Search results for: psychosocial treatment
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8225

Search results for: psychosocial treatment

7835 Computation of Radiotherapy Treatment Plans Based on CT to ED Conversion Curves

Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić

Abstract:

Radiotherapy treatment planning computers use CT data of the patient. For the computation of a treatment plan, treatment planning system must have an information on electron densities of tissues scanned by CT. This information is given by the conversion curve CT (CT number) to ED (electron density), or simply calibration curve. Every treatment planning system (TPS) has built in default CT to ED conversion curves, for the CTs of different manufacturers. However, it is always recommended to verify the CT to ED conversion curve before actual clinical use. Objective of this study was to check how the default curve already provided matches the curve actually measured on a specific CT, and how much it influences the calculation of a treatment planning computer. The examined CT scanners were from the same manufacturer, but four different scanners from three generations. The measurements of all calibration curves were done with the dedicated phantom CIRS 062M Electron Density Phantom. The phantom was scanned, and according to real HU values read at the CT console computer, CT to ED conversion curves were generated for different materials, for same tube voltage 140 kV. Another phantom, CIRS Thorax 002 LFC which represents an average human torso in proportion, density and two-dimensional structure, was used for verification. The treatment planning was done on CT slices of scanned CIRS LFC 002 phantom, for selected cases. Interest points were set in the lungs, and in the spinal cord, and doses recorded in TPS. The overall calculated treatment times for four scanners and default scanner did not differ more than 0.8%. Overall interest point dose in bone differed max 0.6% while for single fields was maximum 2.7% (lateral field). Overall interest point dose in lungs differed max 1.1% while for single fields was maximum 2.6% (lateral field). It is known that user should verify the CT to ED conversion curve, but often, developing countries are facing lack of QA equipment, and often use default data provided. We have concluded that the CT to ED curves obtained differ in certain points of a curve, generally in the region of higher densities. This influences the treatment planning result which is not significant, but definitely does make difference in the calculated dose.

Keywords: Computation of treatment plan, conversion curve, radiotherapy, electron density

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7834 Constructed Wetlands: A Sustainable Approach for Waste Water Treatment

Authors: S. Sehar, S. Khan, N. Ali, S. Ahmed

Abstract:

In the last decade, the hunt for cost-effective, eco-friendly and energy sustainable technologies for waste water treatment are gaining much attention due to emerging water crisis and rapidly depleting existing water reservoirs all over the world. In this scenario, constructed wetland being a “green technology” could be a reliable mean for waste water treatment especially in small communities due to cost-effectiveness, ease in management, less energy consumption and sludge production. Therefore, a low cost, lab-scale sub-surface flow hybrid constructed wetland (SS-HCW) was established for domestic waste water treatment.It was observed that not only the presence but also choice of suitable vegetation along with hydraulic retention time (HRT) are key intervening ingredients which directly influence pollutant removals in constructed wetlands. Another important aspect of vegetation is that it may facilitate microbial attachment in rhizosphere, thus promote biofilm formation via microbial interactions. The major factors that influence initial aggregation and subsequent biofilm formation i.e. divalent cations (Ca2+) and extra cellular DNA (eDNA) were also studied in detail. The presence of Ca2+ in constructed wetland demonstrate superior performances in terms of effluent quality, i.e BOD5, COD, TDS, TSS, and PO4- than in absence of Ca2+. Finally, light and scanning electron microscopies coupled with EDS were carried out to get more insights into the mechanics of biofilm formation with or without Ca addition. Therefore, the same strategy can be implemented in other waste water treatment technologies.

Keywords: hybrid constructed wetland, biofilm formation, waste water treatment, waste water

Procedia PDF Downloads 382
7833 Wastewater Treatment Using Sodom Apple Tree in Arid Regions

Authors: D. Oulhaci, M. Zehah, S. Meguellati

Abstract:

Collected by the sewerage network, the wastewater contains many polluting elements, coming from the population, commercial, industrial and agricultural activities. These waters are collected and discharged into the natural environment and pollute it. Hence the need to transport them before discharge to a treatment plant to undergo several treatment phases. The objective of this study is to highlight the purification performance of the "Sodom apple tree" which is a very common shrub in the region of Djanet and Illizi in Algeria. As material, we used small buckets filled with sand with a gravel substrate. We sowed seeds that we let grow a few weeks. The water supply is under a horizontal flow regime under-ground. The urban wastewater used is preceded by preliminary treatment. The water obtained after purification is collected using a tap in a container placed under the seal. The comparison between the inlet and the outlet waters showed that the presence of the Sodom apple tree contributes to reducing their pollutant parameters with significant rates: 81% for COD, 84%, for BOD , 95% for SM , 82% for NO⁻² , and 85% for NO⁻³ and can be released into the environment without risk of pollution

Keywords: arid zone, pollution, purification, re-use, wastewater.

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7832 Prevalence of Malocclusion and Assessment of Orthodontic Treatment Needs in Malay Transfusion-Dependent Thalassemia Patients

Authors: Mohamed H. Kosba, Heba A. Ibrahim, H. Rozita

Abstract:

Statement of the Problem: The life expectancy for transfusion-dependent thalassemia patients has increased dramatically with iron-chelation therapy and other modern management modalities. In these patients, the most dominant maxillofacial manifestations are protrusion of zygomatic bones and premaxilla due to the hyperplasia of bone marrow. The purpose of this study is to determine the prevalence of malocclusion and orthodontic treatment needs according to the Dental Aesthetic Index (DAI) among Malay transfusion-dependent thalassemia patients. Orientation: This is a cross-sectional study consist of 43 Malay transfusion-dependent thalassemia patients, 22 males, and 19 females with the mean age of 15.9 years old (SD 3.58). The subjects were selected randomly from patients attending Paediatrics and Internal Medicine Clinic at Hospital USM and Hospital Sultana Bahiyah. The subjects were assessed for malocclusion according to Angle’s classification, and orthodontic treatment needs using DAI. The results show that 22 of the subjects (51.1%) have class II malocclusion, 12 subjects (28%) have class І, while 9 subjects (20.9%) have class Ⅲ. The assessment of orthodontic treatment needs to reveal 22 cases (51.1%) fall in the normal/minor needs category, 12 subjects (28%) fall in the severe and very severe category, while 9 subjects (20.9%) fall in the definite category. Conclusion & Significance: Half of Malay transfusion-dependent thalassemia patients have Class Ⅱmalocclusion. About 28% had malocclusion and required orthodontic treatment. This research shows that Malay transfusion-dependent thalassemia may require orthodontic management; earlier intervention to reduce the complexity of the treatment later, suggesting functional appliance as a suitable treatment option for them, a twin block appliance together with headgear to restrict maxillary growth suggested for management. The current protocol implemented by the Malaysian Ministry of Health for the management of these patients seems to be sufficient since the result shows that about 28% require orthodontic treatment need, according to DAI.

Keywords: prevalence, DAI, thalassaemia, angle classification

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7831 The Epigenetic Background Depended Treatment Planning for Glioblastoma Multiforme

Authors: Rasime Kalkan, Emine Ikbal Atli, Ali Arslantaş, Muhsin Özdemir, Sevilhan Artan

Abstract:

Glioblastoma (WHO grade IV), is the malignant form of brain tumor, the genetic background of the GBM is highly variable. The tumor mass of a GBM is multilayered and every tumor layer shows distinct characteristics with a different cell population. The treatment planning of GBM should be focused on the tumor genetic characteristics. We screened primary glioblastoma multiforme (GBM) in a population-based study for MGMT and RARβ methylation and IDH1 mutation correlated them with clinical data and treatment. There was no correlation between MGMT-promoter methylation and overall survival. The overall survival time of the patients with methylated RARβ was statically (OS;p<0,05) significance between the patients who were treated with chemotherapy and radiotherapy. Here we showed the status of IDH1 gene associatied with younger age. We demonstrated that the together with MGMT gene the RARβ gene should be used as a potantial treatment decision marker for GBMs.

Keywords: RARβ, primary glioblastoma multiforme, methylation, MGMT

Procedia PDF Downloads 323
7830 The Effect of Undernutrition on Sputum Culture Conversion and Treatment Outcomes among People with Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis

Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray

Abstract:

Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.

Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis

Procedia PDF Downloads 129
7829 Energy Savings with the Use of LED Lights at the Wastewater Treatment Plant

Authors: Kishen Prathivadi

Abstract:

The Sewer Authority Mid-Coastside (SAM) is a Joint Powers Authority formed in 1976 and provides secondary wastewater treatment to an average flow of 2.0 million gallons per day. SAM owns and operates a Wastewater Treatment Plant (WWTP) and a sanitary sewage collection system that collects sewage from its three member agencies: the City of Half Moon Bay, the Granada Community Services District and Montara Water and Sanitary District. The Sewer Authority Mid-Coastside (SAM) partnered with Pacific Gas & Electric, and its contractor GEL America, to review and replace all inefficient lighting fixtures and bulbs at the SAM treatment plant and administrative office. The project focused on replacing old and inefficient lighting fixtures and bulbs, reducing annual operating and maintenance costs, and reducing SAM’s carbon footprint. The project resulted in a 55% overall energy reduction, higher light quality and acuity, and a total operational savings of $495,000 over ten years.

Keywords: energy savings, LED, lighting, electrical

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7828 Effect of Cellulase Pretreatment for n-Hexane Extraction of Oil from Garden Cress Seeds

Authors: Boutemak Khalida, Dahmani Siham

Abstract:

Garden cress (Lepidium Sativum L.) belonging to the family Brassicaceae, is edible growing annual herb. Its various parts (roots, leaves and seeds) have been used to treat various human ailments. Its seed extracts have been screened for various biological activities like hypotensive, antimicrobial, bronchodilator, hypoglycaemic and antianemic. The aim of the present study is to optimize the process parameters (cellulase concentration and incubation time) of enzymatic pre-treatment of the garden cress seeds and to evaluate the effect of cellulase pre-treatment of the crushed seeds on the oil yield, physico-chemical properties and antibacterial activity and comparing to non-enzymatic method. The optimum parameters of cellulase pre-treatment were as follows: cellulase of 0,1% w/w and incubation time of 2h. After enzymatic pre-treatment, the oil was extracted by n-hexane for 1.5 h, the oil yield was 4,01% for cellulase pre-treatment as against 10,99% in the control sample. The decrease in yield might be caused a result of mucilage. Garden cress seeds are covered with a layer of mucilage which gels on contact with water. At the same time, the antibacterial activity was carried out using agar diffusion method against 4 food-borne pathogens (Escherichia coli, Salmonella typhi,Staphylococcus aureus, Bacillus subtilis). The results showed that bacterial strains are very sensitive to the oil with cellulase pre-treatment. Staphylococcus aureus is extremely sensitive with the largest zone of inhibition (40 mm), Escherichia coli and salmonella typhi had a very sensitive to the oil with a zone of inhibition (26 mm). Bacillus subtilizes is averagely sensitive which gave an inhibition of 16 mm. But it does not exhibit sensivity to the oil without enzymatic pre-treatment with a zone inhibition (< 8 mm). Enzymatic pre-treatment could be useful for antimicrobial activity of the oil, and hold a good potential for use in food and pharmaceutical industries.

Keywords: Lepidium sativum L., cellulase, enzymatic pretreatment, antibacterial activity.

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7827 Organic Substance Removal from Pla-Som Family Industrial Wastewater through APCW System

Authors: W. Wararam, K. Angchanpen, T. Pattamapitoon, K. Chunkao, O. Phewnil, M. Srichomphu, T. Jinjaruk

Abstract:

The research focused on the efficiency for treating high organic wastewater from pla-som production process by anaerobic tanks, oxidation ponds and constructed wetland treatment systems (APCW). The combined system consisted of 50-mm plastic screen, five 5.8 m3 oil-grease trap tanks (2-day hydraulic retention time; HRT), four 4.3 m3 anaerobic tanks (1-day HRT), 16.7 m3 oxidation pond no.1 (7-day HRT), 12.0 m3 oxidation pond no.2 (3-day HRT), and 8.2 m3 constructed wetland plot (1-day HRT). After washing fresh raw fishes, they were sliced in small pieces and were converted into ground fish meat by blender machine. The fish meat was rinsed for 8 rounds: 1, 2, 3, 5, 6 and 7 by tap water and 4 and 8 by rice-wash-water, before mixing with salt, garlic, steamed rice and monosodium glutamate, followed by plastic wrapping for 72-hour of edibility. During pla-som production processing, the rinsed wastewater about 5 m3/day was fed to the treatment systems and fully stagnating storage in its components. The result found that, 1) percentage of treatment efficiency for BOD, COD, TDS and SS were 93, 95, 32 and 98 respectively, 2) the treatment was conducted with 500-kg raw fishes along with full equipment of high organic wastewater treatment systems, 3) the trend of the treatment efficiency and quantity in all indicators was similarly processed and 4) the small pieces of fish meat and fish blood were needed more than 3-day HRT in anaerobic digestion process.

Keywords: organic substance, Pla-Som family industry, wastewater, APCW system

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7826 Evaluation of Produced Water Treatment Using Advanced Oxidation Processes and Sodium Ferrate(VI)

Authors: Erica T. R. Mendonça, Caroline M. B. de Araujo, Filho, Osvaldo Chiavone, Sobrinho, Maurício A. da Motta

Abstract:

Oil and gas exploration is an essential activity for modern society, although the supply of its global demand has caused enough damage to the environment, mainly due to produced water generation, which is an effluent associated with the oil and gas produced during oil extraction. It is the aim of this study to evaluate the treatment of produced water, in order to reduce its oils and greases content (OG), by using flotation as a pre-treatment, combined with oxidation for the remaining organic load degradation. Thus, there has been tested Advanced Oxidation Process (AOP) using both Fenton and photo-Fenton reactions, as well as a chemical oxidation treatment using sodium ferrate(VI), Na2[FeO4], as a strong oxidant. All the studies were carried out using real samples of produced water from petroleum industry. The oxidation process using ferrate(VI) ion was studied based on factorial experimental designs. The factorial design was used in order to study how the variables pH, temperature and concentration of Na2[FeO4] influences the O&G levels. For the treatment using ferrate(VI) ion, the results showed that the best operating point is obtained when the temperature is 28 °C, pH 3, and a 2000 mg.L-1 solution of Na2[FeO4] is used. This experiment has achieved a final O&G level of 4.7 mg.L-1, which means 94% percentage removal efficiency of oils and greases. Comparing Fenton and photo-Fenton processes, it was observed that the Fenton reaction did not provide good reduction of O&G (around 20% only). On the other hand, a degradation of approximately 80.5% of oil and grease was obtained after a period of seven hours of treatment using photo-Fenton process, which indicates that the best process combination has occurred between the flotation and the photo-Fenton reaction using solar radiation, with an overall removal efficiency of O&G of approximately 89%.

Keywords: advanced oxidation process, ferrate (VI) ion, oils and greases removal, produced water treatment

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7825 Rasagiline Improves Metabolic Function and Reduces Tissue Injury in the Substantia Nigra in Parkinson's Disease: A Longitudinal In-Vivo Advanced MRI Study

Authors: Omar Khan, Shana Krstevska, Edwin George, Veronica Gorden, Fen Bao, Christina Caon, NP-C, Carla Santiago, Imad Zak, Navid Seraji-Bozorgzad

Abstract:

Objective: To quantify cellular injury in the substantia nigra (SN) in patients with Parkinson's disease (PD) and to examine the effect of rasagiline of tissue injury in the SN in patients with PD. Background: N-acetylaspartate (NAA) quantified with MRS is a reliable marker of neuronal metabolic function. Fractional anisotropy (FA) and mean diffusivity (MD) obtained with DTI, characterize tissue alignment and integrity. Rasagline, has been shown to exert anti-apototic effect. We applied these advanced MRI techniques to examine: (i) the effect of rasagiline on cellular injury and metabolism in patients with early PD, and (ii) longitudinal changes seen over time in PD. Methods: We conducted a prospective longitudinal study in patients with mild PD, naive to dopaminergic treatment. The imaging protocol included multi-voxel proton-MRS and DTI of the SN, acquired on a 3T scanner. Scans were performed at baseline and month 3, during which the patient was on no treatment. At that point, rasagiline 1 mg orally daily was initiated and MRI scans are were obtained at 6 and 12 months after starting rasagiline. The primary objective was to compare changes during the 3-month period of “no treatment” to the changes observed “on treatment” with rasagiline at month 12. Age-matched healthy controls were also imaged. Image analysis was performed blinded to treatment allocation and period. Results: 25 patients were enrolled in this study. Compared to the period of “no treatment”, there was significant increase in the NAA “on treatment” period (-3.04 % vs +10.95 %, p= 0.0006). Compared to the period of “no treatment”, there was significant increase in following 12 month in the FA “on treatment” (-4.8% vs +15.3%, p<0.0001). The MD increased during “no treatment” and decreased in “on treatment” (+2.8% vs -7.5%, p=0.0056). Further analysis and clinical correlation are ongoing. Conclusions: Advanced MRI techniques quantifying cellular injury in the SN in PD is a feasible approach to investigate dopaminergic neuronal injury and could be developed as an outcome in exploratory studies. Rasagiline appears to have a stabilizing effect on dopaminergic cell loss and metabolism in the SN in PD, that warrants further investigation in long-term studies.

Keywords: substantia nigra, Parkinson's disease, MRI, neuronal loss, biomarker

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7824 Digital Self-Identity and the Role of Interactivity in Psychiatric Assessment and Treatment

Authors: Kevin William Taylor

Abstract:

This work draws upon research in the fields of games development and mental health treatments to assess the influence that interactive entertainment has on the populous, and the potential of technology to affect areas of psychiatric assessment and treatment. It will use studies to establish the evolving direction of interactive media in the development of ‘digital self-identity,’ and how this can be incorporated into treatment to the benefit of psychiatry. It will determine that this approach will require collaborative production between developers and psychiatrists in order to ensure precise goals are met, improving the success of serious gaming for psychiatric assessment and treatment. Analysis documents the reach of video games across a growing global community of gamers, highlighting cases of the positives and negatives of video game usage. The games industry is largely oblivious to the psychological negatives, with psychiatrists encountering new conditions such as gaming addiction, which is now recognized by the World Health Organization. With an increasing amount of gamers worldwide, and an additional time per day invested in online gaming and character development, the concept of virtual identity as a means of expressing the id needs further study to ensure successful treatment. In conclusion, the assessment and treatment of game-related conditions are currently reactionary, and while some mental health professionals have begun utilizing interactive technologies to assist with the assessment and treatment of conditions, this study will determine how the success of these products can be enhanced. This will include collaboration between software developers and psychiatrists, allowing new avenues of skill-sharing in interactive design and development. Outlining how to innovate approaches to engagement will reap greater rewards in future interactive products developed for psychiatric assessment and treatment.

Keywords: virtual reality, virtual identity, interactivity, psychiatry

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7823 The Effect of Electrical Discharge Plasma on Inactivation of Escherichia Coli MG 1655 in Pure Culture

Authors: Zoran Herceg, Višnja Stulić, Anet Režek Jambrak, Tomislava Vukušić

Abstract:

Electrical discharge plasma is a new non-thermal processing technique which is used for the inactivation of contaminating and hazardous microbes in liquids. Plasma is a source of different antimicrobial species including UV photons, charged particles, and reactive species such as superoxide, hydroxyl radicals, nitric oxide and ozone. Escherichia coli was studied as foodborne pathogen. The aim of this work was to examine inactivation effects of electrical discharge plasma treatment on the Escherichia coli MG 1655 in pure culture. Two types of plasma configuration and polarity were used. First configuration was with titanium wire as high voltage needle and another with medical stainless steel needle used to form bubbles in treated volume and titanium wire as high voltage needle. Model solution samples were inoculated with Escerichia coli MG 1655 and treated by electrical discharge plasma at treatment time of 5 and 10 min, and frequency of 60, 90 and 120 Hz. With the first configuration after 5 minutes of treatment at frequency of 120 Hz the inactivation rate was 1.3 log₁₀ reduction and after 10 minutes of treatment the inactivation rate was 3.0 log₁₀ reduction. At the frequency of 90 Hz after 10 minutes inactivation rate was 1.3 log₁₀ reduction. With the second configuration after 5 minutes of treatment at frequency of 120 Hz the inactivation rate was 1.2 log₁₀ reduction and after 10 minutes of treatment the inactivation rate was also 3.0 log₁₀ reduction. In this work it was also examined the formation of biofilm, nucleotide and protein leakage at 260/280 nm, before and after treatment and recuperation of treated samples. Further optimization of method is needed to understand mechanism of inactivation.

Keywords: electrical discharge plasma, escherichia coli MG 1655, inactivation, point-to-plate electrode configuration

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7822 The Effectiveness of Pretreatment Methods on COD and Ammonia Removal from Landfill Leachate

Authors: M. Poveda, S. Lozecznik, J. Oleszkiewicz, Q. Yuan

Abstract:

The goal of this experiment is to evaluate the effectiveness of different leachate pre-treatment options in terms of COD and ammonia removal. This research focused on the evaluation of physical-chemical methods for pre-treatment of leachate that would be effective and rapid in order to satisfy the requirements of the sewer discharge by-laws. The four pre-treatment options evaluated were: air stripping, chemical coagulation, electro-coagulation and advanced oxidation with sodium ferrate. Chemical coagulation reported the best COD removal rate at 43%, compared to 18 % for both air stripping and electro-coagulation, and 20 % for oxidation with sodium ferrate. On the other hand, air stripping was far superior to the other treatment options in terms of ammonia removal with 86 %. Oxidation with sodium ferrate reached only 16 %, while chemical coagulation and electro-coagulation removed less than 10 %. When combined, air stripping and chemical coagulation removed up to 50 % COD and 85 % ammonia.

Keywords: leachate pretreatment, air stripping, chemical coagulation, electro-coagulation, oxidation

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7821 Optimisation of Wastewater Treatment for Yeast Processing Effluent Using Response Surface Methodology

Authors: Shepherd Manhokwe, Sheron Shoko, Cuthbert Zvidzai

Abstract:

In the present study, the interactive effects of temperature and cultured bacteria on the performance of a biological treatment system of yeast processing wastewater were investigated. The main objective of this study was to investigate and optimize the operating parameters that reduce organic load and colour. Experiments were conducted based on a Central Composite Design (CCD) and analysed using Response Surface Methodology (RSM). Three dependent parameters were either directly measured or calculated as response. These parameters were total Chemical Oxygen Demand (COD) removal, colour reduction and total solids. COD removal efficiency of 26 % and decolourization efficiency of 44 % were recorded for the wastewater treatment. The optimized conditions for the biological treatment were found to be at 20 g/l cultured bacteria and 25 °C for COD reduction. For colour reduction optimum conditions were temperature of 30.35°C and bacterial formulation of 20g/l. Biological treatment of baker’s yeast processing effluent is a suitable process for the removal of organic load and colour from wastewater, especially when the operating parameters are optimized.

Keywords: COD reduction, optimisation, response surface methodology, yeast processing wastewater

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7820 Influence of UV/Ozone Treatment on the Electrical Performance of Polystyrene Buffered Pentacene-Based OFETs

Authors: Lin Gong, Holger Göbel

Abstract:

In the present study, we have investigated the influence of UV/ozone treatment on pentacene-based organic field effect transistors (OFETs) with a bilayer gate dielectric. The OFETs for this study were fabricated on heavily n-doped Si substrates with a thermally deposited SiO2 dielectric layer (300nm). On the SiO2 dielectric a very thin (≈ 15nm) buffer layer of polystyrene (PS) was first spin-coated and then treated by UV/ozone to modify the surface prior to the deposition of pentacene. We found out that by extending the UV/ozone treatment time the threshold voltage of the OFETs was monotonically shifted towards positive values, whereas the field effect mobility first decreased but eventually reached a stable value after a treatment time of approximately thirty seconds. Since the field effect mobility of the UV/ozone treated bilayer OFETs was found to be higher than the value of a comparable transistor with a single layer dielectric, we propose that the bilayer (SiO2/PS) structure can be used to shift the threshold voltage to a desired value without sacrificing field effect mobility.

Keywords: buffer layer, organic field effect transistors, threshold voltage, UV/ozone treatment

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7819 Role of Preoperative and Postoperative Endovaginal Ultrasound and 24-Hour Pad Test in Evaluation of Efficacy of Various Treatment Modalities for Stress Urinary Incontinence

Authors: J. B. Sharma, Vivek Kakkar, Sunesh Kumar, K. K. Roy, Rajesh Kumari, Kavita Pandey, Smriti Hari

Abstract:

Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and six months postoperatively for levator hiatus, pubovisceral thickness, urethral length, and bladder neck position. A 24-hour pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: Mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI, with the mean duration of symptoms being 4.04 years. On the 24-hour pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%), with mean preoperative 24-hour pad test being 36.69 gm which significantly reduced to 9.79 gm postoperatively (p 0.001). There was a significant change in levator hiatus and pubovisceral thickness with the treatment of SUI. Overall urethral length increased, but there was a significant decrease in urethral length on Valsalva after the treatment (0.40 versus 0.28 cm, p 0.04) and a significant reduction in bladder neck descent after Valsalva after treatment (0.41 cm versus 0.27 cm, p 0.001). Conclusion: Endovaginal ultrasound and 24-hour pad test are useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Keywords: stress urinary incontinence, endovaginal ultrasound, 24-hours pad test, pubovisceral muscle thickness

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7818 Assessment of Germination Loss Due to Dusky Cotton Bug (Oxycarenus laetus) in Relation to Cotton Boll Stage and Bug Intensity

Authors: Ali Hassan, Mian Muhammad Awais, Muhammad Rafique Shahid, Farazia Hassan, Shumaila Rasool

Abstract:

Dusky cotton bug (Oxycarenus laetus) has attained the status of major insect pest of cotton. It is also known as seed bug due to its property of feeding on seeds. It causes floral abscission at flowering stage and reduction in seed germination. Present study was carried out to assess germination loss caused by dusky bug with respect to crop stage and insect intensity. Treatments consisted of three stages immature boll, mature boll and opened boll as well three levels of dusky bug i.e., 50 bugs per boll, 40 bugs per boll along with zero level kept as control. Results showed that the germination percentage was highest in control treatment where no insect was released followed by treatment where 40 insects released and minimum germination showed by treatment in which 50 insects were released. The germination percentage of seeds surpassed after control treatment in the treatment where dusky bugs exposure was given at boll opening stage than on mature boll stage. Minimum germination was observed in immature boll stage. Interaction between crop stages and dusky bug levels showed that germination percentage of seeds was maximum in control treatment then boll opening stage followed by mature boll stage. Minimum seed germination was recorded in dusky bug treatment at immature boll stage which was 34% where 50 insects were released. From the results it is clear that dusky bug should be managed properly at all reproductive stages but immature stage is most critical.

Keywords: Gossypium hirsutum, Oxycarenus laetus, seed bug, seed germination

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7817 Fuzzy Nail Cream Formula Treatment with Basic Iranian Traditional Medicine

Authors: Elahe Najafizade, Ahmad Mohammad Alkhateeb, Seyed Ali Hossein Zahraei, Iman Dianat

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Introduction: Hangnails are short, torn, down parts of the skin surrounding the nails. At times they are very painful. The usual treatment advised is cutting the excess skin with clippers or scissors. To provide instant relief to the patients, we describe a simpler and more effective way to use surgical glue to paste them back into their original position. Method: The cream should not be on the heat; it is on the bain-marie. To achieve the desired emulsifier, 1 gram of borax was mixed in 10 grams of distilled water in a bain-marie until it melted, then stirred oserin, beeswax, and oil in the bain-marie until it melted. After that, 32 grams of distilled water was added little by little. We add and stir and gradually add the borax dissolved in 10 grams of distilled water. The bowl of cream was placed in a bowl of cold water and stirred until the cream was smooth. After that, we add gasoline, alcohol, or methylparaben preservatives. It should be noted that this amount of ingredients is enough for a 350-gram can (when we prepare the cream, we also add the extract). Result: The patient was a 40-year-old female with a hangnail problem that had been used several different creams and Vaseline, but the treatment was not useful, but after this cream was applied for treatment; the hangnail started to cure within one week, and complete treatment achieved after two weeks. Conclusion: Traditional methods with modification without using chemical substances somehow work better and safer, so research programs on them will be useful for less risky treatment procedures.

Keywords: nail, cream, formula, traditional medicine

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7816 Modulation of Isoprenaline-Induced Myocardial Damage by Atorvastatin

Authors: Dalia Atallah, Lamiaa Ahmed, Hala Zaki, Mahmoud Khattab

Abstract:

Background: Isoprenaline (ISO) administration induces myocardial damage via oxidative stress and endothelial dysfunction. Atorvastatin (ATV) treatment improves both oxidative stress and endothelial dysfunction yet recent studies have reported a pro-oxidant effect upon ATV administration on both clinical and experimental studies. The present study was directed to investigate the effect of ATV pre-treatment and treatment on ISO-induced myocardial damage. Methods: Male rats were divided into five groups (n = 10). Rats were given ISO (5mg/kg/day, i.p.) for one week with or without ATV (10mg/kg/day, p.o.). ATV was given either as pre-treatment for one week before its co-administration with ISO for another week or as a treatment for two weeks at the end of the ISO administration. At the end of the experiment, the electrocardiographic examination was done and blood was isolated for the estimation of plasma creatine kinase MB (CK-MB) activity. Rats were then sacrificed and the whole ventricles were isolated for histological examination and the estimation of lipid peroxides as malondialdehyde (MDA) level, reduced glutathione (GSH) level, catalase activity, total nitrate-nitrite (NOx), as well as the estimation of both endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) protein expression. Results: ISO-induced myocardial damage showed a significant elevation in ST segment, an increase in CK-MB activity, as well as increased oxidative stress biomarkers. Also, ISO-treated rats showed a significant decrease in myocardial NOx level and eNOS as well as degeneration in the myocardium. ATV pre-treatment didn’t show any protection to ISO-treated rats. On the other hand, ATV treatment showed a significant decrease in both the elevated ST wave and CK-MB activity. Moreover, ATV Treatment succeeded to improve oxidative stress biomarkers, tissue NOx, and eNOS protein expression, as well as amelioration of the histological alterations. Conclusion: Pre-treatment with ATV failed to protect against ISO-induced damage. This might suggest a synergistic pro-oxidant effect upon administration of the pro-oxidant ISO along with ATV as demonstrated by the increased oxidative stress and endothelial dysfunction. On the other side, ATV treatment succeeded to significantly improve oxidative stress biomarkers, endothelial dysfunction and myocardial degeneration.

Keywords: atorvastatin, endothelial dysfunction, isoprenaline, oxidative stress

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7815 Exploring the Psychosocial Brain: A Retrospective Analysis of Personality, Social Networks, and Dementia Outcomes

Authors: Felicia N. Obialo, Aliza Wingo, Thomas Wingo

Abstract:

Psychosocial factors such as personality traits and social networks influence cognitive aging and dementia outcomes both positively and negatively. The inherent complexity of these factors makes defining the underlying mechanisms of their influence difficult; however, exploring their interactions affords promise in the field of cognitive aging. The objective of this study was to elucidate some of these interactions by determining the relationship between social network size and dementia outcomes and by determining whether personality traits mediate this relationship. The longitudinal Alzheimer’s Disease (AD) database provided by Rush University’s Religious Orders Study/Memory and Aging Project was utilized to perform retrospective regression and mediation analyses on 3,591 participants. Participants who were cognitively impaired at baseline were excluded, and analyses were adjusted for age, sex, common chronic diseases, and vascular risk factors. Dementia outcome measures included cognitive trajectory, clinical dementia diagnosis, and postmortem beta-amyloid plaque (AB), and neurofibrillary tangle (NT) accumulation. Personality traits included agreeableness (A), conscientiousness (C), extraversion (E), neuroticism (N), and openness (O). The results show a positive correlation between social network size and cognitive trajectory (p-value = 0.004) and a negative relationship between social network size and odds of dementia diagnosis (p = 0.024/ Odds Ratio (OR) = 0.974). Only neuroticism mediates the positive relationship between social network size and cognitive trajectory (p < 2e-16). Agreeableness, extraversion, and neuroticism all mediate the negative relationship between social network size and dementia diagnosis (p=0.098, p=0.054, and p < 2e-16, respectively). All personality traits are independently associated with dementia diagnosis (A: p = 0.016/ OR = 0.959; C: p = 0.000007/ OR = 0.945; E: p = 0.028/ OR = 0.961; N: p = 0.000019/ OR = 1.036; O: p = 0.027/ OR = 0.972). Only conscientiousness and neuroticism are associated with postmortem AD pathologies; specifically, conscientiousness is negatively associated (AB: p = 0.001, NT: p = 0.025) and neuroticism is positively associated with pathologies (AB: p = 0.002, NT: p = 0.002). These results support the study’s objectives, demonstrating that social network size and personality traits are strongly associated with dementia outcomes, particularly the odds of receiving a clinical diagnosis of dementia. Personality traits interact significantly and beneficially with social network size to influence the cognitive trajectory and future dementia diagnosis. These results reinforce previous literature linking social network size to dementia risk and provide novel insight into the differential roles of individual personality traits in cognitive protection.

Keywords: Alzheimer’s disease, cognitive trajectory, personality traits, social network size

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7814 IRIS An Interactive Video Game for Children with Long-Term Illness in Hospitals

Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

Abstract:

Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialised software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarise and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, reevaluate their perceptions about hospitalisation, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalised peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimise escapism and feelings of exclusion, and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: long-term illness, children, hospital, interactive games, cognitive, socioemotional development

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7813 Fibromyalgia and Personality: A Review of the Different Personality Types Identified

Authors: Lize Tibiriçá, Ronnie Lee, Samantha Behbahani

Abstract:

Fibromyalgia (FM) is a musculoskeletal disorder affecting men and women of different ages and cultures. The cause of this disorder is unknown; however, studies suggest an etiology that involves biological and psychosocial factors. Few studies have shown that a personality type such as neuroticism is associated with chronic pain conditions. Past research has explored whether patients with FM present with a specific personality trait. However, studies have used different methods (i.e. Minnesota Multiphasic Personality Inventory (MMPI), Sociotropy and Autonomy Scale (SAS) and Dysfunctional Attitude Scale (DAS), Tridimensional Personality Questionnaire or Temperament and Character Inventory (TCI), Karolinska scale of personality, Big Five Inventory or NEO Personality Inventory) to explore the connection between FM and a personality type. They have identified personality types that present similar characteristics but vary in the name (i.e. high harm avoidance and low novelty seeking, psychasthenia/muscular tension/somatic anxiety, neuroticism). Although Zuckerman-Kuhlman Personality Questionnaire and the Big Five Inventory differ in terms of content and structure, both of them identify neuroticism as the personality type of FM patients, and the former also identifies these patients as having a low sociability personality trait. Previous research also shows a trend of sociotropic personality style with FM patients that also suffer from Major Depressive Disorder. Participants in these studies were, for the most part, adult female and researchers have recognized that as a limitation and whether their findings can be generalized to men and younger patients with FM. Furthermore, most studies reviewed were conducted in Europe (i.e. Spain) and had a cross-sectional design. Future research should replicate past studies in different countries and consider conducting a longitudinal study. Although it is suspected that FM course is modulated by FM patients’ personality, it is not known whether individuals with similar personalities will develop FM. This review sought to explain the differences and similarities between the personality types identified. Limitations in the studies reviewed were addressed, and considerations for future research and treatment were discussed.

Keywords: chronic pain, fibromyalgia, neuroticism, personality type

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7812 Effects of Molybdenum Treatments on Maize and Sunflower Seedlings

Authors: Eva Bodi, Szilvia Veres, Farzaneh Garousi, Szilvia Varallay, Bela Kovacs

Abstract:

The aim of the present study was to examine whether increasing molybdenum (Mo) concentration affects on the growth and Mo concentration of maize and sunflower (Helianthus annuus L. cv Arena PR) seedlings within laboratory conditions. In this experiment calcareous chernozem soil was used and Mo was supplemented into the soil as ammonium molybdate [(NH4)6Mo7O24.4H2O] in four different concentrations as follow: 0 (control), 30, 90 and 270 mg/kg. In this study we found that molybdenum in small amount (30 mg/kg) affects positively on growth of maize and sunflower seedlings, however, higher concentration of Mo reduces the dry weights of shoots and roots. In the case of maize the highest Mo treatment (270 mg/kg) and in sunflower 90 mg/kg treatment caused significant reduction in plant growth. In addition, we observed that molybdenum contents in the roots and shoots were very low in case of control soil but were significantly elevated with increasing concentration of Mo treatment. Only in case of sunflower the highest 270 mg/kg Mo treatment caused decrease in Mo concentration.

Keywords: dry weight, maize, molybdenum, sunflower

Procedia PDF Downloads 391
7811 Use of Acid Mine Drainage as a Source of Iron to Initiate the Solar Photo-Fenton Treatment of Municipal Wastewater: Circular Economy Effect

Authors: Tooba Aslam, Efthalia Chatzisymeon

Abstract:

Untreated Municipal Wastewater (MWW) is renowned as the utmost harmful pollution caused to environmental water due to the high presence of nutrients and organic contaminants. Removal of Chemical Oxygen Demand (COD) from synthetic as well as municipal wastewater is investigated by using acid mine drainage as a source of iron to initiate the solar photo-Fenton treatment of municipal wastewater. In this study, Acid Mine Drainage (AMD) and different minerals enriched in iron, such as goethite, hematite, magnetite, and magnesite, have been used as the source of iron to initiate the photo-Fenton process. Co-treatment of real municipal wastewater and acid mine drainage /minerals is widely examined. The effects of different parameters such as minerals recovery from AMD, AMD as a source of iron, H₂O₂ concentration, and COD concentrations on the COD percentage removal of the process are studied. The results show that, out of all the four minerals, only hematite (1g/L) could remove 30% of the pollutants at about 100 minutes and 1000 ppm of H₂O₂. The addition of AMD as a source of iron is performed and compared with both synthetic as well as real wastewater from South Africa under the same conditions, i.e., 1000 ppm of H₂O₂, ambient temperature, 2.8 pH, and solar simulator. In the case of synthetic wastewater, the maximum removal (56%) is achieved with 50 ppm of iron (AMD source) at 160 minutes. On the other hand, in real wastewater, the removal efficiency is 99% with 30 ppm of iron at 90 minutes and 96% with 50 ppm of iron at 120 minutes. In conclusion, overall, the co-treatment of AMD and MWW by solar photo-Fenton treatment appears to be an effective and promising method to remove organic materials from Municipal wastewater.

Keywords: municipal wastewater treatment, acid mine drainage, co-treatment, COD removal, solar photo-Fenton, circular economy

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7810 Titanium-Aluminium Oxide Coating on Aluminized Steel

Authors: Fuyan Sun, Guang Wang, Xueyuan Nie

Abstract:

In this study, a plasma electrolytic oxidation (PEO) process was used to form titanium-aluminium oxide coating on aluminized steel. The present work was mainly to study the effects of treatment time of PEO process on properties of the titanium coating. A potentiodynamic polarization corrosion test was employed to investigate the corrosion resistance of the coating. The friction coefficient and wear resistance of the coating were studied by using pin-on-disc test. The thermal transfer behaviours of uncoated and PEO-coated aluminized steels were also studied. It could be seen that treatment time of PEO process significantly influenced the properties of the titanium oxide coating. Samples with a longer treatment time had a better performance for corrosion and wear protection. This paper demonstrated different treatment time could alter the surface behaviour of the coating material.

Keywords: titanium-aluminum oxide, plasma electrolytic oxidation, corrosion, wear, thermal property

Procedia PDF Downloads 339
7809 The Gold Standard Treatment Plan for Vitiligo: A Review on Conventional and Updated Treatment Methods

Authors: Kritin K. Verma, Brian L. Ransdell

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White patches are a symptom of vitiligo, a chronic autoimmune dermatological condition that causes a loss of pigmentation in the skin. Vitiligo can cause issues of self-esteem and quality of life while also progressing the development of other autoimmune diseases. Current treatments in allopathy and homeopathy exist; some treatments have been found to be toxic, whereas others have been helpful. Allopathy has seemed to offer several treatment plans, such as phototherapy, skin lightening preparations, immunosuppressive drugs, combined modality therapy, and steroid medications to improve vitiligo. This presentation will review the FDA-approved topical cream, Opzelura, a JAK inhibitor, and its effects on limiting vitiligo progression. Meanwhile, other non-conventional methods, such as Arsenic Sulphuratum Flavum used in homeopathy, will be debunked based on current literature. Most treatments still serve to arrest progression and induce skin repigmentation. Treatment plans may differ between patients due to depigmentation location on the skin. Since there is no gold standard plan for treating patients with vitiligo, the oral presentation will review all topical and systemic pharmacological therapies that fight the depigmentation of the skin and categorize their validity from a systematic review of the literature. Since treatment plans are limited in nature, all treatment methods will be mentioned and an attempt will be made to make a golden standard treatment process for these patients.

Keywords: vitiligo, phototherapy, immunosuppressive drugs, skin lightening preparations, combined modality therapy, arsenic sulphuratum flavum, homeopathy, allopathy, golden standard, Opzelura

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7808 Effect of Rubber Treatment on Compressive Strength and Modulus of Elasticity of Self-Compacting Rubberized Concrete

Authors: I. Miličević, M. Hadzima Nyarko, R. Bušić, J. Simonović Radosavljević, M. Prokopijević, K. Vojisavljević

Abstract:

This paper investigates the effects of different treatment methods of rubber aggregates for self-compacting concrete (SCC) on compressive strength and modulus of elasticity. SCC mixtures with 10% replacement of fine aggregate with crumb rubber by total aggregate volume and with different aggregate treatment methods were investigated. The rubber aggregate was treated in three different methods: dry process, water-soaking, and NaOH treatment plus water soaking. Properties of SCC in a fresh and hardened state were tested and evaluated. Scanning electron microscope (SEM) analysis of three different SCC patches were made and discussed. It was observed that applying the proposed NaOH plus water soaking method resulted in the improvement of fresh and hardened concrete properties. It resulted in a more uniform distribution of rubber particles in the cement matrix, a better bond between rubber particles and the cement matrix, and higher compressive strength of SCC rubberized concrete.

Keywords: compressive strength, modulus of elasticity, NaOH treatment, rubber aggregate, self-compacting rubberized concrete, scanning electron microscope analysis

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7807 The Pomade for Treatment of Bovine Papilomavirus-Induced Warts in Teats

Authors: Mehmet Kale, Ramazan Sencan, Sibel Yavru, Ahmet Ak, Nuri Mamak, Sibel Hasırcıoglu, Mesih Kocamuftuoglu, Yakup Yıldırım, Hasbi Sait Saltık

Abstract:

Bovine Papilloma Virus (BPV)-induced warts can cause mastitis, teat blindness, reduction of milk yield, udder deformities, and a difficulty in getting the teats into the milking machine. Especially, surgical operations cannot be performed in BPV-induced teat warts because of the increased sensitivity of the breast region and small-sized papillomas. Thus, there is a need to find new topical treatment methods. We have developed a pomade for treatment of BPV in cattle. The pomade is consists of lanoline, snakeskin (two special kind of snake), alcohol, vaseline, and ether. Firstly, we determined 46 cattle with teat warts. In the study, BPV antigen was detected in 28 cattle blood samples (61%) by ELISA. The pomade was applied to all BPV infected animals. The regression and recovery of warts were 100% in all animals. We advised using the pomade for treatment of BPV-induced warts in teats.

Keywords: bovine papilloma virus, pomade, teat, udder

Procedia PDF Downloads 200
7806 Epidemiology of Low Back Pain among Nurses Working in Public Hospitals of Addis Ababa, Ethiopia

Authors: Mengestie Mulugeta Belay, Serebe Abay Gebrie, Biruk Lambbiso Wamisho, Amare Worku

Abstract:

Background: Low back pain (LBP) related to nursing profession, is a very common public health problem throughout the world. Various risk factors have been implicated in the etiology and LBP is assumed to be of multi-factorial origin as individual, work-related and psychosocial factors can contribute to its development. Objectives: To determine the prevalence and to identify risk factors of LBP among nurses working in Addis Ababa City Public Hospitals, Ethiopia, in the year 2015. Settings: Addis Ababa University, Black-Lion (‘Tikur Anbessa’) Hospital-BLH, is the country’s highest tertiary level referral and teaching Hospital. The three departments in connection with this study: Radiology, Pathology and Orthopedics, run undergraduate and residency programs and receive referred patients from all over the country. Methods: A cross-sectional study with internal comparison was conducted throughout the period October-December, 2015. Sample was chosen by simple random sampling technique by taken the lists of nurses from human resource departments as a sampling frame. A well-structured, pre-tested and self-administered questionnaire was used to collect quantifiable information. The questionnaire included socio-demographic, back pain features, consequences of back pain, work-related and psychosocial factors. The collected data was entered into EpiInfo version 3.5.4 and was analyzed by SPSS. A probability level of 0.05 or less and 95% confidence level was used to indicate statistical significance. Ethical clearance was obtained from all respected administrative bodies, Hospitals and study participants. Results: The study included 395 nurses and gave a response rate of 91.9%. The mean age was 30.6 (±8.4) years. Majority of the respondents were female (285, 72.2%). Nearly half of the participants (n=181, 45.8% (95% CI (40.8%- 50.6%))) were complained low back pain. There was statistical significant association between low back pain and working shift, physical activities at work; sleep disturbance and felt little pleasure by doing things. Conclusion: A high prevalence of low back pain was found among nurses working in Addis Ababa Public Hospitals. Recognition and preventive measures like providing resting periods should be taken to reduce the risk of low back pain in nurses working in Public hospitals.

Keywords: low back pain, risk factors, nurses, public hospitals

Procedia PDF Downloads 277