topex data after incorporating Bouguer correction and all terrain corrections. The anomaly map was compared with the available ground gravity data in the western Bengal basin and the sub-continents of India for consistency of the data used. Initially, the anisotropy associated with the thicknesses of the different crustal units, crustal interfaces and moho boundary was estimated through spectral analysis of the gravity data with varying window size over the study area. The 2D density sections along the traverses were finalized after a number of iterations with the acceptable root mean square (RMS) errors. The estimated thicknesses of the different crustal units and dips of the Moho boundary along both the profiles are consistent with the earlier results. Further the results were encouraged by examining the earthquake database and focal mechanism solutions for better understanding the geodynamics. The earthquake data were taken from the catalogue of US Geological Survey, and the focal mechanism solutions were compiled from the Harvard Centroid Moment Tensor Catalogue. The concentrations of seismic events at different depth levels are not uncommon. The occurrences of earthquakes may be due to stress accumulation as a result of resistance from three sides.

Keywords: anisotropy, interfaces, seismicity, spectrum analysis

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Authors: Pau Rodriguez, Jordi Gonzalez, Josep M. Gonfaus, Xavier Roca

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Image sharing in social networks has increased exponentially in the past years. Officially, there are 600 million Instagrammers uploading around 100 million photos and videos per day. Consequently, there is a need for developing new tools to understand the content expressed in shared images, which will greatly benefit social media communication and will enable broad and promising applications in education, advertisement, entertainment, and also psychology. Following these trends, our work aims to take advantage of the existing relationship between text and personality, already demonstrated by multiple researchers, so that we can prove that there exists a relationship between images and personality as well. To achieve this goal, we consider that images posted on social networks are typically conditioned on specific words, or hashtags, therefore any relationship between text and personality can also be observed with those posted images. Our proposal makes use of the most recent image understanding models based on neural networks to process the vast amount of data generated by social users to determine those images most correlated with personality traits. The final aim is to train a weakly-supervised image-based model for personality assessment that can be used even when textual data is not available, which is an increasing trend. The procedure is described next: we explore the images directly publicly shared by users based on those accompanying texts or hashtags most strongly related to personality traits as described by the OCEAN model. These images will be used for personality prediction since they have the potential to convey more complex ideas, concepts, and emotions. As a result, the use of images in personality questionnaires will provide a deeper understanding of respondents than through words alone. In other words, from the images posted with specific tags, we train a deep learning model based on neural networks, that learns to extract a personality representation from a picture and use it to automatically find the personality that best explains such a picture. Subsequently, a deep neural network model is learned from thousands of images associated with hashtags correlated to OCEAN traits. We then analyze the network activations to identify those pictures that maximally activate the neurons: the most characteristic visual features per personality trait will thus emerge since the filters of the convolutional layers of the neural model are learned to be optimally activated depending on each personality trait. For example, among the pictures that maximally activate the high Openness trait, we can see pictures of books, the moon, and the sky. For high Conscientiousness, most of the images are photographs of food, especially healthy food. The high Extraversion output is mostly activated by pictures of a lot of people. In high Agreeableness images, we mostly see flower pictures. Lastly, in the Neuroticism trait, we observe that the high score is maximally activated by animal pets like cats or dogs. In summary, despite the huge intra-class and inter-class variabilities of the images associated to each OCEAN traits, we found that there are consistencies between visual patterns of those images whose hashtags are most correlated to each trait.

Keywords: emotions and effects of mood, social impact theory in social psychology, social influence, social structure and social networks

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Authors: Cristina Chaminade, Mandar Kulkarni, Balaji Parthasarathy, Monica Plechero

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The characteristics of a regional innovation system (RIS) and the specificity of the knowledge base of an industry may contribute to create peculiar paths for innovation and development of firms’ geographic extended innovation networks. However, the relative empirical evidence in emerging economies remains underexplored. The paper aims to fill the research gap by means of some recent qualitative research conducted in 2016 in Beijing (China) and Bangalore (India). It analyzes cases studies of firms in the new media industry, a sector that merges different IT competences with competences from other knowledge domains and that is emerging in those RIS. The results show that while in Beijing the new media sector results to be more in line with the existing institutional setting and governmental goals aimed at targeting specific social aspects and social problems of the population, in Bangalore it remains a more spontaneous firms-led process. In Beijing what matters for the development of innovation networks is the governmental setting and the national and regional strategies to promote science and technology in this sector, internet and mass innovation. The peculiarities of recent governmental policies aligned to the domestic goals may provide good possibilities for start-ups to develop innovation networks. However, due to the specificities of those policies targeting the Chinese market, networking outside the domestic market are not so promoted. Moreover, while some institutional peculiarities, such as a culture of collaboration in the region, may be favorable for local networking, regulations related to Internet censorship may limit the use of global networks particularly when based on virtual spaces. Mainly firms with already some foreign experiences and contact take advantage of global networks. In Bangalore, the role of government in pushing networking for the new media industry at the present stage is quite absent at all geographical levels. Indeed there is no particular strategic planning or prioritizing in the region toward the new media industry, albeit one industrial organization has emerged to represent the animation industry interests. This results in a lack of initiatives for sustaining the integration of complementary knowledge into the local portfolio of IT specialization. Firms actually involved in the new media industry face institutional constrains related to a poor level of local trust and cooperation, something that does not allow for full exploitation of local linkages. Moreover, knowledge-provider organizations in Bangalore remain still a solid base for the IT domain, but not for other domains. Initiatives to link to international networks seem therefore more the result of individual entrepreneurial actions aimed at acquiring complementary knowledge and competencies from different domains and exploiting potentiality in different markets. From those cases, it emerges that role of government, soft institutions and organizations in the two RIS differ substantially in the creation of barriers and opportunities for the development of innovation networks and their specific aim.

Keywords: regional innovation system, emerging economies, innovation network, institutions, organizations, Bangalore, Beijing

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Authors: Miranda E. Karban

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A distinctive pattern of occipital squama convexity, known as the occipital bun or chignon, has traditionally been considered a derived Neandertal trait. However, some early modern and extant Homo sapiens share similar occipital bone morphology, showing pronounced internal and external occipital squama curvature and paralambdoidal flattening. It has been posited that these morphological patterns are homologous in the two groups, but this claim remains disputed. Many developmental hypotheses have been proposed, including assertions that the chignon represents a developmental response to a long and narrow cranial vault, a narrow or flexed basicranium, or a prognathic face. These claims, however, remain to be metrically quantified in a large subadult sample, and little is known about the feature’s developmental, functional, or evolutionary significance. This study assesses patterns of chignon development and covariation in a comparative sample of extant human growth study cephalograms. Cephalograms from a total of 549 European-derived North American subjects (286 male, 263 female) were scored on a 5-stage ranking system of chignon prominence. Occipital squama shape was found to exist along a continuum, with 34 subjects (6.19%) possessing defined chignons, and 54 subjects (9.84%) possessing very little occipital squama convexity. From this larger sample, those subjects represented by a complete radiographic series were selected for metric analysis. Measurements were collected from lateral and posteroanterior (PA) cephalograms of 26 subjects (16 male, 10 female), each represented at 3 longitudinal age groups. Age group 1 (range: 3.0-6.0 years) includes subjects during a period of rapid brain growth. Age group 2 (range: 8.0-9.5 years) includes subjects during a stage in which brain growth has largely ceased, but cranial and facial development continues. Age group 3 (range: 15.9-20.4 years) includes subjects at their adult stage. A total of 16 landmarks and 153 sliding semi-landmarks were digitized at each age point, and geometric morphometric analyses, including relative warps analysis and two-block partial least squares analysis, were conducted to study covariation patterns between midsagittal occipital bone shape and other aspects of craniofacial morphology. A convex occipital squama was found to covary significantly with a low, elongated neurocranial vault, and this pattern was found to exist from the youngest age group. Other tested patterns of covariation, including cranial and basicranial breadth, basicranial angle, midcoronal cranial vault shape, and facial prognathism, were not found to be significant at any age group. These results suggest that the chignon, at least in this sample, should not be considered an independent feature, but rather the result of developmental interactions relating to neurocranial elongation. While more work must be done to quantify chignon morphology in fossil subadults, this study finds no evidence to disprove the developmental homology of the feature in modern humans and Neandertals.

Keywords: chignon, craniofacial covariation, human cranial development, longitudinal growth study, occipital bun

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Authors: Violet Petit-Steeghs, Jochem J. R. Van Roon, Jacqueline E. W. Broerse

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Last decennia the retirement age in Europe is gradually increasing. As a result, people have to continue working for a longer period of time. Health problems due to increased sedentary behavior and mental conditions like burn-out, pose a threat in fulfilling employees’ working life. In order to stimulate the ability and willingness to work in the present and future, it is important to stay vital. Vitality is regarded in literature as a sense of energy, motivation and resilience. It is assumed that by increasing their vitality, employees will stay healthier and be more satisfied with their job, leading to a more sustainable employment and less absenteeism in the future. The aim of this project is to obtain insights into the experiences and barriers of employees, and specifically office workers, with regard to their vitality. These insights are essential in order to develop appropriate measures in the future. To get more insights in the experiences of office workers on their vitality, 8 focus group discussions were organized with 6-10 office workers from 4 different employers (an university, a national construction company and a large juridical and care service organization) in the Netherlands. The discussions were transcribed and analyzed via open coding. This project is part of a larger consortium project Provita2, and conducted in collaboration with University of Technology Eindhoven. Results showed that a range of interdependent factors form a complex network that influences office workers’ vitality. These factors can be divided in three overarching groups: (1) personal (2) organizational and (3) environmental factors. Personal intrinsic factors, relating to the office worker, comprise someone’s physical health, coping style, life style, needs, and private life. Organizational factors, relating to the employer, are the workload, management style and the structure, vision and culture of the organization. Lastly, environmental factors consist of the air, light, temperature at the workplace and whether the workplace is inspiring and workable. Office workers experienced barriers to improve their own vitality due to a lack of autonomy. On the one hand, because most factors were not only intrinsic but extrinsic, like work atmosphere or the temperature in the room. On the other hand, office workers were restricted in adapting both intrinsic as well as extrinsic factors. Restrictions to for instance the flexibility of working times and the workload, can set limitations for improving vitality through personal factors like physical activity and mental relaxation. In conclusion, a large range of interdependent factors influence the vitality of office workers. Office workers are often regarded to have a responsibility to improve their vitality, but are limitedly autonomous in adapting these factors. Measures to improve vitality should therefore not only focus on increasing awareness among office workers, but also on empowering them to fulfill this responsibility. A holistic approach that takes the complex mutual dependencies between the different factors and actors (like managers, employees and HR personnel) into account is highly recommended.

Keywords: occupational health, perspectives office workers, sustainable employment, vitality at work, work & wellbeing

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Authors: Sandra Hartl, Meena Chavan

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This paper presents the outcome of a four year Ph.D. research on cross-cultural conflict management in transnational business relationships. An important and complex problem about managing conflicts that arise across cultures in business relationships is investigated, and conflict resolution strategies are identified. This paper particularly focuses on transnational relationships within a Chinese, German and Middle Eastern framework. Unlike many papers on this issue which have been built on experiments with international MBA students, this research provides real-life cases of cross-cultural conflicts which are not easy to capture. Its uniqueness is underpinned as the real case data was gathered by interviewing top executives at management positions in large multinational corporations through a qualitative case study method approach. This paper makes a valuable contribution to the theory of cross-cultural conflicts, and despite the sensitivity, this research primarily presents real-time business data about breaches of contracts between two counterparties engaged in transnational operating organizations. The overarching aim of this research is to identify the degree of significance for the cultural factors and the communication factors embedded in cross-cultural business conflicts. It questions from a cultural perspective what factors lead to the conflicts in each of the cases, what the causes are and the role of culture in identifying effective strategies for resolving international disputes in an increasingly globalized business world. The results of 20 face to face interviews are outlined, which were conducted, recorded, transcribed and then analyzed using the NVIVO qualitative data analysis system. The outcomes make evident that the factors leading to conflicts are broadly organized under seven themes, which are communication, cultural difference, environmental issues, work structures, knowledge and skills, cultural anxiety and personal characteristics. When evaluating the causes of the conflict it is to notice that these are rather multidimensional. Irrespective of the conflict types (relationship or task-based conflict or due to individual personal differences), relationships are almost always an element of all conflicts. Cultural differences, which are a critical factor for conflicts, result from different cultures placing different levels of importance on relationships. Communication issues which are another cause of conflict also reflect different relationships styles favored by different cultures. In identifying effective strategies for solving cross-cultural business conflicts this research identifies that solutions need to consider the national cultures (country specific characteristics), organizational cultures and individual culture, of the persons engaged in the conflict and how these are interlinked to each other. Outcomes identify practical dispute resolution strategies to resolve cross-cultural business conflicts in reference to communication, empathy and training to improve cultural understanding and cultural competence, through the use of mediation. To conclude, the findings of this research will not only add value to academic knowledge of cross-cultural conflict management across transnational businesses but will also add value to numerous cross-border business relationships worldwide. Above all it identifies the influence of cultures and communication and cross-cultural competence in reducing cross-cultural business conflicts in transnational business.

Keywords: business conflict, conflict management, cross-cultural communication, dispute resolution

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Authors: Abha Gupta, Deepak K. Mishra

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Food security issue in India has surrounded over availability and accessibility of cereal which is regarded as the only food group to check hunger and improve nutrition. Significance of fruits, vegetables, meat and other food products have totally been neglected given the fact that they provide essential nutrients to the body. There is a need to shift the emphasis from cereal-based approach to a more diverse diet so that aim of achieving food security may change from just reducing hunger to an overall health. This paper attempts to analyse how far dietary diversity level has been achieved across different socio-economic groups in India. For this purpose, present paper sets objectives to determine (a) percentage share of different food groups to total food expenditure and consumption by background characteristics (b) source of and preference for all food items and, (c) diversity of diet across socio-economic groups. A cross sectional survey covering 304 households selected through proportional stratified random sampling was conducted in six villages of Aligarh district of Uttar Pradesh, India. Information on amount of food consumed, source of consumption and expenditure on food (74 food items grouped into 10 major food groups) was collected with a recall period of seven days. Per capita per day food consumption/expenditure was calculated through dividing consumption/expenditure by household size and number seven. Food variety score was estimated by giving 0 values to those food groups/items which had not been eaten and 1 to those which had been taken by households in last seven days. Addition of all food group/item score gave result of food variety score. Diversity of diet was computed using Herfindahl-Hirschman index. Findings of the paper show that cereal, milk, roots and tuber food groups contribute a major share in total consumption/expenditure. Consumption of these food groups vary across socio-economic groups whereas fruit, vegetables, meat and other food consumption remain low and same. Estimation of dietary diversity show higher concentration of diet due to higher consumption of cereals, milk, root and tuber products and dietary diversity slightly varies across background groups. Muslims, Scheduled caste, small farmers, lower income class, food insecure, below poverty line and labour families show higher concentration of diet as compared to their counterpart groups. These groups also evince lower mean intake of number of food item in a week due to poor economic constraints and resultant lower accessibility to number of expensive food items. Results advocate to make a shift from cereal based diet to dietary diversity which not only includes cereal and milk products but also nutrition rich food items such as fruits, vegetables, meat and other products. Integrating a dietary diversity approach in food security programmes of the country would help to achieve nutrition security as hidden hunger is widespread among the Indian population.

Keywords: dietary diversity, food Security, India, socio-economic groups

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Authors: Marcus Goh Tian Xi, Alicia Chua Si Wen, Eunice Gan Ghee Wu, Helen Bound, Lee Liang Ying, Albert Lee

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The Map of Dialogical Inquiry provides a conceptual look at the underlying nature of future-oriented skills. According to the Map, learning is learner-oriented, with conversational time shifted from teachers to learners, who play a strong role in deciding what and how they learn. For example, in courses operating on the principles of Dialogical Inquiry, learners were able to leave the classroom with a deeper understanding of the topic, broader exposure to differing perspectives, and stronger critical thinking capabilities, compared to traditional approaches to teaching. Despite its contributions to learning, the Map is grounded in a qualitative approach both in its development and its application for providing feedback to learners and educators. Studies hinge on openended responses by Map users, which can be time consuming and resource intensive. The present research is motivated by this gap in practicality by aiming to develop and validate a quantitative measure of the Map. In addition, a quantifiable measure may also strengthen applicability by making learning experiences trackable and comparable. The Map outlines eight learning aspects that learners should holistically engage. This research focuses on the Analysing aspect of learning. According to the Map, Analysing has four key components: liking or engaging in logic, using interpretative lenses, seeking patterns, and critiquing and deconstructing. Existing scales of constructs (e.g., critical thinking, rationality) related to these components were identified so that the current scale could adapt items from. Specifically, items were phrased beginning with an “I”, followed by an action phrase, to fulfil the purpose of assessing learners' engagement with Analysing either in general or in classroom contexts. Paralleling standard scale development procedure, the 26-item Analysing scale was administered to 330 participants alongside existing scales with varying levels of association to Analysing, to establish construct validity. Subsequently, the scale was refined and its dimensionality, reliability, and validity were determined. Confirmatory factor analysis (CFA) revealed if scale items loaded onto the four factors corresponding to the components of Analysing. To refine the scale, items were systematically removed via an iterative procedure, according to their factor loadings and results of likelihood ratio tests at each step. Eight items were removed this way. The Analysing scale is better conceptualised as unidimensional, rather than comprising the four components identified by the Map, for three reasons: 1) the covariance matrix of the model specified for the CFA was not positive definite, 2) correlations among the four factors were high, and 3) exploratory factor analyses did not yield an easily interpretable factor structure of Analysing. Regarding validity, since the Analysing scale had higher correlations with conceptually similar scales than conceptually distinct scales, with minor exceptions, construct validity was largely established. Overall, satisfactory reliability and validity of the scale suggest that the current procedure can result in a valid and easy-touse measure for each aspect of the Map.

Keywords: analytical thinking, dialogical inquiry, education, lifelong learning, pedagogy, scale development

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Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

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Authors: Ekemini M. Okon, Reuben C. Okocha, Babatunde T. Adesina, Judith O. Ehigie, Babatunde M. Falana, Boluwape T. Okikiola

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Antimicrobial resistance (AMR) has evolved to become a significant threat to global public health and food safety. The development of AMR in animals has been associated with antimicrobial overuse. In recent years, the number of antimicrobials used in food animals such as fish and poultry has escalated. It, therefore, becomes imperative to understand the patterns of AMR in fish and poultry and map out future directions for better surveillance efforts. This study used the Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA) to assess the trend, patterns, and spatial distribution for AMR research in Egypt, Nigeria, and South Africa. A literature search was conducted through the Scopus and Web of Science databases in which published studies on AMR between 1989 and 2021 were assessed. A total of 172 articles were relevant for this study. The result showed progressive attention on AMR studies in fish and poultry from 2018 to 2021 across the selected countries. The period between 2018 (23 studies) and 2021 (25 studies) showed a significant increase in AMR publications with a peak in 2019 (28 studies). Egypt was the leading exponent of AMR research (43%, n=74) followed by Nigeria (40%, n=69), then South Africa (17%, n=29). AMR studies in fish received relatively little attention across countries. The majority of the AMR studies were on poultry in Egypt (82%, n=61), Nigeria (87%, n=60), and South Africa (83%, n=24). Further, most of the studies were on Escherichia and Salmonella species. Antimicrobials frequently researched were ampicillin, erythromycin, tetracycline, trimethoprim, chloramphenicol, and sulfamethoxazole groups. Multiple drug resistance was prevalent, as demonstrated by antimicrobial resistance patterns. In poultry, Escherichia coli isolates were resistant to cefotaxime, streptomycin, chloramphenicol, enrofloxacin, gentamycin, ciprofloxacin, oxytetracycline, kanamycin, nalidixic acid, tetracycline, trimethoprim/sulphamethoxazole, erythromycin, and ampicillin. Salmonella enterica serovars were resistant to tetracycline, trimethoprim/sulphamethoxazole, cefotaxime, and ampicillin. Staphylococcusaureus showed high-level resistance to streptomycin, kanamycin, erythromycin, cefoxitin, trimethoprim, vancomycin, ampicillin, and tetracycline. Campylobacter isolates were resistant to ceftriaxone, erythromycin, ciprofloxacin, tetracycline, and nalidixic acid at varying degrees. In fish, Enterococcus isolates showed resistance to penicillin, ampicillin, chloramphenicol, vancomycin, and tetracycline but sensitive to ciprofloxacin, erythromycin, and rifampicin. Isolated strains of Vibrio species showed sensitivity to florfenicol and ciprofloxacin, butresistance to trimethoprim/sulphamethoxazole and erythromycin. Isolates of Aeromonas and Pseudomonas species exhibited resistance to ampicillin and amoxicillin. Specifically, Aeromonashydrophila isolates showed sensitivity to cephradine, doxycycline, erythromycin, and florfenicol. However, resistance was also exhibited against augmentinandtetracycline. The findings constitute public and environmental health threats and suggest the need to promote and advance AMR research in other countries, particularly those on the global hotspot for antimicrobial use.

Keywords: antibiotics, antimicrobial resistance, bacteria, environment, public health

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Authors: Gyu-Dong Kim, Wuk-Jae Yoo, Sang-Youl Lee

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Composite structures offer numerous advantages over conventional structural systems in the form of higher specific stiffness and strength, lower life-cycle costs, and benefits such as easy installation and improved safety. Recently, there has been a considerable increase in the use of composites in engineering applications and as wraps for seismic upgrading and repairs. However, these composites deteriorate with time because of outdated materials, excessive use, repetitive loading, climatic conditions, manufacturing errors, and deficiencies in inspection methods. In particular, damaged fibers in a composite result in significant degradation of structural performance. In order to reduce the failure probability of composites in service, techniques to assess the condition of the composites to prevent continual growth of fiber damage are required. Condition assessment technology and nondestructive evaluation (NDE) techniques have provided various solutions for the safety of structures by means of detecting damage or defects from static or dynamic responses induced by external loading. A variety of techniques based on detecting the changes in static or dynamic behavior of isotropic structures has been developed in the last two decades. These methods, based on analytical approaches, are limited in their capabilities in dealing with complex systems, primarily because of their limitations in handling different loading and boundary conditions. Recently, investigators have introduced direct search methods based on metaheuristics techniques and artificial intelligence, such as genetic algorithms (GA), simulated annealing (SA) methods, and neural networks (NN), and have promisingly applied these methods to the field of structural identification. Among them, GAs attract our attention because they do not require a considerable amount of data in advance in dealing with complex problems and can make a global solution search possible as opposed to classical gradient-based optimization techniques. In this study, we propose an alternative damage-detection technique that can determine the degraded stiffness distribution of vibrating laminated composites made of Glass Fiber-reinforced Polymer (GFRP). The proposed method uses a modified form of the bivariate Gaussian distribution function to detect degraded stiffness characteristics. In addition, this study presents a method to detect the fiber property variation of laminated composite plates from the micromechanical point of view. The finite element model is used to study free vibrations of laminated composite plates for fiber stiffness degradation. In order to solve the inverse problem using the combined method, this study uses only first mode shapes in a structure for the measured frequency data. In particular, this study focuses on the effect of the interaction among various parameters, such as fiber angles, layup sequences, and damage distributions, on fiber-stiffness damage detection.

Keywords: stiffness detection, fiber damage, genetic algorithm, layup sequences

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Authors: Carmen W. H. Chan, Helen Y. L. Chan, Kai Chow Choi, Ka Ming Chow, Cecilia W. M. Kwan, Nancy H. Y. Ng, Jackie Robinson

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Introduction: In Hong Kong, a significant number of deaths occur in acute care wards, which requires nurses in these settings to provide end-of-life care and lead ACP implementation. However, nurses in these settings, in fact, have very low-level involvement in ACP discussions because of limited training in ACP conversations. Objective: This study aims to assess the impact of a multi-media experiential ACP (MEACP) training program, which is guided by the experiential learning model and theory of planned behaviour, on nurses' knowledge and confidence in assisting patients with ACP. Methodology: The study utilizes a cluster randomized controlled trial with a 12-week follow-up. Eligible nurses working in acute care hospital wards are randomly assigned at the ward level, in a 1:1 ratio, to either the control group (no ACP education) or the intervention group (4-week MEACP training program). The training programme includes training through a webpage and mobile application, as well as a face-to-face training workshop with enhanced lectures and role play, which is based on the Theory of Planned Behavior and Kolb's Experiential Learning Model. Questionnaires were distributed to assess nurses' knowledge (a 10-item true/false questionnaire) and level of confidence (five-point Likert scale) in ACP at baseline (T0), four weeks after the baseline assessment (T1), and 12 weeks after T1 (T2). In this interim report, data analysis was mainly descriptive in nature. Result: The interim report focuses on the preliminary results of 165 nurses at T0 (Control: 74, Intervention: 91) over a 5-month period, 69 nurses from the control group who completed the 4-week follow-up and 65 nurses from the intervention group who completed the 4-week MEACP training program at T1. The preliminary attrition rate is 6.8% and 28.6% for the control and intervention groups, respectively, as some nurses did not complete the whole set of online modules. At baseline, the two groups were generally homogeneous in terms of their years of nursing practice, weekly working hours, working title, and level of education, as well as ACP knowledge and confidence levels. The proportion of nurses who answered all ten knowledge questions correctly increased from 13.8% (T0) to 66.2% (T1) for the intervention group and from 13% (T0) to 20.3% (T1) for the control group. The nurses in the intervention group answered an average of 7.57 and 9.43 questions correctly at T0 and T1, respectively. They showed a greater improvement in the knowledge assessment at T1 with respect to T0 when compared with their counterparts in the control group (mean difference of change score, Δ=1.22). They also exhibited a greater gain in level of confidence at T1 compared to their colleagues in the control group (Δ=0.91). T2 data is yet available. Conclusion: The prevalence of nurses engaging in ACP and their level of knowledge about ACP in Hong Kong is low. The MEACP training program can enrich nurses by providing them with more knowledge about ACP and increasing their confidence in conducting ACP.

Keywords: advance directive, advance care planning, confidence, knowledge, multi-media experiential, randomised control trial

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Authors: Drew Commandeur, Ryan Brodie, Sandra Hundza, Marc Klimstra

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The amplitude of raw electromyography (EMG) is affected by recording conditions and often requires normalization to make meaningful comparisons. Bioelectric methods normalize with an EMG signal recorded during a standardized task or from the experimental protocol itself, while biomechanical methods often involve measurements with an additional sensor such as a force transducer. Common bioelectric normalization techniques for treadmill walking include maximum voluntary isometric contraction (MVIC), dynamic EMG peak (EMGPeak) or dynamic EMG mean (EMGMean). There are several concerns with using MVICs to normalize EMG, including poor reliability and potential discomfort. A limitation of bioelectric normalization techniques is that they could result in a misrepresentation of the absolute magnitude of force generated by the muscle and impact the interpretation of EMG between functionally disparate groups. Additionally, methods that normalize to EMG recorded during the task may eliminate some real inter-individual variability due to biological variation. This study compared biomechanical and bioelectric EMG normalization techniques during treadmill walking to assess the impact of the normalization method on the functional interpretation of EMG data. For the biomechanical method, we normalized EMG to a target torque (EMGTS) and the bioelectric methods used were normalization to the mean and peak of the signal during the walking task (EMGMean and EMGPeak). The effect of normalization on muscle activation pattern, EMG amplitude, and inter-individual variability were compared between disparate cohorts of OLD (76.6 yrs N=11) and YOUNG (26.6 yrs N=11) adults. Participants walked on a treadmill at a self-selected pace while EMG was recorded from the right lower limb. EMG data from the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), vastus lateralis (VL), and biceps femoris (BF) were phase averaged into 16 bins (phases) representing the gait cycle with bins 1-10 associated with right stance and bins 11-16 with right swing. Pearson’s correlations showed that activation patterns across the gait cycle were similar between all methods, ranging from r =0.86 to r=1.00 with p<0.05. This indicates that each method can characterize the muscle activation pattern during walking. Repeated measures ANOVA showed a main effect for age in MG for EMGPeak but no other main effects were observed. Interactions between age*phase of EMG amplitude between YOUNG and OLD with each method resulted in different statistical interpretation between methods. EMGTS normalization characterized the fewest differences (four phases across all 5 muscles) while EMGMean (11 phases) and EMGPeak (19 phases) showed considerably more differences between cohorts. The second notable finding was that coefficient of variation, the representation of inter-individual variability, was greatest for EMGTS and lowest for EMGMean while EMGPeak was slightly higher than EMGMean for all muscles. This finding supports our expectation that EMGTS normalization would retain inter-individual variability which may be desirable, however, it also suggests that even when large differences are expected, a larger sample size may be required to observe the differences. Our findings clearly indicate that interpretation of EMG is highly dependent on the normalization method used, and it is essential to consider the strengths and limitations of each method when drawing conclusions.

Keywords: electromyography, EMG normalization, functional EMG, older adults

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Authors: Nataliya G. Olkhovik

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Nowadays in the system of Russian higher medical education there have been undertaken initiatives that resulted in focusing on the resources of e-learning in teaching foreign languages. Obviously, the face-to-face communication in foreign languages bears much more advantages in terms of effectiveness in comparison with the potential of e-learning. Thus, we’ve faced the necessity of strengthening the capacity of e-learning via integration of active methods into the process of teaching foreign languages, such as project activity of students. Successful project activity of students should involve the following components: monitoring, control, methods of organizing the student’s activity in foreign languages, stimulating their interest in the chosen project, approaches to self-assessment and methods of raising their self-esteem. The contemporary methodology assumes the project as a specific method, which activates potential of a student’s cognitive function, emotional reaction, ability to work in the team, commitment, skills of cooperation and, consequently, their readiness to verbalize ideas, thoughts and attitudes. Verbal activity in the foreign language is a complex conception that consolidates both cognitive (involving speech) capacity and individual traits and attitudes such as initiative, empathy, devotion, responsibility etc. Once we organize the project activity by the means of e-learning within the ‘Foreign language’ discipline we have to take into consideration all mentioned above characteristics and work out an effective way to implement it into the teaching practice to boost its educational potential. We have integrated into the e-platform Moodle the module of project activity consisting of the following blocks of tasks that lead students to research, cooperate, strive to leadership, chase the goal and finally verbalize their intentions. Firstly, we introduce the project through activating self-activity of students by the tasks of the phase ‘Preparation of the project’: choose the topic and justify it; find out the problematic situation and its components; set the goals; create your team, choose the leader, distribute the roles in your team; make a written report on grounding the validity of your choices. Secondly, in the ‘Planning the project’ phase we ask students to represent the analysis of the problem in terms of reasons, ways and methods of solution and define the structure of their project (here students may choose oral or written presentation by drawing up the claim in the e-platform about their wish, whereas the teacher decides what form of presentation to prefer). Thirdly, the students have to design the visual aids, speech samples (functional phrases, introductory words, keywords, synonyms, opposites, attributive constructions) and then after checking, discussing and correcting with a teacher via the means of Moodle present it in front of the audience. And finally, we introduce the phase of self-reflection that aims to awake the inner desire of students to improve their verbal activity in a foreign language. As a result, by implementing the project activity into the e-platform and project activity, we try to widen the frameworks of a traditional lesson of foreign languages through tapping the potential of personal traits and attitudes of students.

Keywords: active methods, e-learning, improving verbal activity in foreign languages, personal traits and attitudes

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Authors: Dedjo Yao Simon, Takahiro Saito, Norikazu Inuzuka, Ikuo Sugiyama

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The megacity of Abidjan is a coastal urban area where the number of floods reported and the associated impacts are on a rapid increase due to climate change, an uncontrolled urbanization, a rapid population increase, a lack of flood disaster mitigation and citizens’ awareness. The objective of this research is to reduce in the short and long term period, the human and socio-economic impact of the flood. Hydrological simulation is applied on free of charge global spatial data (digital elevation model, satellite-based rainfall estimate, landuse) to identify the flood-prone area and to map the risk of flood. A direct interview to a sample residents is used to validate the simulation results. Then a mobile application (Flood Locator) is prototyped to disseminate the risk information to the citizen. In addition, a value capture strategy is proposed to mobilize financial resource for disaster risk reduction (DRRf) to reduce the impact of the flood. The town of Cocody in Abidjan is selected as a case study area to implement this research. The mapping of the flood risk reveals that population living in the study area is highly vulnerable. For a 5-year flood, more than 60% of the floodplain is affected by a water depth of at least 0.5 meters; and more than 1000 ha with at least 5000 buildings are directly exposed. The risk becomes higher for a 50 and 100-year floods. Also, the interview reveals that the majority of the citizen are not aware of the risk and severity of flooding in their community. This shortage of information is overcome by the Flood Locator and by an urban flood database we prototype for accumulate flood data. Flood Locator App allows the users to view floodplain and depth on a digital map; the user can activate the GPS sensor of the mobile to visualize his location on the map. Some more important additional features allow the citizen user to capture flood events and damage information that they can send remotely to the database. Also, the disclosure of the risk information could result to a decrement (-14%) of the value of properties locate inside floodplain and an increment (+19%) of the value of property in the suburb area. The tax increment due to the higher tax increment in the safer area should be captured to constitute the DRRf. The fund should be allocated to the reduction of flood risk for the benefit of people living in flood-prone areas. The flood prevention system discusses in this research will minimize in the short and long term the direct damages in the risky area due to effective awareness of citizen and the availability of DRRf. It will also contribute to the growth of the urban area in the safer zone and reduce human settlement in the risky area in the long term. Data accumulated in the urban flood database through the warning app will contribute to regenerate Abidjan towards the more resilient city by means of risk avoidable landuse in the master plan.

Keywords: abidjan, database, flood, geospatial techniques, risk communication, smartphone, value capture

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Authors: Piotr Kacejko, Mariusz Duk, Miroslaw Wendeker

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This paper presents an adaptive controller to track the maximum power point of a photovoltaic modules (PV) under fast irradiation change on the city-bus roof. Photovoltaic systems have been a prominent option as an additional energy source for vehicles. The Municipal Transport Company (MPK) in Lublin has installed photovoltaic panels on its buses roofs. The solar panels turn solar energy into electric energy and are used to load the buses electric equipment. This decreases the buses alternators load, leading to lower fuel consumption and bringing both economic and ecological profits. A DC–DC boost converter is selected as the power conditioning unit to coordinate the operating point of the system. In addition to the conversion efficiency of a photovoltaic panel, the maximum power point tracking (MPPT) method also plays a main role to harvest most energy out of the sun. The MPPT unit on a moving vehicle must keep tracking accuracy high in order to compensate rapid change of irradiation change due to dynamic motion of the vehicle. Maximum power point track controllers should be used to increase efficiency and power output of solar panels under changing environmental factors. There are several different control algorithms in the literature developed for maximum power point tracking. However, energy performances of MPPT algorithms are not clarified for vehicle applications that cause rapid changes of environmental factors. In this study, an adaptive MPPT algorithm is examined at real ambient conditions. PV modules are mounted on a moving city bus designed to test the solar systems on a moving vehicle. Some problems of a PV system associated with a moving vehicle are addressed. The proposed algorithm uses a scanning technique to determine the maximum power delivering capacity of the panel at a given operating condition and controls the PV panel. The aim of control algorithm was matching the impedance of the PV modules by controlling the duty cycle of the internal switch, regardless of changes of the parameters of the object of control and its outer environment. Presented algorithm was capable of reaching the aim of control. The structure of an adaptive controller was simplified on purpose. Since such a simple controller, armed only with an ability to learn, a more complex structure of an algorithm can only improve the result. The presented adaptive control system of the PV system is a general solution and can be used for other types of PV systems of both high and low power. Experimental results obtained from comparison of algorithms by a motion loop are presented and discussed. Experimental results are presented for fast change in irradiation and partial shading conditions. The results obtained clearly show that the proposed method is simple to implement with minimum tracking time and high tracking efficiency proving superior to the proposed method. This work has been financed by the Polish National Centre for Research and Development, PBS, under Grant Agreement No. PBS 2/A6/16/2013.

Keywords: adaptive control, photovoltaic energy, city bus electric load, DC-DC converter

Procedia PDF Downloads 184