Search results for: cross gain modultation

Authors: Isaiah Chacha, Samuel Arimi, Andrew Thaiya

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Background: This study was conducted to assess knowledge, attitudes and practices regarding anthrax in Maragua, Kenya to provide baseline information to design interventions. Methods: A cross sectional survey was conducted among head of households, health and veterinary workers in Maragua Sub-county in August and September 2014. Administered questionnaires were used to collect data from household members and a key informant interview held with health and veterinary workers. Multi stage sampling was used to obtain participants’ knowledge, attitudes and practices. Questions were scored and descriptively analyzed using Excel spreadsheet then exported to GenStat Discovery Edition 4. Results: A total of 293 community members were recruited in this study. The overall level of knowledge was 77.9% of all community members regarding cause, transmission, symptoms and prevention of the disease in both humans and animals. Majority of the participants (96.3%) had heard about anthrax. A total of 99 (33.8%) correspondents had seen a person with anthrax and 75.1% think that anthrax is a very serious disease in the area. Of the interviewed correspondents, 14.3% of them have had their animals (mostly cattle) suffer from anthrax while 15.7% had either suffered from anthrax or have had their family member who suffered from anthrax. Conclusion: The study findings indicate above average knowledge on cause, symptoms, transmission and prevention of anthrax among community members in humans and animals. Practices in this study were still risk among community members. Veterinary and Medical health planners should design anthrax awareness interventions as a team targeting to reach these communities and the public through barazas, radio, CHW and other communication channel on a regular basis.

Keywords: anthrax, attitudes, Kenya, knowledge, Maragua, practices

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Authors: Md Abdullah Al Mamun

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Background: The current situation of Ensuring WHO recommended feeding practices for infant and young children which is becoming a challenge nowadays in many developing countries, especially in areas where household food security is at risk. Because many households of the developing countries often encounter severe food insecurity hence provision of adequate child nutrition is threatened. Aim: The study aimed to assess the child feeding practices of 0-24 months childbearing mothers and explore their household food insecurity in a coastal region of Bangladesh. Methods: This study was conducted in Suborno Char (one of the coastal suburbs in Noakhali District in Bangladesh) from October 2019 to April 2020. A total of 400 mothers were selected with their children of 0-24 months following a cross sectional study sampling procedure of the population. Data were collected through a standard questionnaire and analyzed using statistical tests in SPSS version 20.0.0. Results: The frequency of exclusive breastfeeding, timely initiation of complementary feeding, and giving foods from four food groups to the children were 53.5%, 75.5%, and 22.2%, respectively. Mother's level of education showed a strong association with the child feeding practices of the mothers. Mothers of severely food insecure households showed lower odds in exclusive breastfeeding practice (COR 0.233 at 95% CI 0.083, 0.655; and AOR 0.478 at 95% CI 0.133, 1.713) than mothers of food secured households. Similar results have also been found in case of timely initiation of complementary feeding and minimum dietary diversity of the children.

Keywords: household food insecurity, exclusive breastfeeding, complementary feeding, maternal education, mothers age, household income

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Authors: Tunde Szecsi, Janka Szilagyi

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Students majoring in education are underrepresented in undergraduate scholarship. To enable and encourage teacher candidates to engage in scholarly activities, it is essential to infuse skills such as problem-solving, critical thinking, oral and written communication, collaboration and the utilization of information literacy, into courses in teacher preparation programs. In this empirical study, we examined two teacher education programs – one in New York State and one in Florida – in terms of the approaches of the course-based infusion of skills for undergraduate research, and the effectiveness of this infusion. First, course-related documents such as syllabi, assignment descriptions, and course activities were reviewed and analyzed. The goal of the document analysis was to identify and describe the targeted skills, and the pedagogical approaches and strategies for promoting research skills in teacher candidates. Next, a selection of teacher candidates’ scholarly products from the institution in Florida was used as a data set to examine teacher candidates’ skill development in the context of the identified assignments. This dataset was analyzed both quantitatively and qualitatively to describe the changes that occurred in teacher candidates’ critical thinking, communication, and information literacy skills, and to uncover patterns in the skill development at the two institutions. Descriptive statistics were calculated to explore the changes in these skills of teacher candidates over a period of three years. The findings based on data from the teacher education program in Florida indicated a steady gain in written communication and critical thinking and a modest increase in informational literacy. At the institution in New York, candidates’ submission and success rates on the edTPA, a New York State Teacher Certification exam, was used as a measure of scholarly skills. Overall, although different approaches were used for infusing the development of scholarly skills in the courses, the results suggest that a holistic and well-orchestrated infusion of the skills into most courses in the teacher education program might result in steadily developing scholarly skills. These results offered essential implications for teacher education programs in terms of further improvements in teacher candidates’ skills for engaging in undergraduate research and scholarship. In this presentation, our purpose is to showcase two approaches developed by two teacher education programs to demonstrate how diverse approaches toward the promotion of undergraduate scholarship activities are responsive to the context of the teacher preparation programs.

Keywords: critical thinking, pedagogical strategies, teacher education, undergraduate student research

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Authors: Umar Sambo Umar, Ahmad Isah Haruna, Abubakar Sadik Maigari, Muhammad Bello Abubakar

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Schist belts in Nigeria occur prominently west of longitude 80 E and sporadic to the east, they are upper Proterozioc low-medium grade deformed metasediments and metavolcanics that were intruded by Pan-African granitoids. The Wonaka schist belt, though reportedly distinctive in composition and metamorphism, is the least understood; the host for primary gold were not defined, structures which may control primary enrichment have not been delineated. The aim of this work is to determine the relationship between litho-structures and the gold around Wonaka schist belt through geological field mapping, petrographic studies and structural data analysis via ArcGis 10.2, Surfer 11.0 and Stereopro 2.0. The results show that the major rock types are mica schist and migmatites, muscovites detected during microstructural analysis suggests low-grade metamorphism in the metapelites. The shear zones identified were trending North Northeast – South Southwest (NNE-SSW), fractures trend mostly Northeast-Southwest (NE-SW) perpendicular to planes of gneissic foliations, these conform to the late Pan-African deformational episode. Pegmatite lodes, net self-cross cutting quartz veins as well as the quartz stringers hosted by both migmatites and schist are delineated as targets for primary gold mineralization, while major confluences of the streams serve as zones for secondary (placer) gold targets since the streams are dendritic and intermittent.

Keywords: gold mineralization, Nigeria, migmatites, Wonaka schist belt

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Authors: Supannika Klangphukhiew, Roongnapa Srichana, Rina Patramanon

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Cortisol has been used as a well-known commercial stress biomarker. A homeostasis response to psychological stress is indicated by an increased level of cortisol produced in hypothalamus-pituitary-adrenal (HPA) axis. Chronic psychological stress contributing to the high level of cortisol relates to several health problems. In this study, the cortisol biosensor was fabricated that mimicked the natural receptors. The artificial antibodies were prepared using molecular imprinted polymer technique that can imitate the performance of natural anti-cortisol antibody with high stability. Cortisol-molecular imprinted polymer (cortisol-MIP) was obtained using the multi-step swelling and polymerization protocol with cortisol as a target molecule combining methacrylic acid:acrylamide (2:1) with bisacryloyl-1,2-dihydroxy-1,2-ethylenediamine and ethylenedioxy-N-methylamphetamine as cross-linkers. Cortisol-MIP was integrated to the sensor. It was coated on the disposable screen-printed carbon electrode (SPCE) for portable electrochemical analysis. The physical properties of Cortisol-MIP were characterized by means of electron microscope techniques. The binding characteristics were evaluated via covalent patterns changing in FTIR spectra which were related to voltammetry response. The performance of cortisol-MIP modified SPCE was investigated in terms of detection range, high selectivity with a detection limit of 1.28 ng/ml. The disposable cortisol biosensor represented an application of MIP technique to recognize steroids according to their structures with feasibility and cost-effectiveness that can be developed to use in point-of-care.

Keywords: stress biomarker, cortisol, molecular imprinted polymer, screen-printed carbon electrode

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Authors: Liang Weichien

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Without adequate information and mitigation plan for natural disaster, the risk to urban populated areas will increase in the future as populations grow, especially in Taiwan. Taiwan is recognized as the world's high-risk areas, where an average of 5.7 times of floods occur per year should seek to strengthen coherence and consensus in how cities can plan for flood and climate change. Therefore, this study aims at understanding the vulnerability to flooding in Taipei city, Taiwan, by creating indicators and calculating the vulnerability of each study units. The indicators were grouped into sensitivity and adaptive capacity based on the definition of vulnerability of Intergovernmental Panel on Climate Change. The indicators were weighted by using Principal Component Analysis. However, current researches were based on the assumption that the composition and influence of the indicators were the same in different areas. This disregarded spatial correlation that might result in inaccurate explanation on local vulnerability. The study used Geographically Weighted Principal Component Analysis by adding geographic weighting matrix as weighting to get the different main flood impact characteristic in different areas. Cross Validation Method and Akaike Information Criterion were used to decide bandwidth and Gaussian Pattern as the bandwidth weight scheme. The ultimate outcome can be used for the reduction of damage potential by integrating the outputs into local mitigation plan and urban planning.

Keywords: flood vulnerability, geographically weighted principal components analysis, GWPCA, highly urbanized area, spatial correlation

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Authors: Jack Johnstone

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This research presents postcolonial translation as an approach to eradicate traces of colonialism in former colonies. An example of demonstrating postcolonial translation in the Indonesian context is in Hasan Aspahani's Chairil, a biographical narrative and history book based on the personal life of a well-known Indonesian poet and writer, Chairil Anwar (1922-1949) in Dutch occupied Indonesia. This postcolonial translation approach has been applied in the first five chapters on his early years under Dutch colonization, in an attempt to show a postcolonialised TT. This approach aims to demonstrate the postcolonial refutation of the Dutch colonial language to convey the Indonesian setting to target readers. It is also designed to explicate the summary of the book as well as my attempt to apply postcolonial translation as a strategy to reject the Dutch colonial terms in this book. The data conveys 26 important examples of the ST and TT, in consideration of the chosen three factors of culture, forced-Europeanisation, and cross-genre between a biographical narrative and history under categories of Cultural Bound Objects, Politics and Place. However, the 10 selected examples will be analyzed in the Analysis Chapter, which are discussed at word, sentence, and paragraph level. As well, the translation strategies used, namely retention, substitution and specification on four main examples, on the methods utilized to achieve a postcolonialised translation that attempts to 1) examine the way the alteration of the TT can affect the message portrayed within the ST, 2) show the notion of disagreement between the Dutch colonizers and colonized Indonesians on their views on the way Indonesia should be governed and 3) present a translation that reverses the inequality between the superior colonials and inferior Indigenous Indonesians during the Dutch colonial era.

Keywords: Chairil, Dutch colonialism, Indonesia, postcolonial translation

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Authors: Tyler D. Cesarone, Tatiana M. Wugalter

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The movement of patients from the Global North to the Global South in pursuit of inexpensive healthcare and touristic experiences dominates the academic discourse on international medical travel (IMT). However, medical travel exists in higher numbers between Global South countries as patients who lack trust in, and feel disenfranchised by, their national healthcare systems seek treatment in nearby countries. Through a review of the existing literature, this paper examines patterns of IMT in the Middle East, Southeast Asia, and Southern Africa, distinguishing North-South medical tourism from South-South intra-regional medical mobility (IRMM). Evidence from these case studies demonstrates that notions of medical distrust and disenfranchisement, rooted in low-resourced and poor quality healthcare systems, are key drivers of IRMM in the Global South. The movement of patients from lower income to proximate higher income countries not only reveals tensions between patients and their healthcare systems but widens gaps in the quality of healthcare between departing and destination countries. In analyzing these cross-regional similarities, the paper moves beyond the current literature’s focus on singular case studies to expose global patterns of South-South IRMM. This presents a shift from the traditional focus on North-South medical tourism, demonstrating how disparities in healthcare systems both influence and are influenced by IRMM.

Keywords: global South, healthcare quality, international medical travel (IMT), intra-regional medical mobility (IRMM), medical disenfranchisement, medical distrust, medical tourism

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Authors: Tewodros Abate Alemayehu, Abebe Getahun, Akewake Geremew, Dawit Solomon Demeke, John Recha, Dawit Solomon, Gebremedihin Ambaw, Fasil Dawit Moges

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The purpose of this study was to examine the effects of supplementation of zinc oxide (ZnO) nanoparticles and Mannan-oligosaccharide (MOS) on growth performance, feed utilization, fatty acid profiles, hematology, and intestinal morphology of Chamo strain Nile tilapia Oreochromis niloticus (L.) fry reared at optimal temperature (28.62 ± 0.11 ⁰C). Nile tilapia fry (initial weight 1.45 ± 0.01g) were fed basal diet/control diet (Diet-T1), 6 g kg-¹ MOS supplemented diet (Diet-T2), 4 mg ZnO-NPs supplemented diet (Diet-T3), 4 mg ZnO-Bulk supplemented diet (Diet-T4), a combination of 6 g kg-¹ MOS and 4 mg ZnO-Bulk supplemented diet (Diet-T5) and combination of 6 g kg-¹ MOS and 4 mg ZnO-NPs supplemented diet (Diet-T6). Randomly, duplicate aquariums for each diet were assigned and hand-fed to apparent satiation three times daily (08:00, 12:00, and 16:00) for 12 weeks. Fish fed MOS, ZnO-NPs, and a combination of MOS and ZnO-Bulk supplemented diet had higher weight gain, Daily Growth Rate (DGR), and Specific Growth Rate (SGR) than fish fed the basal diet and other feeding groups, although the effect was not significant. According to the GC analysis, Nile tilapia was supplemented with 6 g kg-¹ MOS, 4 mg ZnO-NPs, or a combination of ZnO-NPs, and MOS showed the highest content of EPA, DHA, and higher ratios of PUFA/SFA than other feeding groups. Mean villi length in the proximal and middle portion of the Nile tilapia intestine was affected significantly (p<0.05) by diet. Fish fed Diet-T2 and Diet-T3 had significantly higher villi lengths in the proximal and middle portions of the intestine compared to other feeding groups. The inclusion of additives significantly improved goblet numbers at the proximal, middle, and distal portions of the intestine. Supplementation of additives had also improved some hematological parameters compared with control groups. In conclusion, dietary supplementation of additives MOS and ZnO-NPs could confer benefits on growth performance, fatty acid profiles, hematology, and intestinal morphology of Chamo strain Nile tilapia.

Keywords: chamo strain nile tilapia, fatty acid profile, hematology, intestinal morphology, MOS, ZnO-Bulk, ZnO-NPs

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Authors: Mohammad Reza Dousti, Yaman Boluk, Vivek Bindiganavile

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Well cementing is one of the most crucial and important steps in any well completion. Oil well cement paste is employed to fill the annulus between the casing string and the well bore. However, since the cementing process takes place at the end of the drilling process, a satisfying and acceptable job may not be performed. During the cementing process, the cement paste must be pumped in the annulus, therefore concerns arise both in the workability and the flowability associated with the paste. On the other hand, the cement paste around the casing must demonstrate the adequate compressive strength in order to provide a suitable mechanical support for the casing and desirably prevent collapse of the formation. In this experimental study, the influence of cellulose nanocrystal particles on the workability, flowability and also mechanical properties of oil well cement paste has been investigated. The cementitious paste developed in this research is composed of water, class G oil well cement, bentonite and cellulose nanocrystals (CNC). Bentonite is used as a cross contamination component. Two method of testing were considered to understand the flow behavior of the samples: (1) a mini slump test and (2) a conventional flow table test were utilized to study the flowability of the cementitious paste under gravity and also under applied load (number of blows for the flow table test). Furthermore, the mechanical properties of hardened oil well cement paste dosed with CNC were assessed by performing a compression test on cylindrical specimens. Based on the findings in this study, the addition of CNC led to developing a more viscous cement paste with a reduced spread diameter. Also, by introducing a very small dosage of CNC particles (as an additive), a significant increase in the compressive strength of the oil well cement paste was observed.

Keywords: cellulose nanocrystal, cement workability, mechanical properties, oil well cement

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Authors: Troy A. Tyre

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Organizational behavior and organizational change are elements of the ever-changing global business environment. Leadership and organizational behavior are 21st century disciplines. Network marketing organizations need to understand the ever-changing nature of global business and be ready and willing to adapt to the environment. Network marketing organizations have a challenge keeping up with a rapid escalation in global growth. Network marketing growth has been steady and global. Network marketing organizations have been slow to develop a 21st century global strategy to manage the rapid escalation of growth degrading organizational behavior, job satisfaction, increasing attrition, and degrading customer service. Development of an organizational behavior and leadership theory for the 21st century to help network marketing develops a global business strategy to manage the rapid escalation in growth that affects organizational behavior. Managing growth means organizational leadership must develop and adapt to the organizational environment. Growth comes with an open mind and one’s departure from the comfort zone. Leadership growth operates in the tacit dimension. Systems thinking and adaptation of mental models can help shift organizational behavior. Shifting the organizational behavior requires organizational learning. Organizational learning occurs through single-loop, double-loop, and triple-loop learning. Triple-loop learning is the most difficult, but the most rewarding. Tools such as theory U can aid in developing a landscape for organizational behavioral development. Additionally, awareness to espoused and portrayed actions is imperatives. Theories of motivation, cross-cultural diversity, and communications are instrumental in founding an organizational behavior suited for the 21st century.

Keywords: global, leadership, network marketing, organizational behavior

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Authors: Nidia Thalia Alva Rangel, Ferran Padros Blazquez, Ma. Ines Gomez Del Campo Del Paso

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Happiness has been since antiquity a concept of interest around the world. Positive psychology is the science that begins to study happiness in a more precise and controlled way, obtaining wide amount of research which can be applied. One of the central constructs of Positive Psychology is Carol Ryff’s psychological well-being model as eudaimonic happiness, which comprehends six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Humanistic psychology is a clear precedent of Positive Psychology, which has studied human development topics and it features a great variety of intervention techniques nevertheless has little evidence with controlled research. Therefore, the present research had the aim to evaluate the efficacy of a humanistic intervention program to increase psychological well-being in healthy adults through a mixed methods study. Before and after the intervention, it was applied Carol Ryff’s psychological well-being scale (PWBS) and the Symptom Check List 90 as pretest and posttest. In addition, a questionnaire of five open questions was applied after each session. The intervention program was designed in experiential workshop format, based on the foundational attitudes defined by Carl Rogers: congruence, unconditional positive regard and empathy, integrating humanistic intervention strategies from gestalt, psychodrama, logotherapy and psychological body therapy, with the aim to strengthen skills in the six dimensions of psychological well-being model. The workshop was applied to six volunteer adults in 12 sessions of 2 hours each. Finally, quantitative data were analyzed with Wilcoxon statistic test through the SPSS program, obtaining as results differences statistically significant in pathology symptoms between prettest and postest, also levels of dimensions of psychological well-being were increased, on the other hand for qualitative strand, by open questionnaires it showed how the participants were experiencing the techniques and changing through the sessions. Thus, the humanistic psychology program was effective to increase psychological well-being. Working to promote well-being prompts to be an effective way to reduce pathological symptoms as a secondary gain. Experiential workshops are a useful tool for small groups. There exists the need for research to count with more evidence of humanistic psychology interventions in different contexts and impulse the application of Positive Psychology knowledge.

Keywords: happiness, humanistic psychology, positive psychology, psychological well-being, workshop

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Authors: Haruo Okabayashi

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The mutual understanding in conversation is very important for human relations. This study investigates the mental function of the formation of mutual understanding between two people in conversation using the embodied approach. Forty people participated in this study. They are divided into pairs randomly. Four conversation situations between two (make/listen to fun or pleasant talk, make/listen to regrettable talk) are set for four minutes each, and the finger plethysmogram (200 Hz) of each participant is measured. As a result, the attractors of the participants who reported “I did not understand my partner” show the collapsed shape, which means the fluctuation of their rhythm is too small to match their partner’s rhythm, and their cross correlation is low. The autonomic balance of both persons tends to resonate during conversation, and both LLEs tend to resonate, too. In human history, in order for human beings as weak mammals to live, they may have been with others; that is, they have brought about resonating characteristics, which is called self-organization. However, the resonant feature sometimes collapses, depending on the lifestyle that the person was formed by himself after birth. It is difficult for people who do not have a lifestyle of mutual gaze to resonate their biological signal waves with others’. These people have features such as anxiety, fatigue, and confusion tendency. Mutual understanding is thought to be formed as a result of cooperation between the features of self-organization of the persons who are talking and the lifestyle indicated by mutual gaze. Such an entanglement phenomenon is called a nonlinear relation. By this research, it is found that the formation of mutual understanding is expressed by the rhythm of a biological signal showing a nonlinear relationship.

Keywords: embodied approach, finger plethysmogram, mutual understanding, nonlinear phenomenon

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Authors: Betsy H. Edwards

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Background: Public Health England recognises unprotected sex and consequent transmission of sexually transmitted infections (STIs) as significant problems within student populations. Government surveys show that 50% of sexually-active young adults engage in unprotected sex with new partners, with 10% never using condoms. The recent Channel Four mini-series ‘It’s a Sin’ dramatises the 1980s AIDS epidemic and has been praised for its educational value and for promoting safe sexual practices to its viewers. This mixed-methods questionnaire study aims to investigate whether the series can change attitudes towards safe sex in student populations, can promote the use of condoms in student populations, and whether television, in general, is a useful tool for promoting health education. Methods: A questionnaire, created on Microsoft Forms, was distributed to students at the University of Birmingham via Facebook groups between September 2021 and May 2022. To consent, participants had to be aged 18 or over, a student at the university, have seen the entire series of ‘It’s a Sin’, and read the study information. Data was confidentially stored within the University’s secured OneDrive in accordance with the study’s approved ethics application. Quantitative questions measured participants’ attitudes and behaviours using Likert scales. Qualitative data was analysed using thematic analysis. Quantitative Results: 78 students completed the questionnaire. 43 participants (55%) felt that the series ‘It’s a Sin’ promoted safe sex. 74 participants (96%) and 31 participants (39%) said they were ‘very likely’ or ‘likely’ to use condoms with a casual partner during penetrative sex and oral sex respectively. 27 participants (35%) felt that watching ‘It’s a Sin’ made them more likely to use condoms; of these 27 participants, all were ‘very likely’ or ‘likely’ to use condoms during penetrative sex, and 9 were ‘very likely’ or ‘likely’ to during oral sex. 49 participants (63%) and 53 participants (68%) felt that television is a good way to provide health education and to promote healthy behaviours respectively. Qualitative Results: 56 participants (72%) gave reasons why the series had been associated with an increased uptake in HIV testing. Three themes emerged: increased education and attention, decreased stigmatisation, and relatability of characters on screen. Conclusions: This study suggests that the series ‘It’s a Sin’ can influence attitudes towards and the uptake of safe sexual practices. It would be useful for further research - using larger, randomised samples - to explore impacts upon populations lesser-educated about sexual health, who potentially have more to gain from watching series such as ‘It’s a Sin’.

Keywords: GUM, It's a sin, media, sexual health, students, television, tv

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Authors: Mangala Kohli, P. A. Athira, Reeha Mahajan

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The subthalamic nucleus (STN) is a biconvex nucleus situated in the diencephalon. The knowledge of the morphometry of the subthalamic nucleus is essential for accurate targeting of the nucleus during Deep Brain Stimulation. The present study aims to note the morphometry of the subthalamic nucleus in both the cerebral hemispheres which will prove to be of great value to radiologists and neurosurgeons. A cross‐sectional observational study was conducted in the Departments of Anatomy and Forensic Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi on thirty adult cadaveric brain specimens of unclaimed and donated corpses. The specimens were categorized into 3 age groups: 20-35, 35-50 and above 50 years. All samples were collected after following the standard protocol for ethical clearance. The morphometric study of 60 subthalamic nucleus was thus conducted. Transverse section of the brain was made at a plane 4mm ventral to the plane containing mid commissural point. The dimensions of the subthalamic nucleus were measured bilaterally with the aid of digital Vernier caliper and magnifying glass. In the present study, the mean length and width and AC-PC length of the subthalamic nucleus was recorded on the right and left side in Group A, B and C. On comparison of mean of subthalamic nucleus dimensions between the right and left side in Group C, no statistically significant difference was observed. The length and width of subthalamic nucleus measured in the 3 age groups were compared with each other and the p value calculated. There was no statistically significant difference between the dimensions of Group A and B, Group B and C as well as Group A and C. The present study reveals that there is no significant reduction in the size of the nucleus was noted with increasing age. Thus, the values obtained in the present study can be used as a reference for various invasive and non-invasive procedures on subthalamic nucleus.

Keywords: cerebral hemisphere, deep brain stimulation, morphometry, subthalamic nucleus

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Authors: P. G. S. Madushani, L. D. Illeperuma

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Abstract Noise is one of the most common physical hazards in industrial settings. The prevalence of Noise Induced Hearing Loss (NIHL) is on the rise with increasedduration of exposure and the increase in the severity of hearing loss. The purpose of the study was to determine auditory effects among textile workers and to establish associations between the degree of hearing loss and exposure duration, degree of hearing loss and noise level and the proportion of hearing related complaints. A cross sectional descriptive study using purposive sampling was carried out. An interviewer administered questionnaire and Distortion Product Oto Acoustic Emission (DPOAE) hearing screening on 127 (72 female and 55 male) textile workers of the selected textile plant in Seeduwa, Sri Lanka was done (Age: M= 31.16, SD=7.75). Noise measurements were done in six sections of the factory and average noise levels were obtained. Diagnostic hearing evaluations were done for 60 (57.75%) subjects, referred from the DPOAE hearing screening test. The degree of hearing loss and the exposure duration had a significant association in the high frequency region of 4 kHz to 8 kHz (p < 0.05). Noise levels fluctuated between 90.3±0.8 dBA and 50.6. ±0.52 dBA. 30.83% of workers reported having NIHL. Most of the workers (33.9%) complained difficulty in conversing in noisy backgrounds. Other complaints as tinnitus, dizziness, ear fullness and headache were reported in less than 30%. workers who were exposed to noise for more than 15 years were affected with NIHL in the high frequency region. Administrative controls and engineering controls need to be implemented to manage hazardous noise levels in industrial settings. Hearing Conservation Programs should be initiated and implemented for textile workers.

Keywords: textile industry, NIHL, degree of hearing loss, noise levels, auditory effects

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Authors: Khitam Ibrahem Shlash Mohammad

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Background: Postnatal depression is a focus of considerable research attention, but little is known about the pattern of stress across this period. Objective: to investigate the prevalence of stress after childbirth for Jordanian women and identify associated risk factors. Method: Design: A descriptive cross-sectional study. Participants were recruited six to eight weeks postpartum, provided personal, social and obstetric information, and completed the stress subscale of Depression Anxiety and Stress Scale (DASS-S), the Maternity Social Support Scale (MSSS), and Perceived Self-Efficacy Scale (PSES). Setting: maternal and child health care clinics in four health care centres in Maan city in Southern Jordan. Participants: Arabic speaking women (n = 324) between the ages of 18 and 45 years, six to eight weeks postpartum, primiparous or multiparous at low risk for obstetric complications. Data collection took place between October 2015 and January 2016. Ethical clearance was obtained prior to data collection. Results: The prevalence of postpartum stress among Jordanian women was 39.8 %. A regression analysis revealed that occupation, low social support, financial problems, difficult marital relationships, difficult relationship with family-in-law, giving birth to a female baby, difficult childbirth, and low self-efficacy were associated with postpartum stress. Conclusions and implications for practice: Jordanian women need support during pregnancy, during and after childbirth. Postpartum emotional support and assessment of symptoms of stress need to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about postpartum stress is necessary.

Keywords: prevalence, postpartum, stress, Jordanian women

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Authors: Aspasia Koutsokosta, Stefanos Katsavounis

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This paper reviews the model-based qualitative and quantitative Operations Management research in the context of Construction Supply Chain Management (CSCM). Construction industry has been traditionally blamed for low productivity, cost and time overruns, waste, high fragmentation and adversarial relationships. The construction industry has been slower than other industries to employ the Supply Chain Management (SCM) concept and develop models that support the decision-making and planning. However the last decade there is a distinct shift from a project-based to a supply-based approach of construction management. CSCM comes up as a new promising management tool of construction operations and improves the performance of construction projects in terms of cost, time and quality. Modeling the Construction Supply Chain (CSC) offers the means to reap the benefits of SCM, make informed decisions and gain competitive advantage. Different modeling approaches and methodologies have been applied in the multi-disciplinary and heterogeneous research field of CSCM. The literature review reveals that a considerable percentage of CSC modeling accommodates conceptual or process models which discuss general management frameworks and do not relate to acknowledged soft OR methods. We particularly focus on the model-based quantitative research and categorize the CSCM models depending on their scope, mathematical formulation, structure, objectives, solution approach, software used and decision level. Although over the last few years there has been clearly an increase of research papers on quantitative CSC models, we identify that the relevant literature is very fragmented with limited applications of simulation, mathematical programming and simulation-based optimization. Most applications are project-specific or study only parts of the supply system. Thus, some complex interdependencies within construction are neglected and the implementation of the integrated supply chain management is hindered. We conclude this paper by giving future research directions and emphasizing the need to develop robust mathematical optimization models for the CSC. We stress that CSC modeling needs a multi-dimensional, system-wide and long-term perspective. Finally, prior applications of SCM to other industries have to be taken into account in order to model CSCs, but not without the consequential reform of generic concepts to match the unique characteristics of the construction industry.

Keywords: construction supply chain management, modeling, operations research, optimization, simulation

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Authors: Lou-Hon Sun, Yu-Ming Chiu, Chen-Wei Tao, Chia-Yun Tsai

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It is common practice for many companies to ask employees to provide heart-touching service for customers and to emphasize the attitude of 'customer first'. However, services may not necessarily gain praise, and may actually be considered excessive, if customers do not appreciate such behaviors. In reality, many restaurant businesses try to provide as much service as possible without taking into account whether over-provision may lead to negative customer reception. A survey of 894 people in Britain revealed that 49 percent of respondents consider over-attentive waiters the most annoying aspect of dining out. It can be seen that merely aiming to exceed customers’ expectations without actually addressing their needs, only further distances and dissociates the standard of services from the goals of customer satisfaction itself. Over-service is defined, as 'service provided that exceeds customer expectations, or simply that customers deemed redundant, resulting in negative perception'. It was found that customers’ reactions and complaints concerning over-service are not as intense as those against service failures caused by the inability to meet expectations; consequently, it is more difficult for managers to become aware of the existence of over-service. Thus the ability to manage over-service behaviors is a significant topic for consideration. The Kano model classifies customer preferences into five categories: attractive quality attribute, one-dimensional quality attribute, must-be quality attribute, indifferent quality attribute and reverse quality attributes. The model is still very popular for researchers to explore the quality aspects and customer satisfaction. Nevertheless, several studies indicated that Kano’s model could not fully capture the nature of service quality. The concept of over-service can be used to restructure the model and provide a better understanding of the service quality construct. In this research, the structure of Kano's two-dimensional questionnaire will be used to classify the factors into different dimensions. The same questions will be used in the second questionnaire for identifying the over-service experienced of the respondents. The finding of these two questionnaires will be used to analyze the relevance between service quality classification and over-service behaviors. The subjects of this research are customers of fine dining chain restaurants. Three hundred questionnaires will be issued based on the stratified random sampling method. Items for measurement will be derived from DINESERV scale. The tangible dimension of the questionnaire will be eliminated due to this research is focused on the employee behaviors. Quality attributes of the Kano model are often regarded as an instrument for improving customer satisfaction. The concept of over-service can be used to restructure the model and provide a better understanding of service quality construct. The extension of the Kano model will not only develop a better understanding of customer needs and expectations but also enhance the management of service quality.

Keywords: consumer satisfaction, DINESERV, kano model, over-service

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Authors: Anna Keuchenius

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Broadly speaking, scientific development is studied in either a qualitative manner with a focus on the behavior and interpretations of academics, such as the sociology of science and science studies or in a quantitative manner with a focus on the analysis of publications, such as scientometrics and bibliometrics. Both come with a different set of methodologies and few cross-references. This paper contributes to the bridging of this divide, by on the on hand approaching the process of scientific progress from a qualitative sociological angle and using on the other hand quantitative and computational techniques. As a case study, we analyze the diffusion of Granovetter's hypothesis from his 1973 paper 'On The Strength of Weak Ties.' A network is constructed of all scientists that have referenced this particular paper, with directed edges to all other researchers that are concurrently referenced with Granovetter's 1973 paper. Studying the structure and growth of this network over time, it is found that Granovetter's hypothesis is used by distinct communities of scientists, each with their own key-narrative into which the hypothesis is fit. The diffusion within the communities shares similarities with the diffusion of an innovation in which innovators, early adopters, and an early-late majority can clearly be distinguished. Furthermore, the network structure shows that each community is clustered around one or few hub scientists that are disproportionately often referenced and seem largely responsible for carrying the hypothesis into their scientific subfield. The larger implication of this case study is that the diffusion of scientific hypotheses and ideas are not the spreading of well-defined objects over a network. Rather, the diffusion is a process in which the object itself dynamically changes in concurrence with its spread. Therefore it is argued that the methodology presented in this paper has potential beyond the scientific domain, in the study of diffusion of other not well-defined objects, such as opinions, behavior, and ideas.

Keywords: diffusion of innovations, network analysis, scientific development, sociology of science

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Authors: Fall Abdourahmane, Lazrak Meryem, El Hsaini Houda, El Ammari Laila, Gamih Hasnae, Yahyane Abdelhakim, Benjouad Abdelaziz, Aguenaou Hassan, El Kari Khalid

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Introduction: The double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overnutrition, is a significant health challenge, particularly in low- and middle-income countries. In Morocco, 61.3% of women of reproductive age (WRA) are overweight or obese, including 30.4% who were obese, while 34.4% were anaemic, and 49.7% have iron deficiency anaemia. Objective: This study aims to determine the prevalence of DBM at the individual level among Moroccan WRA, defined by the coexistence of iron deficiency anaemia and overweight/obesity. Methods: a cross-sectional national survey was conducted among a representative sample of 2090 Moroccan WRA. Data collected included socio-economic parameters, anthropometric measurements, and blood samples. Haemoglobin levels were measured photometrically using Hemocue, while ferritin and CRP were assessed through immunoturbudimetry. Results: The prevalence of overweight/obesity, iron deficiency, anaemia and iron deficiency anaemia among WRA in Morocco were 60.2%, 30.6%, 34.4% and 50.0% respectively. The coexistence of overweight/obesity with anaemia and iron deficiency was observed in 19.2% and 16.3% of women, respectively. Among overweight/obese women, 32.5% were anaemic, 28.4% were iron deficient, and 47.6% had iron deficiency anaemia. the prevalence of DBM was higher in urban areas compared to rural settings. Conclusion: The coexistence of undernutrition and overnutrition among WRA highlights the urgent need for integrated public health interventions addressing both anaemia and obesity simultaneously. Tailored strategies should consider the specific socio-economic and geographical contexts to effectively combat this dual burden.

Keywords: the double burden of malnutrition, iron deficiency anaemia, overweight, obesity

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Authors: Ossama Salman

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Background and objective: Sacroiliac joint pain is a common cause for chronic axial low back pain, with up to 20% prevalence rate. To date, no effective long-term treatment intervention has been embarked on yet. The aim of our study was to compare steroid block to radiofrequency ablation for SIJ pain conditions. Methods: A randomized, blind, study was conducted in 30 patients with sacroiliac joint pain. Fifteen patients received radiofrequency denervation of L4-5 primary dorsal rami and S1-3 lateral sacral branch, and 15 patients received steroid under fluoroscopy. Those in the steroid group who did not respond to steroid injections were offered to cross over to get radiofrequency ablation. Results: At 1-, 3- and 6-months post-intervention, 73%, 60% and 53% of patients, respectively, gained ≥ 50 % pain relief in the radiofrequency (RF) ablation group. In the steroid group, at one month post intervention follow up, only 20% gained ≥ 50 % pain relief, but failed to show any improvement at 3 months and 6 months follow up. Conclusions: Radiofrequency ablation at L4 and L5 primary dorsal rami and S1-3 lateral sacral branch may provide effective and longer pain relief compared to the classic intra-articular steroid injection, in properly selected patients with suspected sacroiliac joint pain. Larger studies are called for to confirm our results and lay out the optimal patient selection and treatment parameters for this poorly comprehended disorder.

Keywords: lateral branch denervation, LBD, radio frequency, RF, sacroiliac joint, SIJ, visual analogue scale, VAS

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Authors: Harriet Kebirungi, Majaliwa Jackson-Gilbert Mwanjalolo, S. Livingstone Luboobi, Richard Joseph Kimwaga, Consolata Kabonesa

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This paper assessed gender responsiveness of water and sanitation policies and legal frameworks at Makerere University, Uganda. The objectives of the study were to i) examine the gender responsiveness of water and sanitation related policies and frameworks implemented at Makerere University; and ii) assess the challenges faced by the University in customizing national water and sanitation policies and legal frameworks into University policies. A cross-sectional gender-focused study design was adopted. A checklist was developed to analyze national water and sanitation policies and legal frameworks and University based policies. In addition, primary data was obtained from Key informants at the Ministry of Water and Environment and Makerere University. A gender responsive five-step analytical framework was used to analyze the collected data. Key findings indicated that the policies did not adequately address issues of gender, water and sanitation and the policies were gender neutral consistently. The national policy formulation process was found to be gender blind and not backed by situation analysis of different stakeholders including higher education institutions like Universities. At Makerere University, due to lack of customized and gender responsive water and sanitation policy and implementation framework, there were gender differences and deficiencies in access to and utilization of water and sanitation facilities. The University should take advantage of existing expertise within them to customize existing national water policies and gender, and water and sanitation sub-sector strategy. This will help the University to design gender responsive, culturally acceptable and environmental friendly water and sanitation systems that provide adequate water and sanitation facilities that address the needs and interests of male and female students.

Keywords: gender, Makerere University, policies, water, sanitation

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Authors: Ayse Inel Manav, Saliha Bozdogan Yesilot, Pinar Yesil Demirci, Gursel Oztunc

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Introduction: This study was conducted with a view to evaluating cognitive function level, depression, and quality of life of elderly people living in a nursing home. Methods: This study, which is cross-sectional and descriptive in nature, was conducted in the Nursing and Rehabilitation Center for the Elderly in Adana/Turkey between 1st of May and 1st of August, 2016. The participants included 118 elderly people who were chosen using simple random sampling method. The data were collected using the Personal Information Form, the Standardized Mini Mental State Exam (SMMSE), the Geriatric Depression Scale (GDS), and the World Health Organization Quality of Life-OLD (WHOQOL-OLD) module. The data were analyzed using IBM SPSS Statistics 22 (IBM, SPSS, Turkey) program. Results: Of all the participants, 36,4% (n=43) were female, 63,6% (n=75) were male, and average age was 74,08 ± 8,23 years. The participants’ SMMSE mean score was found 20,37 ± 7,08, GDS mean score was 14,92 ± 4,29, and WHOQOL-OLD module mean score was 69,76 ± 11,54. There was a negative, significant relationship between SMMSE and GDS scores, a positive relationship between WHOQOL-OLD module total scores and a negative, significant relationship between GDS scores and WHOQOL-OLD module total scores. Discussıon and Conclusion: Results showed that more than half of the elderly people living in the nursing home experienced cognitive deterioration and depression; and cognitive state, depression, and quality of life were found to be significantly related to each other.

Keywords: depression, cognitive function level, quality of life

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Authors: Aminu Bashir Mohammad, Agwu Ezera, Abdulrazaq G. Habib, Garba Iliyasu

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Background: Drug resistance tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Routine screening for primary DR-TB before commencing treatment is not done in public hospitals in Nigeria, even with the large body of evidence that shows a high prevalence of primary DR-TB. Data on drug resistance and its genetic determinant among follow up TB patients is lacking in Nigeria. Hence the aim of this study was to determine the prevalence and genetic determinant of drug resistance among follow up TB patients in a tertiary hospital in Nigeria. Methods: This was a cross-sectional laboratory-based study conducted on 384 sputum samples collected from consented follow-up tuberculosis patients. Standard microbiology methods (Zeil-Nielsen staining and microscopy) and PCR (Line Probe Assay)] were used to analyze the samples collected. Person’s Chi-square was used to analyze the data generated. Results: Out of three hundred and eighty-four (384) sputum samples analyzed for mycobacterium tuberculosis (MTB) and DR-TB twenty-five 25 (6.5%) were found to be AFB positive. These samples were subjected to PCR (Line Probe Assay) out of which 18(72%) tested positive for DR-TB. Mutations conferring resistance to rifampicin (rpo B) and isoniazid (katG, and or inhA) were detected in 12/18(66.7%) and 6/18(33.3%), respectively. Transmission dynamic of DR-TB was not significantly (p>0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthened the laboratory capacity for diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Keywords: drug resistance tuberculosis, genetic determinant, intensive phase, Nigeria

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Authors: Hamad Alhamad

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Introduction: The number of retirees in Kuwait is rising quickly, and this is causing more people to become concerned about their well-being. Despite the fact that loneliness and quality of life are significant indices of retiree wellbeing, little research has been done on the topic among retirees in Kuwait. The aim of this study is to explore the level of loneliness and quality of life among retirees in Kuwait. Methods: This is a a cross-sectional descriptive research targeting retirees who live in Kuwait. The UCLA loneliness scale (version 3) and the 36-Item Short Form Survey (36- SF) were utilized. Data was analyzed using SPSS. The ethical approval was obtained from Kuwait University and the Ministry of Health (286). Results: Total respondents in this research were 202 (N=202). The results indicate 77.7% (N=157) experience moderate level of loneliness, 19.8% (N=40) experience high level of loneliness, and only 205% (N=5) experience low level of loneliness. The results of the SF-36 health related questionnaire, participants scores in the eight domains: Physical functioning, general health, role limitations due to physical and emotional health, energy, social functioning, pain, and emotional wellbeing , scored low means. The average of the means was calculated and was (49.8), which indicated that all participants have moderately low Quality of life. Significant relationship with p value equal to ( p= 0.004), was found between a sociodemographic characteristic and level of loneliness in which retirees who were married indicated higher levels of loneliness compared to the single, divorced, and widowed retirees. Conclusion: The study revealed retirees in Kuwait feel moderate loneliness and have a low Quality of Time. The study indicates that retirees should be more considered emotionally and improved and help explore the negative effects on their quality of time In addition to exploring the leading factors to the feeling of loneliness.

Keywords: older adults, social isolation, work, retirement

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Authors: Maria Hopkins, Sarah Koch, Fred Biasini

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Autism is lifelong disorder that affects one out of every 110 Americans. The deficits that accompany Autism Spectrum Disorders (ASD), such as abnormal behaviors and social incompetence, often make it extremely difficult for these individuals to gain functional independence from caregivers. These long-term implications necessitate an immediate effort to improve social skills among children with an ASD. Any technology that could teach individuals with ASD necessary social skills would not only be invaluable for the individuals affected, but could also effect a massive saving to society in treatment programs. The overall purpose of the first study was to develop, implement, and evaluate an avatar tutor for social skills training in children with ASD. “Face Say” was developed as a colorful computer program that contains several different activities designed to teach children specific social skills, such as eye gaze, joint attention, and facial recognition. The children with ASD were asked to attend to FaceSay or a control painting computer game for six weeks. Children with ASD who received the training had an increase in emotion recognition, F(1, 48) = 23.04, p < 0.001 (adjusted Ms 8.70 and 6.79, respectively) compared to the control group. In addition, children who received the FaceSay training had higher post-test scored in facial recognition, F(1, 48) = 5.09, p < 0.05 (adjusted Ms: 38.11 and 33.37, respectively) compared to controls. The findings provide information about the benefits of computer-based training for children with ASD. Recent research suggests the value of also using socially assistive robots with children who have an ASD. Researchers investigating robots as tools for therapy in ASD have reported increased engagement, increased levels of attention, and novel social behaviors when robots are part of the social interaction. The overall goal of the second study was to develop a social robot designed to teach children specific social skills such as emotion recognition. The robot is approachable, with both an animal-like appearance and features of a human face (i.e., eyes, eyebrows, mouth). The feasibility of the robot is being investigated in children ages 7-12 to explore whether the social robot is capable of forming different facial expressions to accurately display emotions similar to those observed in the human face. The findings of this study will be used to create a potentially effective and cost efficient therapy for improving the cognitive-emotional skills of children with autism. Implications and study findings using the robot as an intervention tool will be discussed.

Keywords: autism, intervention, technology, emotions

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Authors: Aziz Ghoufi, Ayman Kanaan

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Clean water is ubiquitous from drinking to agriculture and from energy supply to industrial manufacturing. Since the conventional water sources are becoming increasingly rare, the development of new technologies for water supply is crucial to address the world’s clean water needs in the 21st century. Desalination is in many regards the most promising approach to long-term water supply since it potentially delivers an unlimited source of fresh water. Seawater desalination using reverse osmosis (RO) membranes has become over the past decade a standard approach to produce fresh water. While this technology has proven to be efficient, it remains however relatively costly in terms of energy input due to the use of high-pressure pumps resulting of the low water permeation through polymeric RO membranes. Recently, water channels incorporated in lipidic and polymeric membranes were demonstrated to provide a selective water translocation that enables to break permeability- selectivity trade-off. Biomimetic Artificial Water channels (AWCs) are becoming highly attractive systems to achieve a selective transport of water. The first developed AWCs formed from imidazole quartet (I-quartet) embedded in lipidic membranes exhibited an ion selectivity higher than AQPs however associated with a lower water flow performance. Recently it has been conducted pioneer work in this field with the fabrication of the first AWC@Polyamide(PA) composite membrane with outstanding desalination performance. However, the microscopic desalination mechanism in play is still unknown and its understanding represents the shortest way for a long-term conception and design of AWC@PA composite membranes with better performance. In this work we gain an unprecedented fundamental understanding and rationalization of the nanostructuration of the AWC@PA membranes and the microscopic mechanism at the origin of their water transport performance from advanced molecular simulations. Using osmotic molecular dynamics simulations and a non-equilibrium method with water slab control, we demonstrate an increase in porosity near the AWC@PA interfaces, enhancing water transport without compromising the rejection rate. Indeed, the water transport pathways exhibit a single-file structure connected by hydrogen bonds. Finally, by comparing AWC@PA and PA membranes, we show that the difference in water flux aligns well with experimental results, validating the model used.

Keywords: water desalination, biomimetic membranes, molecular simulation, nanochannels

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Authors: Akanksha Dogra, Abhilasha Singh

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This paper revolves around the cultural complexities, cultural similarities, and national sentiments of the contemporary period. It deals with the idea of cultural hybridization and the failure of socio-psychological and cultural boundaries to include all the members of society. The writers like Amitav Ghosh and Bapsi Sidhwa have a significant mark to cultural imperialism and diversity which lead to fluid identity in the present society. The paper invokes that partition could have been a solution to social and religious homogeneity. As writers like Amitav Ghosh and Bapsi Sidhwa focus on historical fiction, as they do not indulge in border activities rather exhibits complex cultural complexities. In terms of identity they believe that it is constructed and fragmented which is further shaped by colonialism and displacement. They reflect on culture in relation to the disruptions and transformations experienced by communities. Further, the division not only led to the creation of national boundaries but forced individuals to form identities based on religion. The paper aims at analyzing the contemporary scenario and comprehending the multiplicity of cross-cultural interactions leading to convolutions. It fathoms cultural and political complexities as a result of nation and nation-building as a part of collective consciousness. The paper limits itself by comprehending Amitav Ghosh’s work The Shadow Lines and The Hungry Tide and Bapsi Sidhwa’s work Pakistani Bride and The Crow Eaters through the study of Homi K. Bhabha’s The Location of Culture and Edward Said’s Culture and Imperialism.

Keywords: culture, imperialism, cultural hybridization, nation-building, hybridity

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Authors: Joseph Marfo Boaheng, Daniel Ansong, Eugenia Amporfo

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Health Insurance is proposed to provide financial protection against catastrophic health care cost arising from disease. Ghana has had a National Health Insurance Scheme (NHIS) since 2003 with the current enrolment/retention rate of 36%. The main goal of the scheme is to provide equity in the health sector as well as ensuring affordable health care for the poor. However, the current payment system is not flexible to attract significant proportion of the poor informal sector onto the scheme. Looking at the extensive use of mobiles in the Ghana where about 29,220,602.00 registered mobile phone lines are actively in used as of June 2014, paying health insurance premium through mobile phone could be feasible to attract larger proportion of the informal sector onto the scheme. Methodology: The quantitative cross-sectional survey was used to solicit the required information from 877 respondents living in Kumasi, the second capital city of Ghana. The magnitude of the effect of Pro-rata system (flexible payment terms) on NHIS enrollment rate was estimated with binary logistic regression model. Results: The odds for an individual to enroll onto NHIS with mobile phone increases about 2 times more when payment of insurance premium is on pro-rata basis ie. flexible payment terms (p=0.008, CI=1.212-3.565). Conclusion: The study advocates the National Health Insurance Authority consider this alternative payment system that has the potential of attracting a greater proportion of the informal sector to be enrolled or retained onto the scheme.

Keywords: enrollment, health insurance, mobile phone, pro-rata

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