Showing 114 results for Di
Mohammad Javad Sheikhmozafari, Fatemeh Sadat Mirnajafi Zadeh, Neda Sasani Nasab, Parsa Mohammad Alizadeh, Jamal Biganeh, Seyed Abolfazl Zakerian,
Volume 13, Issue 4 (12-2023)
Abstract
Introduction: Work-related musculoskeletal disorders (WMSDs) are a prevalent occupational health concern, influenced by both physical and psychosocial factors. Valid questionnaires offer a cost-effective and efficient means of evaluating WMSDs. This study aimed to validate the Persian version of the MDRF questionnaire, assess its applicability in Iran, and investigate the prevalence of WMSDs among employees in an automotive industry.
Material and Methods: This descriptive cross-sectional study was conducted among 100 employees (50 production line workers and 50 office workers) in Kerman province. The linguistic validity of the questionnaire and its translation were ensured using the Backward-Forward method. Content validity was assessed through CVI and CVR indexes. To evaluate the questionnaire’s reliability and agreement, Cronbach’s alpha and ICC were employed. User responses from the first and second series of the questionnaires were validated using Kappa and Spearman’s tests.
Results: Results indicated high reliability which was achieved by Cronbach’s alpha and ICC values of 0.960 and 0.925, respectively. The questionnaire’s validity was acceptable based on CVR and CVI tests. The prevalence of WMSDs was the highest in the lower back for both production line and office workers over the past year. The job satisfaction factor exhibited the highest risk level among the questionnaire’s four subgroups. Approximately 85% of participants were classified as having a high or very high-risk level, reflecting concerning conditions among the employees. The prevalence of WMSDs in different body parts significantly correlated with all physical and psychosocial stress factors.
Conclusion: This research highlights the influence of diverse physical and psychosocial risk factors on the occurrence of WMSDs among both occupational workers and office employees. Also, the MDRF questionnaire, whose high applicability in assessing the WMSDs risk factors was proven in this study, is an effective tool for prioritizing, planning, and executing educational and preventive measures within the workforce community to mitigate and prevent WMSDs.
Zeinab Rostami, Mohammad Reza Abedi, Parisa Nilforooshan,
Volume 13, Issue 4 (12-2023)
Abstract
Introduction: Due to the lack of an instrument for measuring the career issues of those with bipolar disorder, the present study was conducted to develop and examine the psychometric characteristics of the Career Issues Inventory for Persons with Bipolar Disorder (CII-BD).
Material and Methods: To check the diagnostic validity, via purposive sampling and interviews by a psychiatrist, 108 people were selected from two sample groups (53 normal people and 55 participants with bipolar disorder). The items were extracted from three sources including scientific articles related to the career issues of bipolar people, interviews with individuals with bipolar disorder, and interviews with experts using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) systematic qualitative method. Finally, the items of the CII-BD were reduced to 81 questions. Content, construct, and convergent validity plus factor analysis of CII-BD were also examined. The reliability of CII-BD was evaluated by internal consistency and test-retest method with seven weeks intervals after the initial implementation of the CII-BD.
Results: The convergent validity of the sum score of CII-BD with the sum score of the symptom inventory of people with bipolar disorder among the sample of normal people and the sample of persons with bipolar disorder was (r=0.79, P<0.01, N=53) and (r=0.78, P<0.0001, N=53) respectively. In construct validity examination, nine subscales were extracted using the factor analysis method with varimax rotation, which included communication problems, poor work performance, insecurity, grandiosity, unreliability, change-seeking, vulnerability, lack of boundaries, and lack of self-control towards the opposite sex. In the reliability analysis, Cronbach’s alpha coefficient was 0.96 (N=55, participants with bipolar disorder) and 0.86 (N=53, normal people), respectively, P<0.05, showing the high internal consistency of CII-BD. The test-retest correlation coefficient of the sum scores of the CII-BD was r = 0.91, P < 0.01, which indicated the credible stability of the CII-BD.
Conclusion: The CII-BD is a valid and reliable instrument to measure the specific career issues of bipolar persons and their early vocational rehabilitation. It is suggested that future research should focus on choosing a job and job placement for bipolar disorder persons.
Mojtaba Zokaei, Marzieh Sadeghian, Mohsen Falahati, Azam Biabani,
Volume 13, Issue 4 (12-2023)
Abstract
Introduction: Due to the increase in the provision of electronic services to citizens in government offices, the number of computer users and the occurrence of musculoskeletal disorders have increased. Therefore, this study aimed to predict and model the complex relationships between the risk factors of musculoskeletal disorders in computer users working in government offices by an artificial neural network.
Material and Methods: The current cross-sectional study was conducted in 2020 on 342 employees of various government offices in Saveh city. First, the researcher visited the work environment to identify the problems and measure the environmental factors. Then, ergonomic risk assessment and psychosocial factors were evaluated using the Nordic questionnaire and the ROSA method. The effect of various factors in causing musculoskeletal disorders was investigated using a logistic regression test.Then the resulting data were collected and modeled by one of the neural network algorithms. Finally, artificial neural networks presented an optimal model to predict the risk of musculoskeletal disorders.
Results: The results showed that by increasing the level of social interactions, the level of demand, control, and leadership in the job, musculoskeletal disorders in men and women decrease. There was a significant relationship between the prevalence of musculoskeletal disorders and job demand, job control levels, social interaction levels, leadership levels, organizational climate levels, job satisfaction levels, and stress levels, in addition between reports of pain in the neck and shoulder and wrist/hand region. There was a significant relationship with the overall ROSA score. Also, there was a significant relationship between the report of pain or discomfort in the neck area with the phone screen risk score, wrist/hand with the keyboard-mouse risk score, and shoulder, upper back, elbow, and lower back with the chair risk score. The accuracy of the presented model for predicting musculoskeletal disorders was also about 88.5%, which indicates the acceptability of the results.
Conclusion: The results showed that several factors play a role in causing musculoskeletal disorders, which include individual, environmental, psychosocial, and workstation factors. Therefore, in the design of an ergonomic workstation, the effects of the mentioned factors should be investigated. Also, predicting the effectiveness of each of the mentioned factors using an artificial neural network showed that this type of modeling can be used to prevent musculoskeletal disorders or other multifactorial disorders.
Saba Kalantary, Bahman Pourhassan, Zahra Beigzadeh, Vida Shahbazian, Ali Jahani,
Volume 14, Issue 1 (3-2024)
Abstract
Introduction: The prevalence of COVID-19 has significantly impacted work environments and the workforce. Therefore, identifying the most important preventive and control strategies, as well as assessing their effectiveness, is of paramount importance. Various studies have shown that machine learning algorithms can be used to predict complex and nonlinear issues, including predicting the behavior of various diseases such as COVID-19 and the parameters affecting it, and can be beneficial. The purpose of this study has been to examine the importance of preventive measures and hygiene behaviors in preventing COVID-19 in the oil refining industry using various machine learning models.
Material and Methods: For this purpose, demographic information and health behaviors of individuals were collected. Subsequently, a multi-layer perceptron (MLP), radial basis function (RBF), and support vector machine (SVM) models were compared to enhance the analysis of the effects of preventive measures on COVID-19 infection. Finally, the most influential factors affecting the likelihood of COVID-19 infection were determined using sensitivity analysis.
Results: The results showed that the accuracies achieved in predicting the impact of preventive measures and health behaviors on COVID-19 in occupational settings were 78.1%, 81.2%, and 78.1% by MLP, RBF, and SVM respectively. The RBF model was identified as the most accurate model for predicting the impact of health behaviors on COVID-19 disease Additionally, the level of social distancing with customers, handwashing frequency and disinfection, the availability of cleansing and disinfecting agents for hands and surfaces in the workplace, and gatherings for eating meals and snacks were identified as the most significant health behaviors influencing the prevalence of COVID-19 in the workplace.
Conclusion: Studies of this nature can underscore the importance of attention to preventive measures and health behaviors in unprecedented circumstances. Furthermore, the utilization of artificial intelligence models and tools such as DSS (Decision Support Systems) can serve as powerful tools for optimizing control measures in work environments.
Yalda Torabi, Neda Gilani, Yousef Mohammadian, Ali Esmaeili,
Volume 14, Issue 1 (3-2024)
Abstract
Introduction: Acceptance of Health, Safety, and Environment (HSE) rules plays a crucial role in determining the performance of employees in HSE-related areas at the workplace. This study aimed to design a questionnaire to investigate influential factors on acceptance of HSE rules among employees.
Material and Methods: The face validity of the survey was assessed by ten individuals from the target population, while content validity was evaluated by ten HSE experts using both quantitative and qualitative methods. The impact scores were calculated for the quantitative assessment of face validity, and the Content Validity Ratio (CVR) and Content Validity Index (CVI) values were used to assess content validity. Construct validity was determined through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) involving 506 participants. The reliability of the survey was evaluated using Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC).
Results: All items in the survey showed satisfactory levels of impact score (>1.5), CVR (>0.69), and CVI (>0.79). The mean values for the Impact score, CVI, CVR, and S-CVI-UA were 4.26, 0.963, 0.944, and 0.62, respectively. The survey and its dimensions demonstrated strong reliability, as indicated by Cronbach’s alpha and ICC values exceeding 0.70. Additionally, EFA successfully identified the structure of the questionnaire, and CFA confirmed its goodness of fit.
Conclusion: The Persian version of the questionnaire demonstrated satisfactory validity and reliability. This instrument can be effectively used to assess the factors that influence the acceptance of HSE rules among employees in various workplace settings.
Hassan Mehridiz, Mohamad Sadegh Ghasemi Ghasemi, Hassan Saeedi, Mahsa Varmazyar, Ehsan Garosi,
Volume 14, Issue 2 (6-2024)
Abstract
Introduction: Lifting loads in awkward postures is a main cause of low back musculoskeletal disorders. In this context, researchers have used various indicators to determine the relationship between biomechanical variables and the risk of these disorders. This study aimed to investigate the correlation between plantar pressure distribution and the values of UTAH back-compressive forces (BCF) and lifting index (LI) during symmetrical load-lifting tasks.
Material and Methods: Thirteen healthy men, aged 25 to 35, took part in this study. The participants were instructed to symmetrically lift loads weighing 7.5 kg and 15 kg in 15 different postures, considering three horizontal distances (A, B, C) and five different heights (1-5). Pressure on the foot soles was recorded using 16 force-sensitive resistors (FSR) corresponding to eight anatomical areas on each foot. The BCF and LI were also calculated using the UTAH method and the NIOSH equation, respectively. Statistical analysis was performed using SPSS (version 21) software.
Results: Based on the results, when the load was closest to the body (A1-A5), the highest pressure was recorded in the heel and the 4th and 5th metatarsal of both feet. In lifting a load of 15 kg in the A2, B1, B2, C1, C2 postures and lifting a load of 7.5 kg in the C2 posture, the average BCF exceeded 700 pounds. The LI was greater than 1 for specific postures (B1, B2, B4, B5, C1-C5) at 15 kg and (C1, C2, C4, C5) at 7.5 kg load-lifting. During the 7.5 kg and 15 kg load-lifting, there was a significant correlation between the plantar pressure and the values of LI and UTAH (p-values < 0.05) in most postures.
Conclusion: The results showed a significant correlation between plantar pressure distribution and load-lifting postures. The study findings, which identify risk levels associated with lifting postures, lay the groundwork for future research aimed at categorizing safe and unsafe plantar pressure patterns.
Saba Kalantary, Mohammad Reza Pourmand, Ensieh Masoorian, Mirghani Seyd Someah, Zahra Barkhordarian, Sara Hajinejad, Farideh Golbabaei,
Volume 14, Issue 2 (6-2024)
Abstract
Introduction: Protection of the respiratory system has been a vital, and for this purpose, various solutions have been proposed, including the use of masks. One of the most important parameters to measure the effectiveness of the mask against the penetration of microbial agents. The present study was conducted with the aim of evaluating the bacterial and particle filtration of medical masks.
Material and Methods: To assess bacterial performance, the national standard 6138, compliant with EN14683, and Type I medical masks were utilized. Staphylococcus aureus bacterial suspension was prepared and passed through the mask using a nebulizer and through an impactor with a flow rate of 28.3 l/min. Plates containing soy agar were placed in the impactor. Subsequently, all plates were incubated, and the bacterial filtration efficiency (BFE) of the masks was determined by counting the bacterial colonies that passed through the mask’s media as a percentage of the total bacteria. It is worth noting that the pressure drop and particle filtration efficiency were also determined for all masks
Results: Based on the results of the particle removal performance for the particle size of 3 µ, the masks were categorized into three groups with efficiency above 99%, above 95% and 90%. According to the standard, all masks had an acceptable pressure drop below 40 Pa. The acceptable bacterial filtration rate for type I masks should be above 95%. The results showed that type A and B masks have an acceptable bacterial filtration rate and there is a significant correlation between the types of masks examined in terms of bacterial and particle efficiency.
Conclusion: The results showed that different types of masks under investigation have significant differences in terms of particle capture efficiency and bacterial filtration performance. In addition, there is a significant correlation between bacterial and particle filtration efficiency.
Salimeh Ghassemi Jondabeh, Tooraj Dana, Maryam Robati, Zahra Abedi, Farideh Golbabaei,
Volume 14, Issue 2 (6-2024)
Abstract
Introduction: Improving health and the environment is one of the components of development, social welfare, and economic growth. Another influential factor in increasing health costs and reducing social welfare is work-related accidents and diseases, which impose high costs on individuals, industries, and the national economies of countries. Therefore, using multi-criteria decision-making methods, the present study provided a conceptual model to identify and rank work-related diseases’ environmental and health costs.
Material and Methods: The present study was conducted in 2023. A classification model for the economic evaluation of environmental and health costs of occupational diseases was developed to achieve the study’s aim. In the current research, the Delphi method was used to identify health and environmental criteria, and the Analytic Network Process (ANP) was used to weight the sub-criteria. Finally, the cost of health and the environment was estimated based on the available information. Naft Tehran Hospital (NSHT) was also selected as a case study site.
Results: The results showed that the drug and medical equipment cost factor, with a weight of 0.312 in the treatment sector, and the particular and infectious waste cost factor, with a weight of 0.085, were the most critical factors in the economic evaluation. Also, the parametric model results showed that 99.84% of the total costs are related to health costs, and 0.16% are related to environmental costs. In general, the results of this research showed that 61.3% of the costs of the health sector are related to the two sectors of medicine and medical equipment and the cost of service personnel, and 91.7% of the costs of the environmental sector are related to wastewater treatment and the cost of electricity consumption.
Conclusion: This study presented a semi-quantitative model to estimate health and environmental costs caused by occupational diseases. The results can create a novel scientific insight into implementing control measures using the optimal point of cost-benefit parameters. Implementing this integrated model can be a practical and effective step in allocating resources and prioritizing interventions.
Narges Kaydani, Mohsen Sadeghi-Yarandi, Kourosh Zare, Mojdeh Bonyadi, Ahmad Soltanzadeh,
Volume 14, Issue 3 (10-2024)
Abstract
Introduction: Shift work combined with the nature of duty in occupations such as nursing can lead to the spread of psychological consequences and disorders in nurses. The aim of this study was investigating the cognitive and psycho-social consequences associated with shift work in nurses.
Material and Methods: This study was performed in 7 hospitals in 2023. The study population was 636 nurses. Data collection tool in this study was part of a comprehensive questionnaire that translated and modified by Choobineh et al. The data were analyzed using IBM SPSS software v. 22.0, and significance level in this study was considered 0.05.
Results: Out of 636 studied nurses, 474 were shift workers and 162 were day workers. The means of age and work experience of the study population were 37.26±5.25 years and 11.60±4.78 years, respectively. The results showed that the prevalence of psychological consequences in the shift workers group was significantly more than day work nurses (p<0.05). The highest prevalence of cognitive and psycho-social consequences in shift work nurses were related to fatigue (39.66%), insomnia (36.08) and decreased sleep quality (35.44%), respectively.
Conclusion: The findings of this study indicated that the parameters of the shift work system, working hours per week, education and hospital ward are the most important factors affecting the prevalence of cognitive and psycho-social consequences and sleep disorders in the nurses. Therefore, it is suggested that a separate program should be designed and implemented for each hospital ward to control and manage the psychological consequences associated with shift work in nurses.
Farzad Khalili, Afshin Marzban, Mahmoud Ghaseminejad, Abdollah Hayati,
Volume 14, Issue 4 (12-2024)
Abstract
Introduction: Sugarcane is an important and strategic product in many countries, including Iran. While the introduction of mechanization, e.g., sugarcane harvesting machines, has significantly enhanced the production process, operators of these machines still face many ergonomic and safety challenges.
Material and Methods: The present study investigated the ergonomic status of sugarcane harvester operators by examining some of their physiological and physical evaluations. Physiological evaluations included heart rate, oral temperature, and energy consumption of the operators, perceptual strain index, and physiological strain index. Physical evaluation included estimating the amount of pain and discomfort in body segments. The correlation between pain and discomfort of body parts with some demographic and physiological indices of users was investigated using IBM SPSS 24 software.
Results: Sugarcane harvester operators’ heart rate, energy consumption, and physiological strain index were 79.05 beats/min, 18.81 kJ/min, and 0.83, respectively. The average of three indices of thermal sensation, perceived exertion of activity, and perceptual strain index were estimated as 4.40, 9.21, and 8.86, respectively.
Conclusion: Pain and discomfort in the neck and back segments, like many agricultural activities, had the highest rate among the body parts. Also, shorter and thinner operators reported higher pain and discomfort in some segments of the body.
Fatemeh Sadat Mirnajafi Zadeh, Mojtaba Khosravi Danesh, Ali Nahvi, Abbas Rahimi Foroushani, Mohammad Javad Sheikhmozafari, Adel Mazloumi,
Volume 14, Issue 4 (12-2024)
Abstract
Introduction: Despite advancements in road safety and vehicle design, road accidents remain prevalent, a quarter of which are caused by driver distraction. This issue is particularly critical in the public transport sector, especially among urban bus drivers, as distraction can lead to serious injuries and fatalities. Accordingly, this study explored the factors influencing distraction among urban bus drivers through a qualitative approach and a macroergonomics perspective.
Material and Methods: In this study conducted in 2024 in Tehran, 18 urban bus drivers were selected through cluster sampling. The participants included 10 drivers from bus rapid transit (BRT) system and 8 drivers from non-BRT services. Data were collected through semi-structured interviews with the drivers as well as on-site observations. Subsequently, a directed qualitative content analysis approach, based on the balance theory model, was used to analyze the collected data.
Results: The findings revealed that the primary sources of distraction belonged to six levels of the work system, the most cited of which were environment, tasks, and organization. Specifically, inappropriate behavior of other street users as an environmental factor and the driver’s interactions with passengers as task-related factors were identified as key sources. Additionally, organizational factors such as interactions with supervisors and colleagues, as well as salary issues, were significantly important. The participants very limitedly expressed using mobile phone while driving as a main distractor to their driving.
Conclusion: The current study identified various influential factors, spanning different levels of the work system, affecting bus drivers’ distraction, including generic factors that impact all urban drivers and specific factors that uniquely affect bus drivers. Addressing these factors through providing appropriate education for both passengers and street users along with implementing management strategies in the organization to enhance intra-organizational relationships and organizational support can lead to the safety of the bus drivers.
Vahid Kazemizadeh, Amirabbas Monazzami, Fakhredin Saba, Andrew J McAinch,
Volume 14, Issue 4 (12-2024)
Abstract
Introduction: This study aimed to analyze the effects of endurance training (Aerobic) on the levels of inflammatory markers (IL-6/TNF-α) and some metabolic parameters in male rats with non-alcoholic fatty liver disease to investigate the feasibility of using exercise training to reduce inflammation.
Material and Methods: A total of 44 Wistar rats were randomly assigned into two groups: (I) standard diet group of 22 rats and (II) high-fat diet group with 22 rats supplemented with free access to fructose water. After 17 weeks, two rats from each group were sacrificed, and liver tissue was collected for hematoxylin-eosin staining. Subsequently, the remaining 20 rats in the (I) group were divided into a training group (T) and a control group (C). The 20 rats in the (II) group supplemented with fructose water were divided into a fatty liver group (FL) and a fatty liver + training group (FL+T), each comprising ten rats. In the next phase, the T-groups underwent an eight-week endurance training intervention. Then, IL-6, TNF-α, glucose, insulin, insulin resistance and sensitivity levels were measured.
Results: The results of the present study showed that as a result of a high-fat diet with liquid fructose in HFD+HF group rats, non-alcoholic fatty liver disease (NAFLD) with complications such as a significant increase in the levels of IL-6 and TNF-α, Hepatic dysfunction, and metabolic parameters were disturbed (p<0.001). However, endurance training improved most of these complications by reversing the disease process (p<0.001).
Conclusion: According to the results of the present study, it can be concluded that the improvement of inflammatory markers, liver dysfunction, and metabolic parameters through endurance training is one of the key mechanisms of exercise in the treatment of NAFLD, the consequences of which may show the importance of endurance training in treatment of NAFLD highlights.
Marzieh Mohammadi, Zeinab Kazemi, Marzieh Izadi Laybidi, Mohammad Sadegh Ghasemi,
Volume 14, Issue 4 (12-2024)
Abstract
Introduction: Operating room personnel are involved with occupational physical activities such as repetitive bending, holding surgical tools and standing for long hours that can lead to musculoskeletal disorders (MSDs). Low back pain (LBP) is the most prevalent and costly problem among these disorders. The aim of this study was to determine the relationship between occupational physical activity, LBP and disability among operating room personnel.
Material and Methods: A total of 60 operating room personnel voluntarily participated in the study, all of which had at least two years of working experience. At the end of a working week, the degree of disability and pain were assessed by Graded Chronic Pain (GCP) questionnaire. The International Physical Activity Questionnaire (IPAQ) was used to evaluate the level of physical activity. Simple linear regression was conducted to investigate the relationship between physical activity, LBP and disability.
Results: The survey using the GCP questionnaire revealed that 58.3% of participants reported experiencing occupational back pain, while 41.7% reported no back pain. Among those with back pain, the average pain intensity was rated 43.11 (18.22) on the scale. Pain remained stable for an average of 2.3 days (standard deviation = 0.95). The average level of disability associated with back pain was 32.09 (27.44). Statistical analysis using simple linear regression showed a significant relationship between back pain and several factors: vigorous physical activity (p-value = 0.02), prolonged sitting time (p-value = 0.01), and chronic pain (p-value < 0.001).
Conclusion: Occupational physical activity characterized by low intensity, but high repetition and standing for a long time in fixed postures were the most significant contributors to lumbar back pain among operating room personnel. Chronic pain in this population was reported as grade 2, indicating severe pain with minimal disability; if left unaddressed, this could lead to movement restrictions.
Soqrat Omari Shekaftik, Jamal Biganeh, Maedeh Hosseinzadeh, Hamidreza Jafari Nodoushan, Neda Mehrparvar,
Volume 14, Issue 4 (12-2024)
Abstract
Introduction: Workplaces often contain potential risks, such as exposure to toxic chemicals. Conducting a thorough health risk assessment helps employers recognize these dangers and implement necessary controls. In the 20th century, modern risk assessment frameworks began to be established with the rise of public health agencies.
Material and Methods: The present study is a narrative review. In order to obtain necessary information, Persian and English texts were searched in Web of Science, PubMed, Scopus, SID and Magiran databases. Keywords such as “health risk assessment”, “chemicals” and “nanomaterials” were used in this study.
Results: Both quantitative and qualitative health risk assessments play critical roles in occupational health, with each method providing different levels of depth and accuracy depending on the situation. EPA Model, Monte-Carlo Simulation, Physiologically Based Pharmacokinetic (PBPK) Modeling, Quantitative Structure-Activity Relationship (QSAR) Models, Probabilistic Risk Assessment (PRA), Life Cycle Impact Assessment (LCIA), and Biologically Based Dose-Response (BBDR) Models, are among the most important quantitative methods for assessing the health risk of chemicals. COSHH Model, ICCT Model, ICMM Model, Australian Model, and Romanian Model, are the most important qualitative methods for health risk assessment of chemicals. In addition to the quantitative and qualitative methods, semi-quantitative methods like Singapore Model, LEC Method, and SEP Model, have also been proposed for assessing the health risk of chemicals. The preference for qualitative over quantitative methods in the risk assessment of activities involving nanomaterials stems from substantial uncertainties, limited data availability, and the unique and complex behaviors of nanomaterials in the workplaces.
Conclusion: Overall, the evolution of health risk assessment methods reflects a continuous drive towards greater accuracy, reliability, and relevance. As we continue to innovate and expand our knowledge, the field is well-positioned to address the complex and evolving landscape of chemical and material risks, ensuring the protection of human health and the environment.