Search results for: interval-valued hesitant fuzzy setting
Commenced in January 2007
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Paper Count: 2513

Search results for: interval-valued hesitant fuzzy setting

563 A Comparative Study of Burnout and Coping Strategies between HIV Counselors: Face to Face and Online Counseling Services in Addis Ababa

Authors: Yemisrach Mihertu Amsale

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The purpose of this study was to compare burnout and coping strategies between HIV counselors in face to face and online counseling settings in Addis Ababa. The study was mixed approach design that was quantitative and qualitative. For the quantitative data the participants involved in this study included 64 face to face and 47 online HIV counselors in both counseling settings. In addition, 23 participants were involved to offer qualitative data from both counseling settings. For the purpose of gathering the quantitative data, the instruments, namely, demographic questionnaire, Maslach Burnout Inventory and the COPE questionnaire, were used to gather quantitative data. Qualitative data was also gathered in the FGD Guide and Interview Guide. Thus, this study revealed that HIV counselors in online counseling settings scored high on emotional exhaustion, depersonalization and low in personal accomplishment dimensions of burnout as compared to HIV counselors in face to face setting and the difference was statistically significant in emotional exhaustion and personal accomplishment, but there was no a significant difference on depersonalization dimension of burnout between the two groups. In addition, the present study revealed a statistically significant difference on problem focused coping strategy between the two groups and yet for on the emotion focused coping strategy the difference was not statistically significant. Statistically negative correlation was observed between some demographic variables such as age with emotional exhaustion and depersonalization dimensions of burnout; years of experiences and personal accomplishment dimension of burnout. A statistically positive correlation was also observed between average number of clients served per day and emotional exhaustion. Sex was having a statistically positive correlation with coping strategy. Lastly, a significant positive correlation was also observed in the emotional exhaustion dimension of the burnout and the emotional focused coping strategy. Generally, this study has shown that HIV counselors suffer from moderate to high level of burnout. Based on the findings, conclusions were made and recommendations were forwarded.

Keywords: counseling, burnout management, psychological, behavioral sciences

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562 Barrier Analysis of Sustainable Development of Small Towns: A Perspective of Southwest China

Authors: Yitian Ren, Liyin Shen, Tao Zhou, Xiao Li

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The past urbanization process in China has brought out series of problems, the Chinese government has then positioned small towns in essential roles for implementing the strategy 'The National New-type Urbanization Plan (2014-2020)'. As the connector and transfer station of cities and countryside, small towns are important force to narrow the gap between urban and rural area, and to achieve the mission of new-type urbanization in China. The sustainable development of small towns plays crucial role because cities are not capable enough to absorb the surplus rural population. Nevertheless, there are various types of barriers hindering the sustainable development of small towns, which led to the limited development of small towns and has presented a bottleneck in Chinese urbanization process. Therefore, this paper makes deep understanding of these barriers, thus effective actions can be taken to address them. And this paper chooses the perspective of Southwest China (refers to Sichuan province, Yunnan province, Guizhou province, Chongqing Municipality City and Tibet Autonomous Region), cause the urbanization rate in Southwest China is far behind the average urbanization level of the nation and the number of small towns accounts for a great proportion in mainland China, also the characteristics of small towns in Southwest China are distinct. This paper investigates the barriers of sustainable development of small towns which located in Southwest China by using the content analysis method, combing with the field work and interviews in sample small towns, then identified and concludes 18 barriers into four dimensions, namely, institutional barriers, economic barriers, social barriers and ecological barriers. Based on the research above, questionnaire survey and data analysis are implemented, thus the key barriers hinder the sustainable development of small towns in Southwest China are identified by using fuzzy set theory, those barriers are, lack of independent financial power, lack of construction land index, financial channels limitation, single industrial structure, topography variety and complexity, which mainly belongs to institutional barriers and economic barriers. In conclusion part, policy suggestions are come up with to improve the politic and institutional environment of small town development, also the market mechanism are supposed to be introduced to the development process of small towns, which can effectively overcome the economic barriers, promote the sustainable development of small towns, accelerate the in-situ urbanization by absorbing peasants in nearby villages, and achieve the mission of new-type urbanization in China from the perspective of people-oriented.

Keywords: barrier analysis, sustainable development, small town, Southwest China

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561 Globalisation, Growth and Sustainability in Sub-Saharan Africa

Authors: Ourvashi Bissoon

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Sub-Saharan Africa in addition to being resource rich is increasingly being seen as having a huge growth potential and as a result, is increasingly attracting MNEs on its soil. To empirically assess the effectiveness of GDP in tracking sustainable resource use and the role played by MNEs in Sub-Saharan Africa, a panel data analysis has been undertaken for 32 countries over thirty-five years. The time horizon spans the period 1980-2014 to reflect the evolution from before the publication of the pioneering Brundtland report on sustainable development to date. Multinationals’ presence is proxied by the level of FDI stocks. The empirical investigation first focuses on the impact of trade openness and MNE presence on the traditional measure of economic growth namely the GDP growth rate, and then on the genuine savings (GS) rate, a measure of weak sustainability developed by the World Bank, which assumes the substitutability between different forms of capital and finally, the impact on the adjusted Net National Income (aNNI), a measure of green growth which caters for the depletion of natural resources is examined. For countries with significant exhaustible natural resources and important foreign investor presence, the adjusted net national income (aNNI) can be a better indicator of economic performance than GDP growth (World Bank, 2010). The issue of potential endogeneity and reverse causality is also addressed in addition to robustness tests. The findings indicate that FDI and openness contribute significantly and positively to the GDP growth of the countries in the sample; however there is a threshold level of institutional quality below which FDI has a negative impact on growth. When the GDP growth rate is substituted for the GS rate, a natural resource curse becomes evident. The rents being generated from the exploitation of natural resources are not being re-invested into other forms of capital namely human and physical capital. FDI and trade patterns may be setting the economies in the sample on a unsustainable path of resource depletion. The resource curse is confirmed when utilising the aNNI as well, thus implying that GDP growth measure may not be a reliable to capture sustainable development.

Keywords: FDI, sustainable development, genuine savings, sub-Saharan Africa

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560 Influence of Spelling Errors on English Language Performance among Learners with Dysgraphia in Public Primary Schools in Embu County, Kenya

Authors: Madrine King'endo

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This study dealt with the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools in West Embu, Embu County, Kenya. The study purposed to investigate the influence of spelling errors on the English language performance among the class three pupils with dysgraphia in public primary schools. The objectives of the study were to identify the spelling errors that learners with dysgraphia make when writing English words and classify the spelling errors they make. Further, the study will establish how the spelling errors affect the performance of the language among the study participants, and suggest the remediation strategies that teachers could use to address the errors. The study could provide the stakeholders with relevant information in writing skills that could help in developing a responsive curriculum to accommodate the teaching and learning needs of learners with dysgraphia, and probably ensure training of teachers in teacher training colleges is tailored within the writing needs of the pupils with dysgraphia. The study was carried out in Embu county because the researcher did not find any study in related literature review concerning the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools done in the area. Moreover, besides being relatively populated enough for a sample population of the study, the area was fairly cosmopolitan to allow a generalization of the study findings. The study assumed the sampled schools will had class three pupils with dysgraphia who exhibited written spelling errors. The study was guided by two spelling approaches: the connectionist stimulation of spelling process and orthographic autonomy hypothesis with a view to explain how participants with learning disabilities spell written words. Data were collected through interviews, pupils’ exercise books, and progress records, and a spelling test made by the researcher based on the spelling scope set for class three pupils by the ministry of education in the primary education syllabus. The study relied on random sampling techniques in identifying general and specific participants. Since the study used children in schools as participants, voluntary consent was sought from themselves, their teachers and the school head teachers who were their caretakers in a school setting.

Keywords: dysgraphia, writing, language, performance

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559 Nurses Care Practices at End of Life in Intensive Care Units in the Kingdom of Bahrain

Authors: M. Yaqoob, C. S. O’Neill, S. Faraj, C. L. O’Neill

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This paper presents the preliminary findings from a study exploring nurse’s contributions to end of life decisions and to the care of dying patients in ICU units in the Kingdom of Bahrain. The process of dying is complex as medical clinicians are frequently unable to say with certainty when death will occur. It is generally accepted that end of life care begins when it is possible to know that death is imminent. Nurses do not make medical treatment decisions when caring for a dying patient. There are, however, many other types of decisions made when a patient is approaching the end of life and nurses are either formally or informally part of these decision making processes. This study explored nurses care practices at the end of life, in two ICU units in large hospitals in the Kingdom of Bahrain. The research design was a grounded theory approach. Ten nurses participated, six of whom were Bahraini nationals and four were Indian. A core category death avoidance talk was supported by three major subcategories, degrees of involvement in decision making; signalling and creating an awareness of death; care shifting from dying patients to family. Despite nurses asserting that they carried out the orders of doctors and had no role in decision making processes at end of life this study showed that there were degrees of nurse involvement. Doctors frequently discussed the patient’s clinical condition with nurses and also sought information regarding the family. Information about the family was of particular relevance if the doctor was considering a DNR order, which the nurses equated with dying. Families were not always informed when a DNR decision was made. When families were not informed the nurses engaged in sophisticated rituals signalling and creating awareness to family members that the death of their loved one was near. This process also involved a subtle shifting of care from the dying patient to the family. This seminar paper will focus particularly on how nurses signal and create an awareness of death in an ICU setting. The findings suggest that despite the avoidance of death talk in the ICU nurses indirectly convey and create an awareness that death is near to family members.

Keywords: decision making, dying patients, end of life, intensive care unit

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558 Examining the Effects of Increasing Lexical Retrieval Attempts in Tablet-Based Naming Therapy for Aphasia

Authors: Jeanne Gallee, Sofia Vallila-Rohter

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Technology-based applications are increasingly being utilized in aphasia rehabilitation as a means of increasing intensity of treatment and improving accessibility to treatment. These interactive therapies, often available on tablets, lead individuals to complete language and cognitive rehabilitation tasks that draw upon skills such as the ability to name items, recognize semantic features, count syllables, rhyme, and categorize objects. Tasks involve visual and auditory stimulus cues and provide feedback about the accuracy of a person’s response. Research has begun to examine the efficacy of tablet-based therapies for aphasia, yet much remains unknown about how individuals interact with these therapy applications. Thus, the current study aims to examine the efficacy of a tablet-based therapy program for anomia, further examining how strategy training might influence the way that individuals with aphasia engage with and benefit from therapy. Individuals with aphasia are enrolled in one of two treatment paradigms: traditional therapy or strategy therapy. For ten weeks, all participants receive 2 hours of weekly in-house therapy using Constant Therapy, a tablet-based therapy application. Participants are provided with iPads and are additionally encouraged to work on therapy tasks for one hour a day at home (home logins). For those enrolled in traditional therapy, in-house sessions involve completing therapy tasks while a clinician researcher is present. For those enrolled in the strategy training group, in-house sessions focus on limiting cue use in order to maximize lexical retrieval attempts and naming opportunities. The strategy paradigm is based on the principle that retrieval attempts may foster long-term naming gains. Data have been collected from 7 participants with aphasia (3 in the traditional therapy group, 4 in the strategy training group). We examine cue use, latency of responses and accuracy through the course of therapy, comparing results across group and setting (in-house sessions vs. home logins).

Keywords: aphasia, speech-language pathology, traumatic brain injury, language

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557 Spatio-Temporal Analysis of Land Use Change and Green Cover Index

Authors: Poonam Sharma, Ankur Srivastav

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Cities are complex and dynamic systems that constitute a significant challenge to urban planning. The increasing size of the built-up area owing to growing population pressure and economic growth have lead to massive Landuse/Landcover change resulted in the loss of natural habitat and thus reducing the green covers in urban areas. Urban environmental quality is influenced by several aspects, including its geographical configuration, the scale, and nature of human activities occurring and environmental impacts generated. Cities have transformed into complex and dynamic systems that constitute a significant challenge to urban planning. Cities and their sustainability are often discussed together as the cities stand confronted with numerous environmental concerns as the world becoming increasingly urbanized, and the cities are situated in the mesh of global networks in multiple senses. A rapid transformed urban setting plays a crucial role to change the green area of natural habitats. To examine the pattern of urban growth and to measure the Landuse/Landcover change in Gurgoan in Haryana, India through the integration of Geospatial technique is attempted in the research paper. Satellite images are used to measure the spatiotemporal changes that have occurred in the land use and land cover resulting into a new cityscape. It has been observed from the analysis that drastically evident changes in land use has occurred with the massive rise in built up areas and the decrease in green cover and therefore causing the sustainability of the city an important area of concern. The massive increase in built-up area has influenced the localised temperatures and heat concentration. To enhance the decision-making process in urban planning, a detailed and real world depiction of these urban spaces is the need of the hour. Monitoring indicators of key processes in land use and economic development are essential for evaluating policy measures.

Keywords: cityscape, geospatial techniques, green cover index, urban environmental quality, urban planning

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556 Construction of Ovarian Cancer-on-Chip Model by 3D Bioprinting and Microfluidic Techniques

Authors: Zakaria Baka, Halima Alem

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Cancer is a major worldwide health problem that has caused around ten million deaths in 2020. In addition, efforts to develop new anti-cancer drugs still face a high failure rate. This is partly due to the lack of preclinical models that recapitulate in-vivo drug responses. Indeed conventional cell culture approach (known as 2D cell culture) is far from reproducing the complex, dynamic and three-dimensional environment of tumors. To set up more in-vivo-like cancer models, 3D bioprinting seems to be a promising technology due to its ability to achieve 3D scaffolds containing different cell types with controlled distribution and precise architecture. Moreover, the introduction of microfluidic technology makes it possible to simulate in-vivo dynamic conditions through the so-called “cancer-on-chip” platforms. Whereas several cancer types have been modeled through the cancer-on-chip approach, such as lung cancer and breast cancer, only a few works describing ovarian cancer models have been described. The aim of this work is to combine 3D bioprinting and microfluidic technics with setting up a 3D dynamic model of ovarian cancer. In the first phase, alginate-gelatin hydrogel containing SKOV3 cells was used to achieve tumor-like structures through an extrusion-based bioprinter. The desired form of the tumor-like mass was first designed on 3D CAD software. The hydrogel composition was then optimized for ensuring good and reproducible printability. Cell viability in the bioprinted structures was assessed using Live/Dead assay and WST1 assay. In the second phase, these bioprinted structures will be included in a microfluidic device that allows simultaneous testing of different drug concentrations. This microfluidic dispositive was first designed through computational fluid dynamics (CFD) simulations for fixing its precise dimensions. It was then be manufactured through a molding method based on a 3D printed template. To confirm the results of CFD simulations, doxorubicin (DOX) solutions were perfused through the dispositive and DOX concentration in each culture chamber was determined. Once completely characterized, this model will be used to assess the efficacy of anti-cancer nanoparticles developed in the Jean Lamour institute.

Keywords: 3D bioprinting, ovarian cancer, cancer-on-chip models, microfluidic techniques

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555 Role of the Midwifery Trained Registered Nurse in Postnatal Units at Tertiary Care Hospitals in the Western Province of Sri Lanka: A Postal Survey

Authors: Sunethra Jayathilake, Vathsala Jayasuriya-Illesinghe, Kerstin Samarasinghe, Himani Molligoda, Rasika Perera

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In Sri Lanka, postnatal care in the state hospitals is provided by different professional categories: Midwifery trained registered nurses (MTRNs), Registered Nurses (RNs) who do not have midwifery training, doctors and midwives. Even though four professional categories provide postnatal care to mothers and newborn babies, they are not aware of their own tasks and responsibilities in postnatal care. Particularly MTRN’s role in the postnatal unit is unclear. The current study aimed to identify nurses’ (both MTRN and RNs) perception on MTRN’s tasks and responsibilities in postnatal care. This is a descriptive cross sectional study using postal survey. All nurses who were currently working in postnatal units at five selected tertiary care hospitals in the Western Province at that time were invited to participate in the study. Accordingly, the pre evaluated self-administered questionnaire was sent to 201 nurses (53 MTRNs and 148 RNs) in the study setting. The number of valid return questionnaire was 166; response rate was 83%. Respondents rated the responsibility of four professional categories: MTRN, RN, doctor and midwife whether they are 'primarily responsible', 'responsible in absence' and 'not responsible', for each of 15 postnatal (PN) tasks which were previously identified from focus group discussions with care providers during the first phase of the study. Data were analyzed using SPSS version 20; descriptive statistics were calculated. Out of the 15 PN tasks, 13 were identified as MTRNs’ primary responsibilities by 71%-93% of respondents. The respondents also considered six (6) tasks out of 15 as primary responsibility of both MTRN and RN, seven (7) tasks as primary responsibility of MTRN, RN and doctor and the remaining two (2) tasks were identified as the primary responsibility of MTRN, RN and midwife. All 15 PN tasks overlapped with other professional categories. Overlapping tasks may create role confusion leading to conflicts among professional categories which affect the quality of care they provide, eventually, threaten the safety of the client. It is recommended that an official job description for each care provider is needed to recognize their own professional boundaries for ensuring safe, quality care delivery in Sri Lanka.

Keywords: overlapping, postnatal, responsibilities, tasks

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554 Standard Essential Patents for Artificial Intelligence Hardware and the Implications For Intellectual Property Rights

Authors: Wendy de Gomez

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Standardization is a critical element in the ability of a society to reduce uncertainty, subjectivity, misrepresentation, and interpretation while simultaneously contributing to innovation. Technological standardization is critical to codify specific operationalization through legal instruments that provide rules of development, expectation, and use. In the current emerging technology landscape Artificial Intelligence (AI) hardware as a general use technology has seen incredible growth as evidenced from AI technology patents between 2012 and 2018 in the United States Patent Trademark Office (USPTO) AI dataset. However, as outlined in the 2023 United States Government National Standards Strategy for Critical and Emerging Technology the codification through standardization of emerging technologies such as AI has not kept pace with its actual technological proliferation. This gap has the potential to cause significant divergent possibilities for the downstream outcomes of AI in both the short and long term. This original empirical research provides an overview of the standardization efforts around AI in different geographies and provides a background to standardization law. It quantifies the longitudinal trend of Artificial Intelligence hardware patents through the USPTO AI dataset. It seeks evidence of existing Standard Essential Patents from these AI hardware patents through a text analysis of the Statement of patent history and the Field of the invention of these patents in Patent Vector and examines their determination as a Standard Essential Patent and their inclusion in existing AI technology standards across the four main AI standards bodies- European Telecommunications Standards Institute (ETSI); International Telecommunication Union (ITU)/ Telecommunication Standardization Sector (-T); Institute of Electrical and Electronics Engineers (IEEE); and the International Organization for Standardization (ISO). Once the analysis is complete the paper will discuss both the theoretical and operational implications of F/Rand Licensing Agreements for the owners of these Standard Essential Patents in the United States Court and Administrative system. It will conclude with an evaluation of how Standard Setting Organizations (SSOs) can work with SEP owners more effectively through various forms of Intellectual Property mechanisms such as patent pools.

Keywords: patents, artifical intelligence, standards, F/Rand agreements

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553 Evaluation of a Staffing to Workload Tool in a Multispecialty Clinic Setting

Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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552 Disentangling the Sources and Context of Daily Work Stress: Study Protocol of a Comprehensive Real-Time Modelling Study Using Portable Devices

Authors: Larissa Bolliger, Junoš Lukan, Mitja Lustrek, Dirk De Bacquer, Els Clays

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Introduction and Aim: Chronic workplace stress and its health-related consequences like mental and cardiovascular diseases have been widely investigated. This project focuses on the sources and context of psychosocial daily workplace stress in a real-world setting. The main objective is to analyze and model real-time relationships between (1) psychosocial stress experiences within the natural work environment, (2) micro-level work activities and events, and (3) physiological signals and behaviors in office workers. Methods: An Ecological Momentary Assessment (EMA) protocol has been developed, partly building on machine learning techniques. Empatica® wristbands will be used for real-life detection of stress from physiological signals; micro-level activities and events at work will be based on smartphone registrations, further processed according to an automated computer algorithm. A field study including 100 office-based workers with high-level problem-solving tasks like managers and researchers will be implemented in Slovenia and Belgium (50 in each country). Data mining and state-of-the-art statistical methods – mainly multilevel statistical modelling for repeated data – will be used. Expected Results and Impact: The project findings will provide novel contributions to the field of occupational health research. While traditional assessments provide information about global perceived state of chronic stress exposure, the EMA approach is expected to bring new insights about daily fluctuating work stress experiences, especially micro-level events and activities at work that induce acute physiological stress responses. The project is therefore likely to generate further evidence on relevant stressors in a real-time working environment and hence make it possible to advise on workplace procedures and policies for reducing stress.

Keywords: ecological momentary assessment, real-time, stress, work

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551 Microfacies Analysis and Paleoenvironmental Trends of the Paleocene Farrud and Mabruk Reservoirs, Concession 11, West Sirte Basin, Libya

Authors: Nisreen Agha

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Investigation of representative core samples under the petrological microscope reveals common petrographic and mineralogical characteristics with distinct faunal assemblages, allowing establishing of the microfacies associations and deducing the paleoenvironmental trends of the Paleocene Farrud and Mabruk rock units. Recognition of the early and post-diagenetic processes, particularly dolomitization and micritization, as well as dissolution and precipitation of spary drusy calcite as a new morphism process affecting the reservoir rocks, is established. The microfacies trends detected from the investigation of 46 core samples from Farrud member (Lower Paleocene) representing six wells; QQQ1-11, GG1-11, LLL1-11, RRR1-11, RRR40-11, and RRR45-11 indicate that the deposition was started within the realm of shallow supratidal and intertidal subenvironments followed by deeper environments of the shelf bays with maximum sea level during inner shelf environment where fossiliferous bioclastic packstone dominated. The microfacies associations determined in 8 core samples from two wells LLL1and RRR40 representing Mabruk Member (Upper Paleocene), indicate paleoenvironmental trends marked by sea level fluctuations accompanied with a relatively marine shelf bay conditions intervened with short-lived shallow intertidal and supratidal warm coastal sedimentation. As a result, dolostone, evaporitic dismicrites, and gypsiferous dolostone of supratidal characters were deposited. They reflect rapid oscillation of the sea level marked by drop land-ward shift of the sea shore deposition prevailed by supratidal gypsiferous dolostone and numerous ferruginous materials as clouds straining many parts of dolomite and surrounded the micritized fossils. This situation ends the deposition of the Farrud Member in most of the studied wells. On the other hand, the facies in the northern part of the Concession -11 field indicates deposition in a deeper marine setting than in the southern facies.

Keywords: Farrud and Mabruk members, paleocene, microfacies associations, diagenesis, sea level oscillation, depositional environments

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550 Study of Unsteady Behaviour of Dynamic Shock Systems in Supersonic Engine Intakes

Authors: Siddharth Ahuja, T. M. Muruganandam

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An analytical investigation is performed to study the unsteady response of a one-dimensional, non-linear dynamic shock system to external downstream pressure perturbations in a supersonic flow in a varying area duct. For a given pressure ratio across a wind tunnel, the normal shock's location can be computed as per one-dimensional steady gas dynamics. Similarly, for some other pressure ratio, the location of the normal shock will change accordingly, again computed using one-dimensional gas dynamics. This investigation focuses on the small-time interval between the first steady shock location and the new steady shock location (corresponding to different pressure ratios). In essence, this study aims to shed light on the motion of the shock from one steady location to another steady location. Further, this study aims to create the foundation of the Unsteady Gas Dynamics field enabling further insight in future research work. According to the new pressure ratio, a pressure pulse, generated at the exit of the tunnel which travels and perturbs the shock from its original position, setting it into motion. During such activity, other numerous physical phenomena also happen at the same time. However, three broad phenomena have been focused on, in this study - Traversal of a Wave, Fluid Element Interactions and Wave Interactions. The above mentioned three phenomena create, alter and kill numerous waves for different conditions. The waves which are created by the above-mentioned phenomena eventually interact with the shock and set it into motion. Numerous such interactions with the shock will slowly make it settle into its final position owing to the new pressure ratio across the duct, as estimated by one-dimensional gas dynamics. This analysis will be extremely helpful in the prediction of inlet 'unstart' of the flow in a supersonic engine intake and its prominence with the incoming flow Mach number, incoming flow pressure and the external perturbation pressure is also studied to help design more efficient supersonic intakes for engines like ramjets and scramjets.

Keywords: analytical investigation, compression and expansion waves, fluid element interactions, shock trajectory, supersonic flow, unsteady gas dynamics, varying area duct, wave interactions

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549 An Ethnographic Inquiry: Exploring the Saudi Students’ Motivation to Learn English Language

Authors: Musa Alghamdi

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Although Saudi students’ motivation to learn English language as a foreign language in Saudi Arabia have been investigated by a number of studies; these have appeared almost completely as using the quantitative research paradigm. There is a significant lack of research that explores the Saudi students’ motivation using qualitative methods. It was essential, as an investigator, to be immersed in the community to understand the individuals under study via their actions and words, their thoughts, views and beliefs, and how those individuals credited to activities. Thus, the study aims to explore the Saudi students’ motivation to learn English language as a foreign language in Saudi Arabia employing qualitative methodology via applying ethnography. The study will be carried out in Saudi Arabia. Ethnography qualitative approach will be used in the current study by employing formal and informal interview instruments. Gardner’s motivation theory is used as frameworks for this study to aid the understanding of the research findings. The author, an English language lecturer, will undertake participant observations for 4 months. He will work as teaching-assistant (on an unpaid basis) with EFL lecturers in different discipline department at a Saudi university where students study English language as a minor course. The researcher will start with informal ethnographical interview with students during his existence with the informants in their natural context. Then the researcher will utilize the semi-structural interview. The informal interview will be with 14-16 students, then, he will carry out semi-structural interview with the same informants to go deep in their natural context to find out to what extent the Saudi university students are motivated to learn English as a foreign language. As well as, to find out the reasons that played roles in that. The findings of this study will add new knowledge about what factors motivate universities’ Saudi students to learn English language in Saudi Arabia. Very few chances have given to students to express themselves and to speak about their feelings in a more comfortable way in order to gain a clear image of those factors. The working author as an EFL teacher and lecturer will provide him secure access into EFL teaching and learning setting. It will help him attain richer insights into the nature EFL context in universities what will provide him with richer insights into the reasons behind the weakness of EFL level among Saudi students.

Keywords: motivation, ethnography, Saudi, language

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548 Mapping the Adoption Process of Communication Technology to Maintain Contact between Older Adults with Intellectual Disability in Out-of-home Residence and Their Families: A Multiple-Case Study Research

Authors: Carmit Noa Shpigelman, Michal Isaacson

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Over the last decades, the improvement in welfare and health services and the increase in awareness of the needs of people with intellectual disability has led to an increase in their life expectancy, and many of them enter into old age. Furthermore, many older adults with intellectual disability live in out-of-home residence. This situation, in addition to the parents' aging process as the main caregivers, may lead to a reduction in contact with the family and, as a result, decreased level of the residents' (older adults with intellectual disability) well-being. A plausible solution for this condition may be using communication technologies. Previous studies indicate that using communication technologies among older adults contributes to maintaining the relationship with others, decreasing the older adult's sense of loneliness, and increasing their level of well-being. Using communication technologies may be especially valuable for older adults in the current global pandemic of COVID-19 and the associated restrictions of social distancing. However, to date, research on using communication technologies among people with intellectual disability has focused on younger cohorts. Moreover, research on the adoption of technologies among older adults with intellectual disability has focused more on assistive technologies and less on communication technologies. To address these practice and research gaps, the present study focuses on the adoption process of communication technology among older adults with intellectual disability (over the age of 45 years) who live in supported accommodation. Fifteen residents participated in an intervention program where they received a tablet with a video communication application and through which they were able to contact their families. A multiple-case study methodology was applied to capture the experiences, including barriers and needs, of the residents from three perspectives: the resident, the family member, and a staff member from the residential setting. The data was collected via quantitative and qualitative measures at different time points over the intervention. The findings demonstrate the contribution of using communication technology for the well-being of older adults with intellectual disability in supported accommodation. The findings also map the adoption process among this population, including pitfalls. The present study contributes to developing best practices on how to accommodate communication technologies to older adults with intellectual disability for maintaining contact with others.

Keywords: adoption, aging, communication, intellectual disability, technology

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547 Talent Management in Small and Medium Sized Companies: A Multilevel Approach Contextualized in France

Authors: Kousay Abid

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The aim of this paper is to better understand talent and talent management (TM) in small French companies as well as in medium-sized ones (SME). While previous empirical investigations have largely focused on multinationals and big companies and concentrated on the Anglo-Saxon context, we focus on the pressing need for implementing TM strategies and practices, not only on a new ground of SME but also within a new European context related to France and the French context. This study also aims at understanding strategies adopted by those firms as means to attract, retain, maintain and to develop talents. We contribute to TM issues by adopting a multilevel approach, holding the goal of reaching a global holistic vision of interactions between various levels while applying TM, to make it more and more familiar to us. A qualitative research methodology based on a multiple-case study design, bottomed firstly on a qualitative survey and secondly on two in-depth case study, both built on interviews, will be used in order to develop an ideal analysis for TM strategies and practices. The findings will be based on data collected from more than 15 French SMEs. Our theoretical contributions are the fruit of context considerations and the dynamic of multilevel approach. Theoretically, we attempt first to clarify how talents and TM are seen and defined in French SMEs and consequently to enrich the literature on TM in SMEs out of the Anglo-Saxon context. Moreover, we seek to understand how SMEs manage jointly their talents and their TM strategies by setting up this contextualized pilot study. As well, we focus on the systematic TM model issue from French SMEs. Our prior managerial goal is to shed light on the need for TM to achieve a better management of these organizations by directing leaders to better identify the talented people whom they hold at all levels. In addition, our TM systematic model strengthens our analysis grid as recommendations for CEO and Human Resource Development (HRD) to make them rethink about the companies’ HR business strategies. Therefore, our outputs present a multiple lever of action that should be taken into consideration while reviewing HR strategies and systems, as well as their impact beyond organizational boundaries.

Keywords: french context, multilevel approach, small and medium-sized enterprises, talent management

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546 Exploring the In-Between: An Examination of the Contextual Factors That Impact How Young Children Come to Value and Use the Visual Arts in Their Learning and Lives

Authors: S. Probine

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The visual arts have been proven to be a central means through which young children can communicate their ideas, reflect on experience, and construct new knowledge. Despite this, perceptions of, and the degree to which the visual arts are valued within education, vary widely within political, educational, community and family contexts. These differing perceptions informed my doctoral research project, which explored the contextual factors that affect how young children come to value and use the visual arts in their lives and learning. The qualitative methodology of narrative inquiry with inclusion of arts-based methods was most appropriate for this inquiry. Using a sociocultural framework, the stories collected were analysed through the sociocultural theories of Lev Vygotsky as well as the work of Urie Bronfenbrenner, together with postmodern theories about identity formation. The use of arts-based methods such as teacher’s reflective art journals and the collection of images by child participants and their parent/caregivers allowed the research participants to have a significant role in the research. Three early childhood settings at which the visual arts were deeply valued as a meaning-making device in children’s learning, were purposively selected to be involved in the research. At each setting, the study found a unique and complex web of influences and interconnections, which shaped how children utilised the visual arts to mediate their thinking. Although the teachers' practices at all three centres were influenced by sociocultural theories, each settings' interpretations of these theories were unique and resulted in innovative interpretations of the role of the teacher in supporting visual arts learning. These practices had a significant impact on children’s experiences of the visual arts. For many of the children involved in this study, visual art was the primary means through which they learned. The children in this study used visual art to represent their experiences, relationships, to explore working theories, their interests (including those related to popular culture), to make sense of their own and other cultures, and to enrich their imaginative play. This research demonstrates that teachers have fundamental roles in fostering and disseminating the importance of the visual arts within their educational communities.

Keywords: arts-based methods, early childhood education, teacher's visual arts pedagogies, visual arts

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545 Comparative Analysis of Reinforcement Learning Algorithms for Autonomous Driving

Authors: Migena Mana, Ahmed Khalid Syed, Abdul Malik, Nikhil Cherian

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In recent years, advancements in deep learning enabled researchers to tackle the problem of self-driving cars. Car companies use huge datasets to train their deep learning models to make autonomous cars a reality. However, this approach has certain drawbacks in that the state space of possible actions for a car is so huge that there cannot be a dataset for every possible road scenario. To overcome this problem, the concept of reinforcement learning (RL) is being investigated in this research. Since the problem of autonomous driving can be modeled in a simulation, it lends itself naturally to the domain of reinforcement learning. The advantage of this approach is that we can model different and complex road scenarios in a simulation without having to deploy in the real world. The autonomous agent can learn to drive by finding the optimal policy. This learned model can then be easily deployed in a real-world setting. In this project, we focus on three RL algorithms: Q-learning, Deep Deterministic Policy Gradient (DDPG), and Proximal Policy Optimization (PPO). To model the environment, we have used TORCS (The Open Racing Car Simulator), which provides us with a strong foundation to test our model. The inputs to the algorithms are the sensor data provided by the simulator such as velocity, distance from side pavement, etc. The outcome of this research project is a comparative analysis of these algorithms. Based on the comparison, the PPO algorithm gives the best results. When using PPO algorithm, the reward is greater, and the acceleration, steering angle and braking are more stable compared to the other algorithms, which means that the agent learns to drive in a better and more efficient way in this case. Additionally, we have come up with a dataset taken from the training of the agent with DDPG and PPO algorithms. It contains all the steps of the agent during one full training in the form: (all input values, acceleration, steering angle, break, loss, reward). This study can serve as a base for further complex road scenarios. Furthermore, it can be enlarged in the field of computer vision, using the images to find the best policy.

Keywords: autonomous driving, DDPG (deep deterministic policy gradient), PPO (proximal policy optimization), reinforcement learning

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544 Analysis of the Production Time in a Pharmaceutical Company

Authors: Hanen Khanchel, Karim Ben Kahla

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Pharmaceutical companies are facing competition. Indeed, the price differences between competing products can be such that it becomes difficult to compensate them by differences in value added. The conditions of competition are no longer homogeneous for the players involved. The price of a product is a given that puts a company and its customer face to face. However, price fixing obliges the company to consider internal factors relating to production costs and external factors such as customer attitudes, the existence of regulations and the structure of the market on which the firm evolved. In setting the selling price, the company must first take into account internal factors relating to its costs: costs of production fall into two categories, fixed costs and variable costs that depend on the quantities produced. The company cannot consider selling below what it costs the product. It, therefore, calculates the unit cost of production to which it adds the unit cost of distribution, enabling it to know the unit cost of production of the product. The company adds its margin and thus determines its selling price. The margin is used to remunerate the capital providers and to finance the activity of the company and its investments. Production costs are related to the quantities produced: large-scale production generally reduces the unit cost of production, which is an asset for companies with mass production markets. This shows that small and medium-sized companies with limited market segments need to make greater efforts to ensure their profit margins. As a result, and faced with high and low market prices for raw materials and increasing staff costs, the company must seek to optimize its production time in order to reduce loads and eliminate waste. Then, the customer pays only value added. Thus, and based on this principle we decided to create a project that deals with the problem of waste in our company, and having as objectives the reduction of production costs and improvement of performance indicators. This paper presents the implementation of the Value Stream Mapping (VSM) project in a pharmaceutical company. It is structured as follows: 1) determination of the family of products, 2) drawing of the current state, 3) drawing of the future state, 4) action plan and implementation.

Keywords: VSM, waste, production time, kaizen, cartography, improvement

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543 How Natural Environments Are Being Used by Teachers to Improve Student Learning and Wellbeing in Australia

Authors: Jade Fersterer, Tristan Snell, Mark Rickinson

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This paper is designed to provide a review of the literature concerning the impact of natural environments on student learning and wellbeing in Australia. Specific areas of interest include how child-led and teacher-led pedagogies differ in outdoor learning settings, and the impact of each approach on children’s well-being, behavior, relationships with others as well as educational outcomes. The review will include links to possibilities for future research, including a Ph.D. currently being undertaken in Australia, which aims to fulfill a considerable gap in psychological, educational and outdoor learning research, regarding how natural environments are being used by teachers to improve learning and wellbeing among primary school students. The proposed study aims to understand if children’s experience of learning, 1. in a natural environment, and 2. in a child-led way, can support and strengthen their skills across several areas of development, including those required for positive educational outcomes. Data will be collected from a sample of primary school students and teachers via both quantitative and qualitative methods, including a pre- and post-questionnaire, direct observation, and semi-structured interviews. The study will have valuable implications for the provision of quality education as well as the promotion of good health and wellbeing. The implications of the research will be useful not only for teachers and parents but also for Psychologists working with children and young people in both a school and clinical setting. Understanding the impacts and implications of child-led learning and exposure to natural environments provides the opportunity to build on the current school curriculum. The inclusion of child-led experiences in nature may provide a simple way to build enthusiasm for school and learning, cultivating skills for life and relationships as well as meeting current curriculum requirements and building capacity for ongoing academic pursuits. In addition, understanding the impact of learning in a natural environment on wellbeing will assist in the development and dissemination of an educational model that could help mitigate the negative health outcomes associated with reduced physical activity and decreasing contact with nature among children.

Keywords: child-led learning, educational outcomes, natural environments, wellbeing

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542 Third Places for Social Sustainability: A Planning Framework Based on Local and International Comparisons

Authors: Z. Goosen, E. J. Cilliers

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Social sustainability, as an independent perspective of sustainable development, has gained some acknowledgement, becoming an important aspect in sustainable urban planning internationally. However, limited research aiming at promoting social sustainability within urban areas exists within the South African context. This is mainly due to the different perspectives of sustainable development (e.g., Environmental, Economic, and Social) not being equally prioritized by policy makers and supported by implementation strategies, guidelines, and planning frameworks. The enhancement of social sustainability within urban areas relies on urban dweller satisfaction and the quality of urban life. Inclusive cities with high-quality public spaces are proposed within this research through implementing the third place theory. Third places are introduced as any place other than our homes (first place) and work (second place) and have become an integrated part of sustainable urban planning. As Third Places consist of every place 'in between', the approach has taken on a large role of the everyday life of city residents, and the importance of planning for such places can only be measured through identifying and highlighting the social sustainability benefits thereof. The aim of this research paper is to introduce third place planning within the urban area to ultimately enhance social sustainability. Selected background planning approaches influencing the planning of third places will briefly be touched on, as the focus will be placed on the social sustainability benefits provided through third place planning within an urban setting. The study will commence by defining and introducing the concept of third places within urban areas as well as a discussion on social sustainability, acting as one of the three perspectives of sustainable development. This will gain the researcher an improved understanding on social sustainability in order for the study to flow into an integrated discussion of the benefits Third places provide in terms of social sustainability and the impact it has on improved quality of life within urban areas. Finally, a visual case study comparison of local and international examples of third places identified will be illustrated. These international case studies will contribute towards the conclusion of this study where a local gap analysis will be formulated, based on local third place evidence and international best practices in order to formulate a strategic planning framework on improving social sustainability through third place planning within the local South African context.

Keywords: planning benefits, social sustainability, third places, urban area

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541 Rethinking Urban Informality through the Lens of Inclusive Planning and Governance in Contemporary Cities: A Case Study of Johannesburg, South Africa

Authors: Blessings Masuku

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Background: Considering that Africa is urbanizing faster than any other region globally, managing cities in the global South has become the centerpiece for the New Urban Agenda (i.e., a shared vision of how we rethink, rebuild, and manage our cities for a better and more sustainable future). This study is centered on governance and planning of urban informality practices with particular reference to the relationship between the state, informal actors (e.g., informal traders and informal dwellers), and other city stakeholders who are public space users (commuters, businesses, and environmental activists), and how informal actors organize themselves to lobby the state and claim for their rights in the city, and how they navigate their everyday livelihood strategies. Aim: The purpose of this study is to examine and interrogate contemporary approaches, policy and regulatory frameworks to urban spatial planning and management of informality in one of South Africa’s busiest and major cities, Johannesburg. Setting: The study uses the metropolitan region of the city of Johannesburg, South Africa to understand how this contemporary industrial city manages urban informality practices, including the use of public space, land zoning and street life, and paying a closer look at what progress has been made and gaps in their inclusive urban policy frameworks. Methods: This study utilized a qualitative approach that includes surveys (open-ended questions), archival research (i., e policy and other key document reviews), and key interviews mainly with city officials, and informality actors. A thematic analysis was used to analyze the data collected. Contribution: This study contributes to large urban informality scholarship in the global South cities by exploring how major cities particularly in Africa regulate and manage informality patterns and practices in their quest to build “utopian” smart cities. This study also brings a different perspective on the hacking ways used by the informal actors to resist harsh regulations and remain invisible in the city, which is something that previous literature has barely delved in-depth.

Keywords: inclusive planning and governance, infrastructure systems, livelihood strategies urban informality, urban space

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540 Women Entrepreneurship: An Era Facing Challenges

Authors: Neetika Mahajan, Awanish Shukla

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Entrepreneurship is key a driver to economic development. It opens opportunities for business startups and has potential to expand employment opportunities for many. Entrepreneurship gives ‘Purpose thriving’ approach towards society with new technologies and zeal to develop and compete in the market. There are many more advantages of entrepreneurship like freedom to scope of work and independence in setting own goals. Women contribute to nearly 50 percent of India’s population, constitute nearly 10 percent of a total number of entrepreneurs in India. Women are found to be better risk calculators, more ambitious and less prone to self-confidence. However, It is a hard fact that life has not been easy for women aspiring professional success. Gender parity is the biggest threat faced by female aspirant seeking new businesses. More challenges like socio-cultural barriers, insufficient financial assistance, etc. have been faced by the women of our country. To uplift the status of women in the society, a number of initiatives have been taken up by the Government of India. Initiatives like National Mission for Empowerment of Women by (Ministry of Women And Child Development) and SKILL INDIA aim to increase the technical skills and knowledge of women for tapping employment opportunities and self-confidence. Trade Related Entrepreneurship Assistance and Development (TREAD) Scheme and Mahila Coir Yojana are proposed by the Ministry of MSMEs aiming to facilitate employment opportunities for women and entrepreneurship development. This paper will aim to bring out the gaps and barriers, which are still resisting the potential women come upfront and start a new business irrespective of a number of initiatives being put by government of India. The aim is also to identify focus areas where further intervention is required and proposing suitable interventions. The methodology to take forward this research will include primary and secondary data collection from on ground survey to track various kind of challenges faced by aspirant women entrepreneurs. Insight will be put towards initiations by the government of India towards women empowerment and assistance to entrepreneurship. Scientific quantitative tools will be used to analyze collected information. The final output of the research shall focus on achieving the respective aims and objectives.

Keywords: women entrepreneurship, government programs and schemes, key challenges, economic development

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539 Effect of Curing Temperature on the Textural and Rheological of Gelatine-SDS Hydrogels

Authors: Virginia Martin Torrejon, Binjie Wu

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Gelatine is a protein biopolymer obtained from the partial hydrolysis of animal tissues which contain collagen, the primary structural component in connective tissue. Gelatine hydrogels have attracted considerable research in recent years as an alternative to synthetic materials due to their outstanding gelling properties, biocompatibility and compostability. Surfactants, such as sodium dodecyl sulfate (SDS), are often used in hydrogels solutions as surface modifiers or solubility enhancers, and their incorporation can influence the hydrogel’s viscoelastic properties and, in turn, its processing and applications. Literature usually focuses on studying the impact of formulation parameters (e.g., gelatine content, gelatine strength, additives incorporation) on gelatine hydrogels properties, but processing parameters, such as curing temperature, are commonly overlooked. For example, some authors have reported a decrease in gel strength at lower curing temperatures, but there is a lack of research on systematic viscoelastic characterisation of high strength gelatine and gelatine-SDS systems at a wide range of curing temperatures. This knowledge is essential to meet and adjust the technological requirements for different applications (e.g., viscosity, setting time, gel strength or melting/gelling temperature). This work investigated the effect of curing temperature (10, 15, 20, 23 and 25 and 30°C) on the elastic modulus (G’) and melting temperature of high strength gelatine-SDS hydrogels, at 10 wt% and 20 wt% gelatine contents, by small-amplitude oscillatory shear rheology coupled with Fourier Transform Infrared Spectroscopy. It also correlates the gel strength obtained by rheological measurements with the gel strength measured by texture analysis. Gelatine and gelatine-SDS hydrogels’ rheological behaviour strongly depended on the curing temperature, and its gel strength and melting temperature can be slightly modified to adjust it to given processing and applications needs. Lower curing temperatures led to gelatine and gelatine-SDS hydrogels with considerably higher storage modulus. However, their melting temperature was lower than those gels cured at higher temperatures and lower gel strength. This effect was more considerable at longer timescales. This behaviour is attributed to the development of thermal-resistant structures in the lower strength gels cured at higher temperatures.

Keywords: gelatine gelation kinetics, gelatine-SDS interactions, gelatine-surfactant hydrogels, melting and gelling temperature of gelatine gels, rheology of gelatine hydrogels

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538 Evaluation of Age-Friendly Nursing Service System: KKU (AFNS:KKU) Model for the Excellence

Authors: Roongtiwa Chobchuen, Siriporn Mongkholthawornchai, Boonsong Hatawaikarn, Uriwan Chaichangreet, Kobkaew Thongtid, Pusda Pukdeekumjorn, Panita Limpawattana

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Background: Age-friendly nursing service system in Srinagarind Hospital has been developed continuously based on the value and cultural background of Thailand which corporates with the modified WHO’s Age friendly Primary Care Service System. It consists of 3 issues; 1) development of staff training, 2) age-friendly service and 3) appropriate physical environment. Objective: To evaluate the efficacy of Age-friendly Nursing Service System: KKU (AFNS:KKU) model and to evaluate factors associated with nursing perception with AFN:KKU. Study design: Descriptive study Setting: 31 wards that served older patients in Srinagarind Hospital Populations: Nursing staff from 11 departments (31 wards) Instrument: Age-friendly nursing care scale as perceived by hospitalized older person Procedure and statistical analysis: All participants were asked questions using age-friendly nursing care scale as perceived by hospitalized older person questionnaires. Descriptive statistics and multiple logistic regression analyses were used to analyse the outcomes. Results: There were 337 participants recruited in this study. The majority of them were women (92%) with the mean ages of 29 years and 77.45% were nurse practitioners. They had average nursing experiences of 5 years. The average scores of age-friendly nursing care scale were high and highest in the area of attitude and communication. Age, sex, educational level, duration of work among, and having experience in aging training were not associated with nursing perception where type of department was an independent factor. Nurses from department of Surgery and Orthopedic, Eye and ENT, special ward and Obstetrics and Gynecological had significant greater perception than nurses from Internal Medicine Department (p < 0.05). Conclusion: Nurses had high scores in all dimensions of age-friendly concept. The result indicates that nurses have good attitude to aging care which can lead to improve quality of care. Organization should support other domains of ageing care to achieve greater effectiveness in geriatric care.

Keywords: age-friendly, nursing service system, excellence model, geriatric care

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537 Management of Acute Biliary Pathology at Gozo General Hospital

Authors: Kristian Bugeja, Upeshala A. Jayawardena, Clarissa Fenech, Mark Zammit Vincenti

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Introduction: Biliary colic, acute cholecystitis, and gallstone pancreatitis are some of the most common surgical presentations at Gozo General Hospital (GGH). National Institute for Health and Care Excellence (NICE) guidelines advise that suitable patients with acute biliary problems should be offered a laparoscopic cholecystectomy within one week of diagnosis. There has traditionally been difficulty in achieving this mainly due to the reluctance of some surgeons to operate in the acute setting, limited, timely access to MRCP and ERCP, and organizational issues. Methodology: A retrospective study was performed involving all biliary pathology-related admissions to GGH during the two-year period of 2019 and 2020. Patients’ files and electronic case summary (ECS) were used for data collection, which included demographic data, primary diagnosis, co-morbidities, management, waiting time to surgery, length of stay, readmissions, and reason for readmissions. NICE clinical guidance 188 – Gallstone disease were used as the standard. Results: 51 patients were included in the study. The mean age was 58 years, and 35 (68.6%) were female. The main diagnoses on admission were biliary colic in 31 (60.8%), acute cholecystitis in 10 (19.6%). Others included gallstone pancreatitis in 3 (5.89%), chronic cholecystitis in 2 (3.92%), gall bladder malignancy in 4 (7.84%), and ascending cholangitis in 1 (1.97%). Management included laparoscopic cholecystectomy in 34 (66.7%); conservative in 8 (15.7%) and ERCP in 6 (11.7%). The mean waiting time for laparoscopic cholecystectomy for patients with acute cholecystitis was 74 days – range being between 3 and 146 days since the date of diagnosis. Only one patient who was diagnosed with acute cholecystitis and managed with laparoscopic cholecystectomy was done so within the 7-day time frame. Hospital re-admissions were reported in 5 patients (9.8%) due to vomiting (1), ascending cholangitis (1), and gallstone pancreatitis (3). Discussion: Guidelines were not met for patients presenting to Gozo General Hospital with acute biliary pathology. This resulted in 5 patients being re-admitted to hospital while waiting for definitive surgery. The local issues resulting in the delay to surgery need to be identified and steps are taken to facilitate the provision of urgent cholecystectomy for suitable patients.

Keywords: biliary colic, acute cholecystits, laparoscopic cholecystectomy, conservative management

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536 Young Adult Gay Men's Healthcare Access in the Era of the Affordable Care Act

Authors: Marybec Griffin

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Purpose: The purpose of this cross-sectional study was to get a better understanding of healthcare usage and satisfaction among young adult gay men (YAGM), including the facility used as the usual source of healthcare, preference for coordinated healthcare, and if their primary care provider (PCP) adequately addressed the health needs of gay men. Methods: Interviews were conducted among n=800 YAGM in New York City (NYC). Participants were surveyed about their sociodemographic characteristics and healthcare usage and satisfaction access using multivariable logistic regression models. The surveys were conducted between November 2015 and June 2016. Results: The mean age of the sample was 24.22 years old (SD=4.26). The racial and ethnic background of the participants is as follows: 35.8% (n=286) Black Non-Hispanic, 31.9% (n=225) Hispanic/Latino, 20.5% (n=164) White Non-Hispanic, 4.4% (n=35) Asian/Pacific Islander, and 6.9% (n=55) reporting some other racial or ethnic background. 31.1% (n=249) of the sample had an income below $14,999. 86.7% (n=694) report having either public or private health insurance. For usual source of healthcare, 44.6% (n=357) of the sample reported a private doctor’s office, 16.3% (n=130) reported a community health center, and 7.4% (n=59) reported an urgent care facility, and 7.6% (n=61) reported not having a usual source of healthcare. 56.4% (n=451) of the sample indicated a preference for coordinated healthcare. 54% (n=334) of the sample were very satisfied with their healthcare. Findings from multivariable logistical regression models indicate that participants with higher incomes (AOR=0.54, 95% CI 0.36-0.81, p < 0.01) and participants with a PCP (AOR=0.12, 95% CI 0.07-0.20, p < 0.001) were less likely to use a walk-in facility as their usual source of healthcare. Results from the second multivariable logistic regression model indicated that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare (AOR=0.63, 95% CI 0.42-0.96, p < 0.05). In the final multivariable logistic model, results indicated that participants who had disclosed their sexual orientation to their PCP (AOR=2.57, 95% CI 1.25-5.21, p < 0.01) and were comfortable discussing their sexual activity with their PCP (AOR=8.04, 95% CI 4.76-13.58, p < 0.001) were more likely to agree that their PCP adequately addressed the healthcare needs of gay men. Conclusion: Understanding healthcare usage and satisfaction among YAGM is necessary as the healthcare landscape changes, especially given the relatively recent addition of urgent care facilities. The type of healthcare facility used as a usual source of care influences the ability to seek comprehensive and coordinated healthcare services. While coordinated primary and sexual healthcare may be ideal, individual preference for this coordination among YAGM is desired but may be limited due to experiences of discrimination in primary care settings.

Keywords: healthcare policy, gay men, healthcare access, Affordable Care Act

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535 Testing the Life Cycle Theory on the Capital Structure Dynamics of Trade-Off and Pecking Order Theories: A Case of Retail, Industrial and Mining Sectors

Authors: Freddy Munzhelele

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Setting: the empirical research has shown that the life cycle theory has an impact on the firms’ financing decisions, particularly the dividend pay-outs. Accordingly, the life cycle theory posits that as a firm matures, it gets to a level and capacity where it distributes more cash as dividends. On the other hand, the young firms prioritise investment opportunities sets and their financing; thus, they pay little or no dividends. The research on firms’ financing decisions also demonstrated, among others, the adoption of trade-off and pecking order theories on the dynamics of firms capital structure. The trade-off theory talks to firms holding a favourable position regarding debt structures particularly as to the cost and benefits thereof; and pecking order is concerned with firms preferring a hierarchical order as to choosing financing sources. The case of life cycle hypothesis explaining the financial managers’ decisions as regards the firms’ capital structure dynamics appears to be an interesting link, yet this link has been neglected in corporate finance research. If this link is to be explored as an empirical research, the financial decision-making alternatives will be enhanced immensely, since no conclusive evidence has been found yet as to the dynamics of capital structure. Aim: the aim of this study is to examine the impact of life cycle theory on the capital structure dynamics trade-off and pecking order theories of firms listed in retail, industrial and mining sectors of the JSE. These sectors are among the key contributors to the GDP in the South African economy. Design and methodology: following the postpositivist research paradigm, the study is quantitative in nature and utilises secondary data obtainable from the financial statements of sampled firm for the period 2010 – 2022. The firms’ financial statements will be extracted from the IRESS database. Since the data will be in panel form, a combination of the static and dynamic panel data estimators will used to analyse data. The overall data analyses will be done using STATA program. Value add: this study directly investigates the link between the life cycle theory and the dynamics of capital structure decisions, particularly the trade-off and pecking order theories.

Keywords: life cycle theory, trade-off theory, pecking order theory, capital structure, JSE listed firms

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534 ASEAN Limited Centrality in Connectivity: Managing the China-Japan Infrastructure Competition

Authors: Barbora Valockova

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Scholars recommend the establishment of a multilateral coordination mechanism by ASEAN, such as an infrastructure forum, to contain the China-Japan infrastructure financing competition in the region. However, they do not systematically investigate the reasons for its absence. This paper aims to fill the gap by addressing the following question: Why has ASEAN been unable to set up any multilateral coordination mechanism to soften the China-Japan infrastructure financing competition? This paper argues that ASEAN has not been able to set up such a mechanism due to its limited centrality in connectivity. This limited centrality decreases ASEAN’s ability to manage the China-Japan competition in a more comprehensive and coordinated way. Rather, ASEAN acts as a scope setter in connectivity, although this is not completely ineffective. This paper is divided into four sections. The first section explores the key tenets of the concept of ASEAN centrality in connectivity, which is under-examined in the current literature. The second section examines the extent to which ASEAN limited centrality in connectivity is being respected by China and Japan. The third section analyses how various stakeholders, such as ASEAN member states, their leaders and bureaucracy, and foreign private companies prevent ASEAN from attaining stronger centrality. The last section concludes and offers recommendations. Data is gathered using primary sources (official ASEAN, Chinese, and Japanese documents, interviews, etc.) and secondary material. By providing a nuanced analysis of ASEAN centrality in connectivity and developing a new operationalization of the concept, this paper aims to contribute to the international relations literature on ASEAN centrality. Initial findings suggest that while ASEAN limited centrality in connectivity has some effectiveness, it is not sufficient for setting up a multilateral coordination mechanism. While it represents a solid departure point, any potential possessed by ASEAN to evolve beyond a scope setter in connectivity is hampered by stakeholders involved in infrastructure development. While these players and their interactions can have both positive and negative effects on the scope set by ASEAN, it is unlikely that they would allow ASEAN to become the real central player. There can be no stronger ASEAN centrality in connectivity without ASEAN unity and neutrality. However, the last two factors are difficult to attain in the context of infrastructure development since ASEAN member states and stakeholders all have their styles and preferences. All other things being equal, these circumstances favor a loose, vague, and quasi-prescriptive arrangement among the relevant stakeholders.

Keywords: ASEAN centrality, China-Japan infrastructure competition, connectivity, scope setter

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