Search results for: clinical laboratory persons
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6291

Search results for: clinical laboratory persons

3171 Toxicity of Biopesticide Metarhizium anisopliae var acridium "Green Muscle" on the Cuticle of the Desert Locust Schistocerca gegaria (Forskål, 1775)

Authors: F. Haddadj, F. Acheuk, S. Hamdi, S. Zenia, A. Smai, H. Saadi, B. Doumandji-Mitiche

Abstract:

Locust is causing significant losses in agricultural production in the countries concerned by the invasion. Up to the present control strategy has consisted only of the spreaders chemicals; they have proven harmful to the environment and. For this, a new control method appeared it comes to the biological control based mostly by using microorganism. It is in that sense is we've made our contribution by the use of a biopesticide which is entomopathogenic fungus Metarhizium anisopliae var acridium "Green Muscle" on part of the cuticule the larval of fifth instar locust Schistocerca gregaria (Forskål, 1775). Preliminary test on the study of the pathogenicity of M. anisopliae var acridium biocontrol agent, was conducted in the laboratory on L5 S. gregaria, on which we inoculated treatment in the digestive tract and it administrant 20μl of entomopathogenic solution orally at a dose DL50 = 3.25 x107 sp./ ml (median lethal dose estimated at earlier), 5 days after treatment individuals are sacrificed. After dissection cuticles are recovered and then subjected to histological sections. The histological technique followed is that of Martoja Martoja-Pierson (1967). Microscopic observation revealed alterations in the architecture of the cuticule which leads to disorganization of cell layers.

Keywords: biopesticide, cuticle, desert locust, toxicity

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3170 Frailty Patterns in the US and Implications for Long-Term Care

Authors: Joelle Fong

Abstract:

Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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3169 Optimization and Feasibility Analysis of a PV/Wind/ Battery Hybrid Energy Conversion

Authors: Doaa M. Atia, Faten H. Fahmy, Ninet M. A. El-Rahman, Hassan T. Dorra

Abstract:

In this paper, the optimum design for renewable energy system powered an aquaculture pond was determined. Hybrid Optimization Model for Electric Renewable (HOMER) software program, which is developed by U.S National Renewable Energy Laboratory (NREL), is used for analyzing the feasibility of the stand-alone and hybrid system in this study. HOMER program determines whether renewable energy resources satisfy hourly electric demand or not. The program calculates energy balance for every 8760 hours in a year to simulate operation of the system. This optimization compares the demand for the electrical energy for each hour of the year with the energy supplied by the system for that hour and calculates the relevant energy flow for each component in the model. The essential principle is to minimize the total system cost while HOMER ensures control of the system. Moreover the feasibility analysis of the energy system is also studied. Wind speed, solar irradiance, interest rate and capacity shortage are the parameters which are taken into consideration. The simulation results indicate that the hybrid system is the best choice in this study, yielding lower net present cost. Thus, it provides higher system performance than PV or wind stand-alone systems.

Keywords: wind stand-alone system, photovoltaic stand-alone system, hybrid system, optimum system sizing, feasibility, cost analysis

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3168 Predictors of Lost to Follow-Up among HIV Patients Attending Anti-Retroviral Therapy Treatment Centers in Nigeria

Authors: Oluwasina Folajinmi, Kate Ssamulla, Penninah Lutung, Daniel Reijer

Abstract:

Background: Despite of well-verified benefits of anti-retroviral therapy (ART) in prolonging life expectancy being lost to follow-up (LTFU) presents a challenge to the success of ART programs in resource limited countries like Nigeria. In several studies of ART programs in developing countries, researchers have reported that there has been a high rate of LTFU among patients receiving care and treatment at ART treatment centers. This study seeks to determine the cause of LTFU among HIV clients. Method: A descriptive cross sectional study focused on a population of 9,280 persons living with HIV/AIDS who were enrolled in nine treatment centers in Nigeria (both pre-ART and ART patients were included). Out of the total population, 1752 (18.9%) were found to be LTFU. Of this group we randomly selected 1200 clients (68.5%) their d patients’ information was generated through a database. Data on demographics and CD4 counts, causes of LTFU were analyzed and summarized. Results: Out of 1200 LTFU clients selected, 462 (38.5%) were on ART; 341 clients (73.8%) had CD4 level < 500cell/µL and 738 (61.5%) on pre-ART had CD4 level >500/µL. In our records we found telephone number for 675 (56.1%) of these clients. 675 (56.1%) were owners of a phone. The majority of the client’s 731 (60.9%) were living at not more than 25km away from the ART center. A majority were females (926 or 77.2%) while 274 (22.8%) were male. 675 (56.1%) clients were reported traced via telephone and home address. 326 (27.2%) of clients phone numbers were not reachable; 173 (14.4%) of telephone numbers were incomplete. 71 (5.9%) had relocated due to communal crises and expert client trackers reported that some patient could not afford transportation to ART centers. Conclusion: This study shows that, low health education levels, poverty, relocations and lack of reliable phone contact were major predictors of LTFU. Periodic updates of home addresses, telephone contacts including at least two next of kin, phone text messages and home visits may improve follow up. Early and consistent tracking of missed appointments is crucial. Creation of more ART decentralized centres are needed to avoid long distances.

Keywords: anti-retroviral therapy, HIV/AIDS, predictors, lost to follow up

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3167 Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy in People with Depression and Cardiovascular Disorders: A Feasibility Randomised Controlled Trial

Authors: Modi Alsubaie, Chris Dickens, Barnaby Dunn, Andy Gibson, Obioha Ukoumunned, Alison Evans, Rachael Vicary, Manish Gandhi, Willem Kuyken

Abstract:

Background: Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to effectively treat acute depression in those with comorbid cardiovascular disorders, to date there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Therefore, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with co-morbid depression and cardiovascular disorders. Methods: A 3-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, immediately after, and three months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Results: 3400 potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable, and 33 (<1%) were eventually randomised to the three groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disease (one to 25 years). Of 11 participants randomised to adapted MBCT seven completed the full course, levels of home mindfulness practice were high, and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 participants randomised completed all the assessment measures at all three-time points. With regards to the primary outcome (depression), five out of the seven people who completed the adapted MBCT and three out of five under MBSR showed significant clinical change, while in TAU no one showed any clinical change at the three-month follow-up. Conclusions: The adapted MBCT intervention was feasible and acceptable to participants. However, aspects of the trial design were not feasible. In particular, low recruitment rates were achieved, and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high meaning the adapted intervention was unlikely to be well tailored to all participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to more successfully recruit a target sample that optimally matches the adapted intervention.

Keywords: mindfulness-based cognitive therapy (MBCT), depression, cardiovascular disorders, feasibility, acceptability

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3166 Estimation of Probabilistic Fatigue Crack Propagation Models of AZ31 Magnesium Alloys under Various Load Ratio Conditions by Using the Interpolation of a Random Variable

Authors: Seon Soon Choi

Abstract:

The essential purpose is to present the good fatigue crack propagation model describing a stochastic fatigue crack growth behavior in a rolled magnesium alloy, AZ31, under various load ratio conditions. Fatigue crack propagation experiments were carried out in laboratory air under four conditions of load ratio, R, using AZ31 to investigate the crack growth behavior. The stochastic fatigue crack growth behavior was analyzed using an interpolation of random variable, Z, introduced to an empirical fatigue crack propagation model. The empirical fatigue models used in this study are Paris-Erdogan model, Walker model, Forman model, and modified Forman model. It was found that the random variable is useful in describing the stochastic fatigue crack growth behaviors under various load ratio conditions. The good probabilistic model describing a stochastic fatigue crack growth behavior under various load ratio conditions was also proposed.

Keywords: magnesium alloys, fatigue crack propagation model, load ratio, interpolation of random variable

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3165 A Simple Device for Characterizing High Power Electron Beams for Welding

Authors: Aman Kaur, Colin Ribton, Wamadeva Balachandaran

Abstract:

Electron beam welding due to its inherent advantages is being extensively used for material processing where high precision is required. Especially in aerospace or nuclear industries, there are high quality requirements and the cost of materials and processes is very high which makes it very important to ensure the beam quality is maintained and checked prior to carrying out the welds. Although the processes in these industries are highly controlled, however, even the minor changes in the operating parameters of the electron gun can make large enough variations in the beam quality that can result in poor welding. To measure the beam quality a simple device has been designed that can be used at high powers. The device consists of two slits in x and y axis which collects a small portion of the beam current when the beam is deflected over the slits. The signals received from the device are processed in data acquisition hardware and the dedicated software developed for the device. The device has been used in controlled laboratory environments to analyse the signals and the weld quality relationships by varying the focus current. The results showed matching trends in the weld dimensions and the beam characteristics. Further experimental work is being carried out to determine the ability of the device and signal processing software to detect subtle changes in the beam quality and to relate these to the physical weld quality indicators.

Keywords: electron beam welding, beam quality, high power, weld quality indicators

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3164 Experimental Study of Geotextile Effect on Improving Soil Bearing Capacity in Aggregate Surfaced Roads

Authors: Mahdi Taghipour Masoumi, Ali Abdi Kordani, Mahmoud Nazirizad

Abstract:

Geosynthetics utilization plays an important role in the construction of highways with no additive layers, such as asphalt concrete or cement concrete, or in a subgrade layer which affects the bearing capacity of unbounded layers. This laboratory experimental study was carried out to evaluate changes in the load bearing capacity of reinforced soil with these materials in highway roadbed with regard to geotextile properties. California Bearing Ratio (CBR) test samples were prepared with two types of soil: Clayey and sandy containing non-reinforced and reinforced soil. The samples comprised three types of geotextiles with different characteristics (150, 200, 300 g/m2) and depths (H= 5, 10, 20, 30, 50, 100 mm), and were grouped into two forms, one-layered and two-layered, based on the sample materials in order to perform defined tests. The results showed that the soil bearing characteristics increased when one layer of geotextile was used in clayey and sandy samples reinforced by geotextile. However, the bearing capacity of the soil, in the presence of a geotextile layer material with depth of more than 30 mm, had no remarkable effect. Furthermore, when the two-layered geotextile was applied in material samples, although it increased the soil resistance, it also showed that through the addition of a number or weights of geotextile into samples, the natural composition of the soil changed and the results are unreliable.

Keywords: reinforced soil, geosynthetics, geotextile, transportation capacity, CBR experiments

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3163 Proposition of an Intelligent System Based on the Augmented Reality for Warehouse Logistics

Authors: Safa Gharbi, Hayfa Zgaya, Nesrine Zoghlami, Slim Hammadi, Cyril De Barbarin, Laurent Vinatier, Christiane Coupier

Abstract:

Increasing productivity and quality of service, improving the working comfort and ensuring the efficiency of all processes are important challenges for every warehouse. The order picking is recognized to be the most important and costly activity of all the process in warehouses. This paper presents a new approach using Augmented Reality (AR) in the field of logistics. It aims to create a Head-Up Display (HUD) interface with a Warehouse Management System (WMS), using AR glasses. Integrating AR technology allows the optimization of order picking by reducing time of picking process, increasing the efficiency and delivering quickly. The picker will be able to access immediately to all the information needed for his tasks. All the information is displayed when needed in the field of vision (FOV) of the operator, without any action requested from him. These research works are part of the industrial project RASL (Réalité Augmentée au Service de la Logistique) which gathers two major partners: the LAGIS (Laboratory of Automatics, Computer Engineering and Signal Processing in Lille-France) and Genrix Group, European leader in warehouses logistics, who provided his software for implementation, and his logistics expertise.

Keywords: Augmented Reality (AR), logistics and optimization, Warehouse Management System (WMS), Head-Up Display (HUD)

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3162 Measurement of Blood Phenobarbital Concentration Within Newborns Admitted to the NICU of Imam Reza Hospital and Received the Drug by Intravenous Mode

Authors: Ahmad Shah Farhat, Anahita Alizadeh Qamsari, Ashraf Mohammadzadeh, Hamid Reza Goldouzian, Ezat Khodashenas

Abstract:

Introduction: Newborns may be treated with phenobarbital for many reasons. Because in each region, depending on different races and genetic factors, different pharmacokinetic conditions govern the drug. It is essential to control blood levels of certain drugs, especially phenobarbital, and maintain these levels during treatment. Methods: In this study, venous blood was collected from 50 neonates who received intravenous phenobarbital at a loading dose of 20 mg/kg weight and at least three days had passed since the maintenance dose of 5 mg/kg body weight. in 24 hours. and sent to the laboratory. Phenobarbital blood levels were measured, then the results were analyzed descriptively. Results: In this study, the average weight of newborns was 9.93 ± 2.58. The mean blood concentration of phenobarbital, three days after starting the maintenance dose in the group of infants weighing more than 2.5 kg, was 3.33 ± 9.1 micrograms/liter in the group of infants weighing less than 2 kg. and half a kilogram or LBW was 5.9 ± 9.5 micrograms/liter and in the group weighing less than 1.5 kg VLBW was 14.4 ± 15.46 micrograms/liter. There was no significant difference between groups (p>0.05). Three days after starting the maintenance dose in all three groups, the mean blood phenobarbital concentration was 9.86 ± 0.86 micrograms/liter. Conclusion: Blood phenobarbital levels in our newborns are below therapeutic levels, so phenobarbital levels should be evaluated.

Keywords: poisining, neonats, phenobarbital, drug

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3161 High Pressure Multiphase Flow Experiments: The Impact of Pressure on Flow Patterns Using an X-Ray Tomography Visualisation System

Authors: Sandy Black, Calum McLaughlin, Alessandro Pranzitelli, Marc Laing

Abstract:

Multiphase flow structures of two-phase multicomponent fluids were experimentally investigated in a large diameter high-pressure pipeline up to 130 bar at TÜV SÜD’s National Engineering Laboratory Advanced Multiphase Facility. One of the main objectives of the experimental test campaign was to evaluate the impact of pressure on multiphase flow patterns as much of the existing information is based on low-pressure measurements. The experiments were performed in a horizontal and vertical orientation in both 4-inch and 6-inch pipework using nitrogen, ExxsolTM D140 oil, and a 6% aqueous solution of NaCl at incremental pressures from 10 bar to 130 bar. To visualise the detailed structure of the flow of the entire cross-section of the pipe, a fast response X-ray tomography system was used. A wide range of superficial velocities from 0.6 m/s to 24.0 m/s for gas and 0.04 m/s and 6.48 m/s for liquid was examined to evaluate different flow regimes. The results illustrated the suppression of instabilities between the gas and the liquid at the measurement location and that intermittent or slug flow was observed less frequently as the pressure was increased. CFD modellings of low and high-pressure simulations were able to successfully predict the likelihood of intermittent flow; however, further tuning is necessary to predict the slugging frequency. The dataset generated is unique as limited datasets exist above 100 bar and is of considerable value to multiphase flow specialists and numerical modellers.

Keywords: computational fluid dynamics, high pressure, multiphase, X-ray tomography

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3160 Comparison of Incidence and Risk Factors of Early Onset and Late Onset Preeclampsia: A Population Based Cohort Study

Authors: Sadia Munir, Diana White, Aya Albahri, Pratiwi Hastania, Eltahir Mohamed, Mahmood Khan, Fathima Mohamed, Ayat Kadhi, Haila Saleem

Abstract:

Preeclampsia is a major complication of pregnancy. Prediction and management of preeclampsia is a challenge for obstetricians. To our knowledge, no major progress has been achieved in the prevention and early detection of preeclampsia. There is very little known about the clear treatment path of this disorder. Preeclampsia puts both mother and baby at risk of several short term- and long term-health problems later in life. There is huge health service cost burden in the health care system associated with preeclampsia and its complications. Preeclampsia is divided into two different types. Early onset preeclampsia develops before 34 weeks of gestation, and late onset develops at or after 34 weeks of gestation. Different genetic and environmental factors, prognosis, heritability, biochemical and clinical features are associated with early and late onset preeclampsia. Prevalence of preeclampsia greatly varies all over the world and is dependent on ethnicity of the population and geographic region. To authors best knowledge, no published data on preeclampsia exist in Qatar. In this study, we are reporting the incidence of preeclampsia in Qatar. The purpose of this study is to compare the incidence and risk factors of both early onset and late onset preeclampsia in Qatar. This retrospective longitudinal cohort study was conducted using data from the hospital record of Women’s Hospital, Hamad Medical Corporation (HMC), from May 2014-May 2016. Data collection tool, which was approved by HMC, was a researcher made extraction sheet that included information such as blood pressure during admission, socio demographic characteristics, delivery mode, and new born details. A total of 1929 patients’ files were identified by the hospital information management when they apply codes of preeclampsia. Out of 1929 files, 878 had significant gestational hypertension without proteinuria, 365 had preeclampsia, 364 had severe preeclampsia, and 188 had preexisting hypertension with superimposed proteinuria. In this study, 78% of the data was obtained by hospital electronic system (Cerner) and the remaining 22% was from patient’s paper records. We have gone through detail data extraction from 560 files. Initial data analysis has revealed that 15.02% of pregnancies were complicated with preeclampsia from May 2014-May 2016. We have analyzed difference in the two different disease entities in the ethnicity, maternal age, severity of hypertension, mode of delivery and infant birth weight. We have identified promising differences in the risk factors of early onset and late onset preeclampsia. The data from clinical findings of preeclampsia will contribute to increased knowledge about two different disease entities, their etiology, and similarities/differences. The findings of this study can also be used in predicting health challenges, improving health care system, setting up guidelines, and providing the best care for women suffering from preeclampsia.

Keywords: preeclampsia, incidence, risk factors, maternal

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3159 Reliability of Using Standard Penetration Test (SPT) in Evaluation of Soil Properties

Authors: Hossein Alimohammadi, Mohsen Amirmojahedi, Mehrdad Rowhani

Abstract:

Soil properties are used by geotechnical engineers to evaluate and analyze site conditions for designing purposes. Although basic soil classification tests are easy to perform and provide useful information to determine the properties of soils, it may take time to get the result and add some costs to the projects. Standard Penetration Test (SPT) provides an opportunity to evaluate soil parameters without performing laboratory tests. In addition to its simplicity and cheapness, the results become available immediately. This research provides a guideline on the application of the SPT test method, reliability of adapting the SPT test results in evaluating soil physical and mechanical properties such as Atterberg limits, shear strength, and compressive strength compressibility parameters. A total of 70 boreholes were investigated in this study by taking soil samples between depths of 1.2 to 15.25 meters. The project site was located in Morrow County, Ohio. A regression-based formula was proposed based on Tobit regression with a stepwise variable selection analysis conducted between SPT and other typical soil properties obtained from soil tests. The results of the research illustrated that the shear strength and physical properties of the soil affect the SPT number. The proposed correlation can help engineers to use SPT test results in their design with higher accuracy.

Keywords: standard penetration test, soil properties, soil classification, regression method

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3158 English Language Performance and Emotional Intelligence of Senior High School Students of Pit-Laboratory High School

Authors: Sonia Arradaza-Pajaron

Abstract:

English as a second language is widely spoken in the Philippines. In fact, it is used as a medium of instruction in school. However, Filipino students, in general, are still not proficient in the use of the language. Since it plays a very crucial role in the learning and comprehension of some subjects in the school where important key concepts and in English, it is imperative to look into other factors that may affect such concern. This study may post an answer to the said concern because it aimed to investigate the association between a psychological construct, known as emotional intelligence, and the English language performance of the 55 senior high school students. The study utilized a descriptive correlational method to determine the significant relationship of variables with preliminary data, like GPA in English subject as baseline information of their performance. Results revealed that the respondents had an average GPA in the English subject; however, improving from their first-year high school level to the fourth year. Their English performance resulted to an above average level with a notable higher performance in the speaking test than in the written. Further, a strong correlation between English performance and emotional intelligence was manifested. Based on the findings, it can be concluded that students with higher emotional intelligence their English language performance is expected to be the same. It can be said further that when students’ emotional intelligence (EI components) is facilitated well through various classroom activities, a better English performance would just be spontaneous among them.

Keywords: English language performance, emotional intelligence, EI components, emotional literacy, emotional quotient competence, emotional quotient outcomes, values and beliefs

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3157 Diagnostics of Subclinical Mastitis in Dairy Cows

Authors: G. Tanbayeva, Z. Myrzabekov, O. Tagayev, B. Barakhov, M. Tokayeva

Abstract:

Mastitis is widely spread among dairy cows bringing large economic damage resulting in decreased milk yield, deterioration of the milk quality, gastrointestinal tract disorders among young animals, culling of breeding stock, and expenses for sick animal treatment. Up-to-date and accurate diagnostics of subclinical (latent) mastitis in dairy cows has huge practical and economical significance. The aim of the research was to develop a new optimal alternative rapid method for the diagnosis of subclinical mastitis in cows. The study was performed in the laboratory of the Hygiene and Sanitation of Kazakh National Agrarian University. The first stage was to evaluate the different percentages of “Promastit” preparation. It showed that the best diagnostics capacity had 10% dilution. The second stage was to compare “Promastit” with some of the domestic and foreign analogues “Somatic-Test” (Denmark), “MastTest” (Russia), “Mastidin” (Ukraine), “Diagmast” (Kazakhstan). The observation was carried out on 520 dairy cows with subclinical mastitis on farms of Almaty region of Kazakhstan. The effectiveness was checked by milk sedimentation test. Our research tends to show that the diagnostic test "Promastitis" revealed subclinical mastitis in 193 out of 520 lactating cows (37.1% of those examined). At the same time, in the case of using other diagnostic tests, the given index was as follows: 35.5% (mastidin), 34.4% (masttest-AF), 33.8% (somatic-test Ecotest), 30.7% (diagmast).

Keywords: dairy cows, diagnostics, subclinical mastitis, test Promastit

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3156 Heavy Minerals Distribution in the Recent Stream Sediments of Diyala River Basin, Northeastern Iraq

Authors: Abbas R. Ali, Daroon Hasan Khorsheed

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Twenty one samples of stream sediments were collected from the Diyala River Basin (DRB), which represent one of three major tributaries of the Tigris River at northeastern Iraq. This study is concerned with the heavy minerals (HM) analysis in the + 63μ m fraction of the Diyala River sediments, distribution pattern in the various river basin sectors, as well as comparing the present results with previous works.The metastable heavy minerals (epidote, staurolite, garnet) represent more than (30%) Whereas the ultrastable heavy minerals (pyroxene and amphibole) make only about (19 %). Opaques are present in high proportions reaching about (29%) as an average. The ultrastable (zircon, tourmaline, rutile) heavy minerals are the miner constituents (7%) in the sediments.According to the laboratory analytical data of heavy mineral distributions the studied sediments are derived from mafic and ultramafic rocks are found in northeastern Iraq that represent Walash – Nawpordan Series and Mawat complexes in Zagros zones. The presence of zircon and tourmaline in trace amounts may give an indication for the weak role of acidic rocks in the source area whereas the epidote group minerals give an indication for the role of metamorphic rocks.

Keywords: heavy minerals, mineral distribution, recent stream sediment, Diyala river, northeastern Iraq

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3155 Community-Based Assessment Approach to Empower Child with Disabilities: Institutional Study on Deaf Art Community in Yogyakarta, Indonesia

Authors: Mukhamad Fatkhullah, Arfan Fadli, Marini Kristina Situmeang, Siti Hazar Sitorus

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The emergence of a community of people with disabilities along with the various works produced has made great progress to open the public eye to their existence in society. This study focuses attention on a community that is suspected to be one of the pioneers in pursuing the movement. It is Deaf Art Community (DAC), a community of persons with disabilities based in Yogyakarta, with deaf and speech-impaired members who use sign language in everyday communication. Knowing the movement of disabled communities is a good thing, the description of the things behind it then important to know as the basis for initiating similar movements. This research focuses on the question of how community of people with disabilities begin to take shape in different regions and interact with collaborative events. Qualitative method with in-depth interview as data collection techniques was used to describe the process of formation and the emergence of community. The analytical unit in the study initially focuses on the subject in the community, but in the process, it develops to institutional analysis. Therefore some informants were determined purposively and expanded using the snowball technique. The theory used in this research is Phenomenology of Alfred Schutz to be able to see reality from the subject and institutional point of view. The results of this study found that the community is formed because the existing educational institutions (both SLB and inclusion) are less able to empower and make children with disabilities become equal with the society. Through the SLB, the presence of children with disabilities becomes isolated from the society, especially in children of his or her age. Therefore, discrimination and labeling will never be separated from society's view. Meanwhile, facilities for the basic needs of children with disabilities can not be fully provided. Besides that, the guarantee of discrimination, glances, and unpleasant behavior from children without disability does not exist, which then indicates that the existing inclusion schools offer only symbolic acceptance. Thus, both in SLB and Inclusive Schools can not empower children with disabilities. Community-based assistance, in this case, has become an alternative to actually empowering children with disabilities. Not only giving them a place to interact, through the same community, children with disabilities will be guided to discover their talents and develop their potential to be self-reliant in the future.

Keywords: children with disabilities, community-based assessment, community empowerment, social equity

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3154 Sport-Related Hand and Wrist Injuries Treatment

Authors: Sergei Kosarev

Abstract:

Wrong treatment tactics for hand and wrist sport-related injuries can lead to the inability to play sports in the future. It is especially important for professional athletes. The members of the Russian Olympic Team are treated in our hospital -Federal Clinical Research Center (Moscow). For their treatment, we use minimally invasive methods such as wrist arthroscopy and also orthobiologics procedures. In 2022 we had cases with scaphoid fracture and TFCC injuries. In all the cases, we were using the arthroscopy technic for treatment. The scaphoid fracture was fixed by K-wires with free bone grafting. For TFCC injures we used transossal sutures. Rehabilitation started the next day after surgery. Rehabilitation included hand therapy and physiotherapy. All athletes returned to the sport after 8-12 weeks after surgery. One of them had pain in the wrist after 12 weeks after surgery, not more than 4 point VAS. Pain syndrome was blocked after 2 PRP injections in the ulnar side of the wrist.

Keywords: sport trauma, wrist arthroscopy, wrist pain, scaphoid fracture

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3153 Design and Development of a Computerized Medical Record System for Hospitals in Remote Areas

Authors: Grace Omowunmi Soyebi

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A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved, this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, computing, data, innovation

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3152 Mesalazine-Induced Myopericarditis in a Professional Athlete

Authors: Tristan R. Fraser, Christopher D. Steadman, Christopher J. Boos

Abstract:

Myopericarditis is an inflammation syndrome characterised by clinical diagnostic criteria for pericarditis, such as chest pain, combined with evidence of myocardial involvement, such as elevation of biomarkers of myocardial damage, e.g., troponins. It can rarely be a complication of therapeutics used for dysregulated immune-mediated diseases such as inflammatory bowel disease (IBD), for example, mesalazine. The infrequency of mesalazine-induced myopericarditis adds to the challenge in its recognition. Rapid diagnosis and the early introduction of treatment are crucial. This case report follows a 24-year-old professional footballer with a past medical history of ulcerative colitis, recently started on mesalazine for disease control. Three weeks after mesalazine was initiated, he was admitted with fever, shortness of breath, and chest pain worse whilst supine and on deep inspiration, as well as elevated venous blood cardiac troponin T level (cTnT, 288ng/L; normal: <13ng/L). Myocarditis was confirmed on initial inpatient cardiac MRI, revealing the presence of florid myocarditis with preserved left ventricular systolic function and an ejection fraction of 67%. This was a longitudinal case study following the progress of a single individual with myopericarditis over four acute hospital admissions over nine weeks, with admissions ranging from two to five days. Parameters examined included clinical signs and symptoms, serum troponin, transthoracic echocardiogram, and cardiac MRI. Serial measurements of cardiac function, including cardiac MRI and transthoracic echocardiogram, showed progressive deterioration of cardiac function whilst mesalazine was continued. Prior to cessation of mesalazine, transthoracic echocardiography revealed a small global pericardial effusion of < 1cm and worsening left ventricular systolic function with an ejection fraction of 45%. After recognition of mesalazine as a potential cause and consequent cessation of the drug, symptoms resolved, with cardiac MRI performed as an outpatient showing resolution of myocardial oedema. The patient plans to make a return to competitive sport. Patients suffering from myopericarditis are advised to refrain from competitive sport for at least six months in order to reduce the risk of cardiac remodelling and sudden cardiac death. Additional considerations must be taken in individuals for whom competitive sport is an essential component of their livelihood, such as professional athletes. Myopericarditis is an uncommon, however potentially serious medical condition with a wide variety of aetiologies, including viral, autoimmune, and drug-related causes. Management is mainly supportive and relies on prompt recognition and removal of the aetiological process. Mesalazine-induced myopericarditis is a rare condition; as such increasing awareness of mesalazine as a precipitant of myopericarditis is vital for optimising the management of these patients.

Keywords: myopericarditis, mesalazine, inflammatory bowel disease, professional athlete

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3151 Non-linear Analysis of Spontaneous EEG After Spinal Cord Injury: An Experimental Study

Authors: Jiangbo Pu, Hanhui Xu, Yazhou Wang, Hongyan Cui, Yong Hu

Abstract:

Spinal cord injury (SCI) brings great negative influence to the patients and society. Neurological loss in human after SCI is a major challenge in clinical. Instead, neural regeneration could have been seen in animals after SCI, and such regeneration could be retarded by blocking neural plasticity pathways, showing the importance of neural plasticity in functional recovery. Here we used sample entropy as an indicator of nonlinear dynamical in the brain to quantify plasticity changes in spontaneous EEG recordings of rats before and after SCI. The results showed that the entropy values were increased after the injury during the recovery in one week. The increasing tendency of sample entropy values is consistent with that of behavioral evaluation scores. It is indicated the potential application of sample entropy analysis for the evaluation of neural plasticity in spinal cord injury rat model.

Keywords: spinal cord injury (SCI), sample entropy, nonlinear, complex system, firing pattern, EEG, spontaneous activity, Basso Beattie Bresnahan (BBB) score

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3150 Relative Depth Dose Profile and Peak Scatter Factors Measurement for Co-60 Teletherapy Machine Using Chemical Dosimetry

Authors: O. Moussous, T. Medjadj

Abstract:

The suitability of a Fricke dosimeter for the measurement of a relative depth dose profile and the peak scatter factors was studied. The measurements were carried out in the secondary standard dosimetry laboratory at CRNA Algiers using a collimated 60Co gamma source teletherapy machine. The measurements were performed for different field sizes at the phantom front face, at a fixed source-to-phantom distance of 80 cm. The dose measurements were performed by first placing the dosimeters free-in-air at the distance-source-detector (DSD) of 80.5 cm from the source. Additional measurements were made with the phantom in place. The water phantom type Med-Tec 40x40x40 cm for vertical beam was used in this work as scattering martial. The phantom was placed on the irradiation bench of the cobalt unit at the SSD of 80 cm from the beam focus and the centre of the field coincided with the geometric centre of the dosimeters placed at the depth in water of 5 mm Relative depth dose profile and Peak scatter factors measurements were carried out using our Fricke system. This was intercompared with similar measurements by ionization chamber under identical conditions. There is a good agreement between the relative percentage depth–dose profiles and the PSF values measured by both systems using a water phantom.

Keywords: Fricke dosimeter, depth–dose profiles, peak scatter factors, DSD

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3149 Foraging Ecology and Diet of the Philippine Spotted Flying Lizard, Draco Spilopterus (Wiegmann, 1834), in Luzon Biogeographic Region

Authors: Michael A. Tabug, Arvin C. Diesmos

Abstract:

The foraging ecology of the Philippine endemic Draco spilopterus was studied through a combination of in-situ field observations and laboratory examinations of specimens of the species. A total of four populations of the species were studied across the Luzon Biogeographic Region between June 2017 and March 2019. Of the 59 lizards captured, gut contents of 54 individuals were studied. A total of 2933 food items were sorted into seven types, such as Formicidae (ants) (96%), Araneae (spiders) (0.034%), Coleoptera (beetles) (0.579%), Hemiptera (scale insects) (0.102%), Isoptera (termites) (2.796%), Lepidoptera (larvae) (0.307%), and Diplopoda (millipede) (0.102%). Diet analysis revealed that D. spilopterus fed mainly on insect arthropods and were dominated by ants (Formicidae). Of the four populations studied, lizards consumed a relatively high proportion of ants (96%), which strongly implies that D. spilopterus is a specialist predator and a sit-and-wait active forager. The observed feeding activities of D. spilopterus also show that it is diurnal forager and actively hunts for prey from 0830 hr to 1658 hr, with decreasing activity during midday. Draco spilopterus lizards were also observed to use a wide spectrum of perch heights while foraging, regardless of the dimension of trees.

Keywords: ant specialists, diet analysis, flying lizards, foraging ecology, Luzon Biogeographic Region

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3148 Field Tests and Numerical Simulation of Tunis Soft Soil Improvement Using Prefabricated Vertical Drains

Authors: Marwa Ben Khalifa, Zeineb Ben Salem, Wissem Frikha

Abstract:

This paper presents a case study of “Radès la Goulette” bridge project using the technique of prefabricated vertical drains (PVD) associated with step by step construction of preloading embankments with averaged height of about 6 m. These embankments are founded on a highly compressible layer of Tunis soft soil. The construction steps included extensive soil instrumentation such as piezometers and settlement plates for monitoring the dissipation of excess pore water pressures and settlement during the consolidation of Tunis soft soil. An axisymmetric numerical model using the 2D finite difference code FLAC was developed and calibrated using laboratory tests to predict the soil behavior and consolidation settlements. The constitutive model impact for simulating the soft soil behavior is investigated. The results of analyses show that numerical analysis provided satisfactory predictions for the field performance during the construction of Radès la Goulette embankment. The obtained results show the effectiveness of PVD in the acceleration of the consolidation time. A comparison of numerical results with theoretical analysis was presented.

Keywords: tunis soft soil, radès bridge project, prefabricated vertical drains, FLAC, acceleration of consolidation

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3147 The Ethics of Physical Restraints in Geriatric Care

Authors: Bei Shan Lin, Chun Mei Lu, Ya Ping Chen, Li Chen Lu

Abstract:

This study explores the ethical issues concerning the use of physical restraint in geriatric care. Physical restraint use in a medical care setting is seen as a controversial form of treatment that has occurred over decades. There is no doubt that people nowadays are living longer than previous generations. The ageing process is inevitable. Common disease such as impaired comprehension, memory loss, and trouble expressing one’s self contribute to the difficulty that these older patients have in adapting to medical institution. For these reasons, physical restraint is often used in reducing the risk of falling, managing wandering behaviour, preventing agitation, and promoting patient compliance in geriatric care. It can mean that physical restraints are considered as a common practice that is used in the care of older patients. It is most commonly used for three specific purposes, including procedural restraint, restraint to prevent falls, and behavioural restraints. Although there have been well documented instances of morbidity and mortality recognised as being potential risks associated with physical restraint use, it continues to be permitted and used in healthcare, often in the name of safety. However, there is insufficient evidence supporting the effectiveness of physical restraint use reducing injuries from falls and controlling challenging behaviour in geriatric care settings. There is barely any empirical evidence of either a scientific basis or clinical trials have evaluated the improvement in patient safety following physical restraint. In difficult clinical situations, guidelines and practical suggestions for Healthcare professionals to comply requirements can help those making appropriate decisions and to facilitate better judgement regarding physical restraint use. The following recommendations are given for physical restraint use in long-term care settings: an interdisciplinary team approach to assess, evaluate, and treat underlying diseases to determine if treatment can ease issues precipitating physical restraint use; a clearly stated purpose of treatment plan should be made after weighing up the risk of physical restraint use against the risk of without physical restraint use; a care plan for physical restraint has to include individualised treatment planning, informed consent, identification and remedial action to avoid negative consequences, regular assessment and modification, reduction and removal of risks; patients and their families must have the opportunity to consider and give voluntary informed consent prior to physical restraint utilisation; patients, family members, and Healthcare professionals should be educated on use and adverse consequences of physical restraints in order to make raise awareness of potential risks and to take appropriate steps to prevent unnecessary harm; after physical restraint removal, Healthcare professionals should discuss with patients and family members about their experience, feelings, and any anxieties regarding the treatment. Physical restraint should always be considered a last resort as deprive patient’s freedom, control, and individuality. Healthcare professionals should emphasise on providing individualized care, interdisciplinary decision-making process, and creative and collaborative alternatives to promote older patient’s rights, dignity and overall well-being as much as possible.

Keywords: ethics healthcare, geriatric care, healthcare, physical restraint

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3146 Copper Sulphate Effect on Cyprinus Carpio Common Fish Parasites

Authors: Jawdhari Abdulhusein, Dan Mihăilescu, Cristian-Emilian Pop, Nicolai Crăciun

Abstract:

Cyprinus Carpio adult specimens were captured from a single spot location from the Danube River and transported to the Laboratory of Faculty of Biology, University of Bucharest. The specimens were measured, weighed and randomly divided in five groups for later Copper Sulphate (CuSO4) exposure, as well as one control group. From the control group, 3 specimens were immediately sacrificed and microscopically inspected for parasite’s presence in the gills. During the histological inspection of the control group specimens, Ichthyophthiriusmultifiliis, Gyrodactylu ssp., MyxobolusOviforis, and Trichodinacottidarumwere abundantly identified in the gills. The exposure to a single dose of CuSO4 per group took place for 7 days under controlled conditions: water alkalinity ≈ 100 mg/L, temperature 23–24 °C, oxygenation 7.40–7.80 mg/L, and pH 6.10–6.40, the parameters were monitored on an hourly basis and adjusted when needed. After the exposure, all specimens were sacrificed, and the gill tissues were inspected. It was found that concentrations of 0.10, 0.25 and 0.30 ppm of CuSO4 did not affect the presence of parasites, as for 0.40 ppm of CuSO4 it significantly affected onlyIchthyophthiriusmultifiliisandMyxobolusOviforis, while concentration 0.50 ppm of CuSO4 (≈0.20 ppm of Cu2+) eliminated all 4 parasites species previously present in the fish gills, also, there were some histopathological changes to the gills tissue. These findings suggest that low concentrations of CuSO4 treatment for fish parasites are a safe and economical option if used correctly for a brief length of time.

Keywords: copper sulphate, cyprinus carpio, parasites, danube river

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3145 A Multipurpose Inertial Electrostatic Magnetic Confinement Fusion for Medical Isotopes Production

Authors: Yasser R. Shaban

Abstract:

A practical multipurpose device for medical isotopes production is most wanted for clinical centers and researches. Unfortunately, the major supply of these radioisotopes currently comes from aging sources, and there is a great deal of uneasiness in the domestic market. There are also many cases where the cost of certain radioisotopes is too high for their introduction on a commercial scale even though the isotopes might have great benefits for society. The medical isotopes such as radiotracers PET (Positron Emission Tomography), Technetium-99 m, and Iodine-131, Lutetium-177 by is feasible to be generated by a single unit named IEMC (Inertial Electrostatic Magnetic Confinement). The IEMC fusion vessel is the upgrading unit of the Inertial Electrostatic Confinement IEC fusion vessel. Comprehensive experimental works on IEC were carried earlier with promising results. The principle of inertial electrostatic magnetic confinement IEMC fusion is based on forcing the binary fuel ions to interact in the opposite directions in ions cyclotrons orbits with different kinetic energies in order to have equal compression (forces) and with different ion cyclotron frequency ω in order to increase the rate of intersection. The IEMC features greater fusion volume than IEC by several orders of magnitude. The particles rate from the IEMC approach are projected to be 8.5 x 10¹¹ (p/s), ~ 0.2 microampere proton, for D/He-3 fusion reaction and 4.2 x 10¹² (n/s) for D/T fusion reaction. The projected values of particles yield (neutrons and protons) are suitable for medical isotope productions on-site by a single unit without any change in the fusion vessel but only the fuel gas. The PET radiotracers are usually produced on-site by medical ion accelerator whereas Technetium-99m (Tc-99m) is usually produced off-site from the irradiation facilities of nuclear power plants. Typically, hospitals receive molybdenum-99 isotope container; the isotope decays to Tc-99mwith half-life time 2.75 days. Even though the projected current from IEMC is lesser than the proton current from the medical ion accelerator but still the IEMC vessel is simpler, and reduced in components and power consumption which add a new value of populating the PET radiotracers in most clinical centers. On the other hand, the projected neutrons flux from the IEMC is lesser than the thermal neutron flux at the irradiation facilities of nuclear power plants, but in the IEMC case the productions of Technetium-99m is suggested to be at the resonance region of which the resonance integral cross section is two orders of magnitude higher than the thermal flux. Thus it can be said the net activity from both is evened. Besides, the particle accelerator cannot be considered a multipurpose particles production unless a significant change is made to the accelerator to change from neutrons mode to protons mode or vice versa. In conclusion, the projected fusion yield from IEMC is a straightforward since slightly change in the primer IEC and ion source is required.

Keywords: electrostatic versus magnetic confinement fusion vessel, ion source, medical isotopes productions, neutron activation

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3144 Effect of Maize Straw-Derived Biochar on Imidacloprid Adsorption onto Soils Prior to No-Tillage and Rotary Tillage Practices

Authors: Jean Yves Uwamungu, Fiston Bizimana, Chunsheng Hu

Abstract:

Although pesticides are used in crop productivity, their use is highly harming the soil environment, and measures must be taken in the future to eradicate soil and groundwater pollution. The primary aim was to determine the effect of biochar addition on the imidacloprid adsorption on soil prior to no-tillage (NT) and rotational tillage (RT) conditions. In the laboratory, batch tests were conducted to determine the imidacloprid adsorption on soil using equilibrium and kinetic modelling with the addition of biochar. The clay level of the soil was found to be more significant when no-tillage was applied (22.42) than when rotational tillage was applied (14.27). The imidacloprid adsorption equilibrium was significantly shortened to 25 min after biochar addition. The isotherms and kinetic findings confirmed that the adsorption occurred according to Freundlich and pseudo-second-order kinetic models, respectively. The adsorption capacity of imidacloprid (40<35<25 °C) increased with decreasing temperature, indicating an exothermic adsorption behaviour, whereas negative Gibbs free energy (G) values of -6980.5 and 5983.93 Jmol-1, respectively, for soil prior to NT and RT at 25 °C, asserted spontaneous adsorption. The negative values of entropy (ΔS); -22.83 and -38.15 Jmol-1K-1, prior to NT and RT applications, respectively, described a lowered randomness process. The enthalpy was greater when RT was applied (-17533 J mol-1) than when NT was applied (-450 J mol-1). Lastly, it was shown that NTtreatment enhanced imidacloprid adsorption capacity more than RT treatment and that biochar addition enhanced pesticide adsorption in both treatments.

Keywords: adsorption, biochar, imidacloprid, soil, tillage

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3143 Characterization of PRL-3 Oncogenic Phosphatase in Its Role in Mediating Acquired Resistance to Bortezomib in Multiple Myeloma

Authors: Shamill Amedot Udonwa, Phyllis S. Y. Chong, Lim S. L. Julia, Wee-Joo Chng

Abstract:

In this paper, we investigated how PRL-3 expression in H929 and U266 cells affects the efficacy of drug treatment. H929 and U266 cells were treated with Bortezomib (BTZ) of different concentrations, and it was observed that H929 cells were resistant to BTZ, while U266 cells were not viable. Investigations into how BTZ targets these cells were conducted, and it was observed that BTZ affects the PARP-Caspase3 pathway as well as PRL-3-Leo1 pathways. These pathways regulate cell proliferation and cell cycle, respectively. Hence, we are able to show the mechanism of how BTZ affects cells and also the role PRL-3 plays on downstream oncogenes such as cyclin-D1 and c-MYC. More importantly, this investigation into PRL-3 in BTZ resistance will be highly applicable in the future as the first clinical trials of PRL-3 antibody (PRL3-zumab) are ongoing at the National University Hospital, Singapore (NUHS). This would mean that understanding the mechanism of resistance through PRL-3, which has yet to be studied, will demonstrate the potential of PRL-3 in developing novel strategies to improve the treatment of MM.

Keywords: drug resistance, hematology, multiple myeloma, oncogene

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3142 Patient Understanding of Health Information: Implications for Organizational Health Literacy in Germany

Authors: Florian Tille, Heide Weishaar, Bernhard Gibis, Susanne Schnitzer

Abstract:

Introduction: The quality of patient-doctor communication and of written health information is central to organizational health literacy (HL). Whether patients understand their doctors’ explanations and textual material on health, however, is understudied. This study identifies the overall levels of patient understanding of health information and its associations with patients’ social characteristics in outpatient health care in Germany. Materials & Methods: This analysis draws on data collected via a 2017 national health survey with a sample of 6,105 adults. Quality of communication was measured for consultations with general practitioners (GPs) and specialists (SPs) via the Ask Me 3 program questions, and through a question on written health material. Correlations with social characteristics were explored employing bivariate and multivariate logistic regression analyses. Results: Over 90% of all respondents reported that they had understood their doctors’ explanations during the last consultation. Failed understanding was strongly correlated with patients’ very poor health (Odds Ratio [OR]: 5.19; 95% confidence interval [CI]: 2.23–12.10; ref. excellent/very good health), current health problem (OR: 6.54, CI: 1.70–25.12; ref. preventive examination) and age 65 years and above (OR: 2.97, CI: 1.10–8.00; ref. 18 to 34 years). Fewer patients answered they understood written material well (86.7% for las visit at GP, 89.7% at SP). Understanding written material poorly was highly associated with basic education (OR: 4.20, CI: 2.76–6.39; ref. higher education) and 65 years old and above (OR: 2.66, CI: 1.43–4.96). Discussion: Overall ratings of oral patient-doctor communication and written communication of health information are high. Yet, a considerable share of patients reports not-understanding their doctors and poor understanding of the written health-related material. Interventions that can contribute to improving organizational HL in outpatient care in Germany include HL training for doctors, reducing system barriers to easily-accessible health information for patients and combining oral and written health communication means. Conclusion: This work adds to the study of organizational HL in Germany. To increase patient understanding of health-relevant information and thereby possibly reduce health disparities, meeting the communication needs especially of persons in different age groups, with basic education and in very poor health is suggested.

Keywords: health survey, organizational health literacy, patient-doctor communication, social characteristics, outpatient care, Ask Me 3

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