Search results for: group decision

Authors: Lian Tong, Yan Ye, Qiong Yan

Abstract:

Background: Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD and sleep problems. Methods: We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children’s Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms. Results: We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems. Conclusions: Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.

Keywords: ADHD, sleep problems, anxiety/depression, bedtime activities, children

Procedia PDF Downloads 188

Authors: Seyed Esmail Seyedi Bariran, Laysheng Ewe, Amy Ling

Abstract:

Since supplier selection appears as a vital decision, selecting supplier based on the best and most accurate ways has a lot of importance for enterprises. In this study, a new Artificial Intelligence approach is exerted to remove weaknesses of supplier selection. The paper has three parts. First part is choosing the appropriate criteria for assessing the suppliers’ performance. Next one is collecting the data set based on experts. Afterwards, the data set is divided into two parts, the training data set and the testing data set. By the training data set the best structure of GEP and ANN are selected and to evaluate the power of the mentioned methods the testing data set is used. The result obtained shows that the accuracy of GEP is more than ANN. Moreover, unlike ANN, a mathematical equation is presented by GEP for the supplier selection.

Keywords: supplier selection, automotive supply chains, ANN, GEP

Procedia PDF Downloads 609

Authors: Nazli Darkhal

Abstract:

The use of gems and ornaments has been common in Iran since the beginning of history. The prosperity of the country, the wealth, and the interest of the people of this land in luxurious and glorious life, combined with beauty, have always attracted the attention of the gems and ornaments of the Iranian people. Iranians are famous in the world for having a long history of collecting and recognizing precious stones. In this case, we can use the unique treasure of national jewelry. Raman spectroscopy method is one of the oscillating spectroscopy methods that is classified in the group of nondestructive study methods, and like other methods, in addition to several advantages, it also has disadvantages and problems. Micro Raman spectroscopy is one of the different types of Raman spectroscopy in which an optical microscope is combined with a Raman device to provide more capabilities and advantages than its original method. In this way, with the help of Raman spectroscopy and a light microscope, while observing more details from different parts of the historical sample, natural or artificial pigments can be identified in a small part of it. The EDX electron microscope also functions as the basis for the interaction of the electron beam with the matter. The beams emitted from this interaction can be used to examine samples. In this article, in addition to introducing the micro Raman spectroscopy method, studies have been conducted on the structure of three samples of existing stones in the historic citadel of Bam. Using this method of study on precious and semi-precious stones, in addition to requiring a short time, can provide us with complete information about the structure and theme of these samples. The results of experiments and gemology of the stones showed that the selected beads are agate and jasper, and they can be placed in the chalcedony group.

Keywords: bam citadel, precious and semi-precious stones, Raman spectroscopy, scanning electron microscope

Procedia PDF Downloads 113

Authors: Norma Kok, Diemo Masuko, Thandokazi Dlongwana, Komala Pillay

Abstract:

CONTEXT: While many school principals have been outstanding teachers and have inherent leadership potential, many have not had access to the quality of leadership development or support that empowers them to produce high-quality education outcomes in extremely challenging circumstances. Further, school leaders in under-served communities face formidable challenges arising from insufficient infrastructure, overcrowded classrooms, socio-economic challenges within the community, and insufficient parental involvement, all of which put a strain on principals’ ability to lead their schools effectively. In addition few school leaders have access to other supportive networks, and many do not know how to build and leverage social capital to create opportunities for their schools and learners. Moreover, we know that fostering parental involvement in their children’s learning improves a child’s morale, attitude, and academic achievement across all subject areas, and promotes better behaviour and social adjustment. Citizen Leader Lab facilitates the Partners for Possibility (PfP) programme to provide leadership development and support to school leaders serving under-resourced communities in South Africa to create effective environments of learning. This is done by creating partnerships between school leaders and private-sector business leaders over a 12-month period. (185) OBJECTIVES: To explore school leaders’ perceptions of their leadership capacities and changes at their schools after being exposed to a year-long leadership development training programme. METHODS: School leaders gained new leadership capacities e.g. resilience, improved confidence, communication and conflict resolution skills - catalysing into improved cultures of collaborative decision-making and environments for enhanced teaching and learningprogramme based on the 70:20:10 model whereby: 10% of learning comes from workshops, 20% of learning takes place through peer learning and 70% of learning occurs through experiential learning as partnerships work together to identify and tackle challenges in targeted schools. Participants completed a post-programme questionnaire consisting of structured and unstructured questions and semi-structured interviews were conducted with them and their business leader. The interviews were audio-recorded, transcribed and thematic content analysis was undertaken. The analysis was inductive and emerging themes were identified. A code list was generated after coding was undertaken using computer software (Dedoose). Quantitative data gathered from surveys was aggregated and analysed. RESULTS: School leadership found the programme interesting and rewarding. They gained new leadership capacities such as resilience, improved confidence, communication and conflict resolution skills - catalyzing into improved cultures of collaborative decision-making and environments for enhanced teaching and learning. New networks resulted in tangible outcomes such as upgrades to school infrastructure, water and sanitation, vegetable gardens at schools resulting in nutrition for learners and/or intangible outcomes such as skills for members of school management teams (SMTs). Collaborative leadership led to SMTs being more aligned, efficient, and cohesive; and teachers being more engaged and motivated. Notable positive changes at the school inspired parents and community members to become more actively involved in the school and in their children’s education. CONCLUSION: The PfP programme leads to improved leadership capacities and improved school culture which leads to improved teaching and learning and new resources for schools.

Keywords: collaborative decision-making, collaborative leadership, community involvement, confidence

Procedia PDF Downloads 72

Authors: Rodrigo Zeidan

Abstract:

The paper identifies failures of decision making and corporate governance that allow non-financial companies around the world to develop hedging strategies that lead to hefty losses in the aftermath of the financial crisis. The sample is comprised of 346 companies from 10 international markets, of which 49 companies (and a subsample of 13 distressed companies) lose a combined US$18.9 billion. An event study shows that most companies that present losses in derivatives experience negative abnormal returns, including a number of companies in which the effect is persistent after a year. The results of a probit model indicate that the lack of a formal hedging policy, no monitoring to the CFOs, and considerations of hubris and remuneration contribute to the mismanagement of hedging policies.

Keywords: risk management, hedging, derivatives, monitoring, corporate governance structure, event study, hubris

Procedia PDF Downloads 430

Authors: Heiko Scholz

Abstract:

When feeding high qualitysilagetoheifersfromthe age of two, there is a riskofenergyoversupply. Depending on the feeding valueorscarceavailability ofsilageorcorn silage diets withhighproportionsof straw is often incorporated. Foran energetically standardized young cattle supply of strawproportion can be more than 20% of dry matter. It was investigated whether the grinding of straw with the strawmillselective feeding significantly limits. The investigation has been carried out with young cattle in the second year. 78 animals were kept and fed under similar conditions in two groups. The experimental group (EG) consisted of cattle 12 to 15 months, and in the control group (CG), the cattle were 15 to 20 months old. The experimental feeding took place in five days of feed distribution, and residual feed were weighed. The ration of EG contained ground with the straw mill straw, and CG was further fed rotor-cut pressed straw. To determine the selective seizure samples of feed distributionandtheremainingfood with the particle separator boxandthecrude protein-and energy-content have been determined. The grinding of the straw increased the daily feed intake.IntheEGan increase infeed intakewas observedby grinding of the straw. Feed intakedirectlyon the day for changing the dietoflongonground straw increased by more than 2.0 kgofDMper animal. In the following days, the feed intakewasincreasedby 0.9kg DMper animal and day on average (7.4 vs. 8.3 kg DM per day). The results of the screen distribution of residual feed point to a differentiated feeding behavior between the groups. In the EG, the particle length of the residual feed to a large extent with the template matches. The acid-base-balance (NSBA)valuesofEGarewithin normal limits. Ifstrawsharesof25% and more are federations to young cattle (heifers), the theparticlelengthof straw has significant impact ontheselectivefeeding behavior. Aparticlelength of 1.5cmcompared to7.5 cmlongpreventedstrawcertainly discarding of the straw on the feeding barn. The feed intake increases whenshortstrawis mixed into theTMR.

Keywords: straw mill, heifer, feed selection, dry matter intake

Procedia PDF Downloads 179

Authors: Hyun Chul Cho, Hyunkyoung Oh, Hyun Yoon, Jooyeon Jin, Jae Won Lee

Abstract:

Identifying, structuring, and racking the most important factors related to improving athletes’ performances could pave the way for improve training system. The purpose of this study was to identify the relative importance factors to improve performance of the of judo athletes with visual impairments, including blindness by using the Analytic Hierarchy Process (AHP). After reviewing the literature, the relative importance of factors affecting performance of the blind judo was selected. A group of expert reviewed the first draft of the questionnaires, and then finally selected performance factors were classified into the major categories of techniques, physical fitness, and psychological categories. Later, a pre-selected experts group was asked to review the final version of questionnaire and confirm the priories of performance factors. The order of priority was determined by performing pairwise comparisons using Expert Choice 2000. Results indicated that “grappling” (.303) and “throwing” (.234) were the most important lower hierarchy factors for blind judo skills. In addition, the most important physical factors affecting performance were “muscular strength and endurance” (.238). Further, among other psychological factors “competitive anxiety” (.393) was important factor that affects performance. It is important to offer psychological skills training to reduce anxiety of judo athletes with visual impairments and blindness, so they can compete in their optimal states. These findings offer insights into what should be considered when determining factors to improve performance of judo athletes with visual impairments and blindness.

Keywords: analytic hierarchy process, blind athlete, judo, sport performance

Procedia PDF Downloads 203

Authors: K. D. Candido, A. Lissounov, I. Knezevic, N. Knezevic

Abstract:

Background: The most commonly performed pain procedures in the USA is Lumbar Epidural Steroid Injections (LESI). There are three main types of these procedures: transforaminal (TF), interlaminar (IL) and caudal injections. It is expected for TF injections to have better outcomes than IL injections, based on the recently published systematic review. The studies presented in that review used a midline IL approach, but those with parasagittal IL approach were not taken into consideration. Our aim is to emphasize the efficacy of the lateral parasagittal (paramedian) IL approach in this review. Methods: We included five studies in this systematic review, which compared Parasagittal-IL (PIL) with either Midline-IL (MIL) or TF LESI. Total of 296 patients who had undergone different types of LESI were observed across the five studies, and the average pain and functional improvements were calculated and compared among groups. Results: Pain and function improvements with PIL approach is superior on 12 months follow up to MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A 12 months follow-up results between PIL and TF shows a near equivalent effectiveness for pain (58.9% vs. 63.2%) and function improvement (47.3% vs. 48.1%). An average follow-up of 17.1 days have shown better short-term pain relief for PIL than TF approach (45.8% vs. 19.2%), respectively. Number of repeated injections is lower for PIL injections than MIL. Number of weeks between 1st and 2nd injections: PIL averaged 15.8 weeks and MIL averaged 9.7 weeks. Third LESI injection is more common in TF group (30%) than PIL group (18.8%). Conclusion: Higher complication rates are associated with TF injections for which FDA7 issued an official warning. We have recorded better outcomes in pain and function improvement of Parasagittal-IL LESI as compared to midline-IL injection, in the presented systematic review. Parasagittal and TF injections have equivalent efficacy in Pain and Function improvements thus we advocate for Parasagittal-IL approach consideration as an alternative for TF injections.

Keywords: parasagital approach, lumbar, back pain, epidural steroid injection

Procedia PDF Downloads 155

Authors: Danielle Schneider, Ying Xie

Abstract:

Middle school science, technology, engineering, and math (STEM) teachers experience an exceptional challenge in the expectation to incorporate curricula that builds strong spatial reasoning skills on rudimentary geometry concepts. Because spatial ability is so closely tied to STEM students’ success, researchers are tasked to determine effective instructional practices that create an authentic learning environment within the immersive virtual reality learning environment (IVRLE). This study looked to investigate the effect of the IVRLE on middle school STEM students’ spatial reasoning skills as a methodology to benefit the STEM middle school students’ spatial reasoning skills. This experimental study was comprised of thirty 7th-grade STEM students divided into a treatment group that was engaged in an immersive VR platform where they engaged in building an object in the virtual realm by applying spatial processing and visualizing its dimensions and a control group that built the identical object using a desktop computer-based, computer-aided design (CAD) program. Before and after the students participated in the respective “3D modeling” environment, their spatial reasoning abilities were assessed using the Middle Grades Mathematics Project Spatial Visualization Test (MGMP-SVT). Additionally, both groups created a physical 3D model as a secondary measure to measure the effectiveness of the IVRLE. The results of a one-way ANOVA in this study identified a negative effect on those in the IVRLE. These findings suggest that with middle school students, virtual reality (VR) proved an inadequate tool to benefit spatial relation skills as compared to desktop-based CAD.

Keywords: virtual reality, spatial reasoning, CAD, middle school STEM

Procedia PDF Downloads 70

Authors: Yin-Yann Chen, Tzu-Ling Chen

Abstract:

This study presents the case of an actual Taiwanese semiconductor assembly and testing manufacturer. Three major bottleneck manufacturing processes, namely, die bond, wire bond, and molding, are analyzed to determine how to use finite resources to achieve the optimal capacity allocation. A medium-term capacity allocation planning model is developed by considering the optimal total profit to satisfy the promised volume demanded by customers and to obtain the best migration decision among production lines for machines and tools. Finally, sensitivity analysis based on the actual case is provided to explore the effect of various parameter levels.

Keywords: capacity planning, capacity allocation, machine migration, resource configuration

Procedia PDF Downloads 441

Authors: Ehsan Ahmadifar

Abstract:

In this research, the effects of different levels (control group (T0), (T1)1, (T2)2 and (T3)3 gr Inulin per Kg diet) of prebiotic Inulin as nutritional supplement on Danio rerio were investigated for 4 month. Since the beginning of feeding larvae until adult (average weight: 67.1 g, length: 4.5 cm) were fed with experimental diets. The survival rate of fish had no significant effect on rate survival (P > 0.05). The highest food conversion ratio (FCR) was in control group and the lowest was observed in T3. Treatment of T3 significantly caused the best feed conversion ratio in Zebra fish (P < 0.05). By increasing the inulin diet during the experiment, specific growth rate increased. The highest and the lowest body weight gain and condition factor were observed in T3 and control, respectively (P < 0.05). Adding 3 gr inulin in Zebra fish diet can improve the performance of the growth indices and final biomass, also this prebiotic can be considered as a suitable supplement for Cyprinidae diet. In the first sampling stage for feeding fish, fat and muscle protein was significantly higher than the second sampling stage (P < 0.05). Given that the second stage fish were full sexual maturity, the amount of fat in muscle decreased (P < 0.05). Moisture and ash levels were significantly (P < 0.05) higher in the second stage sampling than the first stage. Overall, different stage of living affected on muscle chemical composition muscle. Reproductive performance in treatment T2 and T3 were significantly higher than other treatments (P < 0.05). According to the results, the prebiotic inulin does not have a significant impact on the sex ratio in zebrafish (P > 0.05). Based on histology of the gonads, the use of dietary inulin accelerates the process of gonad development in zebrafish.

Keywords: inulin, zebrafish, reproduction, histology

Procedia PDF Downloads 295

Authors: Réka Kovács, György Téglásy, Szilvia Boros

Abstract:

Introduction: Aim of the Study: Low body fat percentage frequently occurs in aesthetic sports. Because of the unrealistic expectations, their quantity and quality of nutrition intake are inadequate. This can be linked to several health issues which appear in blood samples (iron, ferritin, creatine kinase, etc.). Our retrospective study aimed to investigate the connection between body composition (InBody 770 monitor) and blood samples test results among elite adolescent (14-18 years) and adult (19-28 years) aesthetic athletes. Methods: Data collection happened between 01.08.2022. and 15.08.2022 in National Institute for Sports Medicine, Budapest. The final group consisted of 111 athletes (n=111; adolescents: n=68, adults: n=43). We used descriptive statistics, a two-sample t-test, and correlation analysis with Microsoft Office Excel 2007 software. Our results were considered significant if p<0,05. Results: In 33,3% (37/111) we found low body fat percentage (girls and women: <12%, boys and men: <8%) and in 64% (71/111) high creatine kinase levels. Differences were found mainly in the adolescent group. We found a correlation between body weight and total cholesterol, visceral fat and triglyceride, hematocrit and iron-linking capacity, moreover body fat percentage and ferritin levels. Discussion: It is important to start education about sports nutrition at an early age. The connection between low body fat percentage, serum iron, triglyceride, and ferritin levels refers to the fact that the nutrition intake of the athletes is inadequate. High blood concentrations of creatine kinase may show a lack of proper recovery, which is essential to improve health and performance.

Keywords: body fat percentage, creatine kinase, recovery, sports nutrition

Procedia PDF Downloads 113

Authors: Dimitra Alexiou, Stefanos Katsavounis, Ria Kalfakakou

Abstract:

In an urban area the determination of transportation routes should be planned so as to minimize the provoked pollution taking into account the cost of such routes. In the sequel these routes are cited as pollution routes. The transportation network is expressed by a weighted graph G= (V, E, D, P) where every vertex represents a location to be served and E contains unordered pairs (edges) of elements in V that indicate a simple road. The distances/cost and a weight that depict the provoked air pollution by a vehicle transition at every road are assigned to each road as well. These are the items of set D and P respectively. Furthermore the investigated pollution routes must not exceed predefined corresponding values concerning the route cost and the route pollution level during the vehicle transition. In this paper we present an algorithm that generates such routes in order that the decision maker selects the most appropriate one.

Keywords: bi-criteria, pollution, shortest paths, computation

Procedia PDF Downloads 362

Authors: Malika Yaici, Soraya Aloui, Sara Semchaoui

Abstract:

Recognition of human activities from sensor data is an active research area, and the main objective is to obtain a high recognition rate. In this work, we propose a recognition system based on expert systems. The proposed system makes the recognition based on the objects, object states, and gestures, taking into account the context (the location of the objects and of the person performing the activity, the duration of the elementary actions, and the activity). This work focuses on complex activities which are decomposed into simple easy to recognize activities. The proposed method can be applied to any type of activity. The simulation results show the robustness of our system and its speed of decision.

Keywords: human activity recognition, ubiquitous computing, context-awareness, expert system

Procedia PDF Downloads 123

Authors: Sekou Kangoye, Alexis Todoskoff, Mihaela Barreau

Abstract:

Modified Condition/Decision Coverage (MC/DC) is a structural coverage criterion that is highly recommended or required for safety-critical software coverage. Therefore, many testing standards include this criterion and require it to be satisfied at a particular level of testing (e.g. validation and unit levels). However, an important amount of time is needed to meet those requirements. In this paper we propose to automate MC/DC test data generation. Thus, we present an approach to automatically generate MC/DC test data, from software module description written over a dedicated language. We introduce a new merging approach that provides high MC/DC coverage for the description, with only a little number of test cases.

Keywords: domain-specific language, MC/DC, test data generation, safety-critical software coverage

Procedia PDF Downloads 421

Authors: Hung-Chi Chang

Abstract:

For an extended EPQ model with random yield, the existent study revealed that both the disaggregating and consolidating shipment policies for the imperfect quality items are independent of holding cost, and recommended a model with economic benefit by comparing the least total cost for each of the three models investigated. To better capture the real situation, we generalize the existent study to include different holding costs for perfect and imperfect quality items. Through analysis, we show that the above shipment policies are dependent on holding costs. Furthermore, we derive a simple decision rule solely based on the thresholds of problem parameters to select a superior model. The results are illustrated analytically and numerically.

Keywords: consolidating shipments, disaggregating shipments, EPQ, imperfect quality, inventory

Procedia PDF Downloads 360

Authors: Oluwaponmile D. Alao

Abstract:

In this paper, two models have been developed to ascertain the best network needed for diagnosis of breast cancer. Breast cancer has been a disease that required the attention of the medical practitioner. Experience has shown that misdiagnose of the disease has been a major challenge in the medical field. Therefore, designing a system with adequate performance for will help in making diagnosis of the disease faster and accurate. In this paper, two models: backpropagation neural network and support vector machine has been developed. The performance obtained is also compared with other previously obtained algorithms to ascertain the best algorithms.

Keywords: breast cancer, data mining, neural network, support vector machine

Procedia PDF Downloads 327

Authors: Dhouha Laribi Galalou, Najla Allani Bouhoula, Atef Hammouda

Abstract:

This research delves into the fundamental question of the morphological restitution of built archaeology in order to place it in its paradigmatic context and to seek answers to it. Indeed, the understanding of the object of the study, its analysis, and the methodology of solving the morphological problem posed, are manageable aspects only by means of a thoughtful strategy that draws on well-defined epistemological scaffolding. In this stream, the crisis of natural reasoning in archaeology has generated multiple changes in this field, ranging from the use of new tools to the integration of an archaeological information system where urbanization involves the interplay of several disciplines. The built archaeological topic is also an architectural and morphological object. It is also a set of articulated elementary data, the understanding of which is about to be approached from a logicist point of view. Morphological restitution is no exception to the rule, and the inter-exchange between the different disciplines uses the capacity of each to frame the reflection on the incomplete elements of a given architecture or on its different phases and multiple states of existence. The logicist sequence is furnished by the set of scattered or destroyed elements found, but also by what can be called a rule base which contains the set of rules for the architectural construction of the object. The knowledge base built from the archaeological literature also provides a reference that enters into the game of searching for forms and articulations. The choice of the Roman Forum in North Africa is justified by the great urban and architectural characteristics of this entity. The research on the forum involves both a fairly large knowledge base but also provides the researcher with material to study - from a morphological and architectural point of view - starting from the scale of the city down to the architectural detail. The experimentation of the knowledge deduced on the paradigmatic level, as well as the deduction of an analysis model, is then carried out on the basis of a well-defined context which contextualises the experimentation from the elaboration of the morphological information container attached to the rule base and the knowledge base. The use of logicist analysis and artificial intelligence has allowed us to first question the aspects already known in order to measure the credibility of our system, which remains above all a decision support tool for the morphological restitution of Roman Fora in North Africa. This paper presents a first experimentation of the model elaborated during this research, a model framed by a paradigmatic discussion and thus trying to position the research in relation to the existing paradigmatic and experimental knowledge on the issue.

Keywords: classical reasoning, logicist reasoning, archaeology, architecture, roman forum, morphology, calculation

Procedia PDF Downloads 132

Authors: Swati Gautam, Salman Akhtar, S. P. Jaiswar, Amita Jain

Abstract:

Background: FGTB is now a major global health problem mostly in developing countries including India. In humans, Mycobacterium Tuberculosis (M.tb) is a causating agent of infection. High index of suspicion is required for early diagnosis due to asymptomatic presentation of FGTB disease. In macrophages Toll Like Receptor-2 (TLR-2) is one which mediated host’s immune response to M.tb. The expression of TLR-2 on macrophages is important to determine the fate of innate immune responses to M.tb. TLR-2 have two work. First its high expression on macrophages worsen the outer of infection and another side, it maintains M.tb to its dormant stage avoids activation of M.tb from latent phase. Single Nucleotide Polymorphism (SNP) of TLR-2 gene plays an important role in susceptibility to TB among different populations and subsequently, in the development of infertility. Methodology: This Case-Control study was done in the Department of Obs and Gynae and Department of Microbiology at King George’s Medical University, U.P, Lucknow, India. Total 300 subjects (150 Cases and 150 Controls) were enrolled in the study. All subjects were enrolled only after fulfilling the given inclusion and exclusion criteria. Inclusion criteria: Age 20-35 years, menstrual-irregularities, positive on Acid-Fast Bacilli (AFB), TB-PCR, (LJ/MGIT) culture in Endometrial Aspiration (EA). Exclusion criteria: Koch’s active, on ATT, PCOS, and Endometriosis fibroid women, positive on Gonococal and Chlamydia. Blood samples were collected in EDTA tubes from cases and healthy control women (HCW) and genomic DNA extraction was carried out by salting-out method. Genotyping of TLR2 genetic variants (Arg753Gln and Arg677Trp) were performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 1.2% agarose gel and visualized by gel-doc. Statistical analysis of the data was performed using the SPSS 16.3 software and computing odds ratio (OR) with 95% CI. Linkage Disequiliribium (LD) analysis was done by SNP stats online software. Results: In TLR-2 (Arg753Gln) polymorphism significant risk of FGTB observed with GG homozygous mutant genotype (OR=13, CI=0.71-237.7, p=0.05), AG heterozygous mutant genotype (OR=13.7, CI=0.76-248.06, p=0.03) however, G allele (OR=1.09, CI=0.78-1.52, p=0.67) individually was not associated with FGTB. In TLR-2 (Arg677Trp) polymorphism a significant risk of FGTB observed with TT homozygous mutant genotype (OR= 0.020, CI=0.001-0.341, p < 0.001), CT heterozygous mutant genotype (OR=0.53, CI=0.33-0.86, p=0.014) and T allele (OR=0.463, CI=0.32-0.66, p < 0.001). TT mutant genotype was only found in FGTB cases and frequency of CT heterozygous more in control group as compared to FGTB group. So, CT genotype worked as protective mutation for FGTB susceptibility group. In haplotype analysis of TLR-2 genetic variants, four possible combinations, i.e. (G-T, A-C, G-C, and A-T) were obtained. The frequency of haplotype A-C was significantly higher in FGTB cases (0.32). Control group did not show A-C haplotype and only found in FGTB cases. Conclusion: In conclusion, study showed a significant association with both genetic variants of TLR-2 of FGTB disease. Moreover, the presence of specific associated genotype/alleles suggest the possibility of disease severity and clinical approach aimed to prevent extensive damage by disease and also helpful for early detection of disease.

Keywords: ARMS, EDTA, FGTB, TLR

Procedia PDF Downloads 287

Authors: Habib Alshuwaikhat, Nahid Hossain

Abstract:

Residential sector consumes more than half of the produced electricity in Saudi Arabia, and fossil fuel is the main source of energy to meet growing household electricity demand in the Kingdom. Several studies forecasted and expressed concern that unless the domestic energy demand growth is controlled, it will reduce Saudi Arabia’s crude oil export capacity within a decade and the Kingdom is likely to be incapable of exporting crude oil within next three decades. Though the Saudi government has initiated to address the domestic energy demand growth issue, the demand side energy management policies and programs are focused on industrial and commercial sectors. It is apparent that there is an urgent need to develop a comprehensive energy efficiency strategy for addressing efficient energy use in residential sector in the Kingdom. Then again as Saudi Arabia is at its primary stage in addressing energy efficiency issues in its residential sector, there is a scope for the Kingdom to learn from global energy efficiency practices and design its own energy efficiency policies and programs. However, in order to do that sustainable, it is essential to address local contexts of energy efficiency. It is also necessary to find out the policies and programs that will fit to the local contexts. Thus the objective of this study was set to identify globally best practice energy efficiency policies and programs in residential sector that have replication potential in Saudi Arabia. In this regard two sets of multi-criteria decision analysis matrices were developed to evaluate the energy efficiency policies and programs. The first matrix was used to evaluate the global energy efficiency policies and programs, and the second matrix was used to evaluate the replication potential of global best practice energy efficiency policies and programs for Saudi Arabia. Wuppertal Institute’s guidelines for energy efficiency policy evaluation were used to develop the matrices, and the different attributes of the matrices were set through available literature review. The study reveals that the best practice energy efficiency policies and programs with good replication potential for Saudi Arabia are those which have multiple components to address energy efficiency and are diversified in their characteristics. The study also indicates the more diversified components are included in a policy and program, the more replication potential it has for the Kingdom. This finding is consistent with other studies, where it is observed that in order to be successful in energy efficiency practices, it is required to introduce multiple policy components in a cluster rather than concentrate on a single policy measure. The developed multi-criteria decision analysis matrices for energy efficiency policy and program evaluation could be utilized to assess the replication potential of other globally best practice energy efficiency policies and programs for the residential sector of the Kingdom. In addition it has potential to guide Saudi policy makers to adopt and formulate its own energy efficiency policies and programs for Saudi Arabia.

Keywords: Saudi Arabia, residential sector, energy efficiency, policy evaluation

Procedia PDF Downloads 483

Authors: Biju Lukose

Abstract:

The objective of the study was to identify the isolated and combined effect of multi-media computer assisted coaching and traditional coaching on selected motor ability component and physiological variables among sports school basketball players. Forty male basketball players aged between 14 to 18 years were selected randomly. They were divided into four groups of three experimental and one control. Isolated multi-media computer assisted coaching, isolated traditional coaching and combined coaching (multimedia computer assisted coaching and traditional coaching) are the three experimental groups. All the three experimental groups were given coaching for 24 weeks and control group were not allowed to participate in any coaching programme. The subjects were tested dependent variables such as speed and cardio vascular endurance; at the beginning (pre-test) in middle 12 week (mid-test) and after the coaching 24 week (post-test). The coaching schedule was for a period of 24 weeks. The data were collected two days before and after the coaching schedule and mid test after the 12 weeks of the coaching schedule. The data were analysed by applying ANCOVA and Scheffe’s Post hoc test. The result showed that there were significant changes in dependent variables such as speed and cardio vascular endurance. The results of the study showed that combined coaching (multimedia computer assisted coaching and traditional coaching) is more superior to traditional coaching and multimedia computer assisted coaching groups and no significant change in speed in the case of isolated multimedia computer assisted coaching group.

Keywords: computer, computer-assisted coaching, multimedia coaching, traditional coaching

Procedia PDF Downloads 437

Authors: Jabulani Gilford Kheswa, Thembelihle Lobi

Abstract:

From a cultural perspective, expression of hegemonic masculinity in South Africa continues to escalate among adolescent males who grow up in communities lacking in role models and recreational facilities. However, when the schools are constructive, and peer influence is positive, adolescent male can potentially express character strengths and lead a meaningful life. Drawing from Bronfenbrenner’s Ecological Model and Keyes and Ryff’s six dimensions of psychological well-being and mental health, such youth may exemplify positive self-esteem, problem- focused coping strategies, condom self-efficacy, good leadership skills, enhanced motivation and a positive emotional state, which buffer against risky sexual behaviors. This paper was aimed at investigating the relationships between adolescent males’ sexual behavior and psychological well-being. This study employed a quantitative research to collect data from 54 Xhosa-speaking adolescent males from one school high school in Fort Beaufort, Eastern Cape, South Africa. These learners were from grade nine, ten and eleven with their ages ranging from 14 to 20. Prior the research commenced, the school principal and caregivers of the learners who participated in the study, gave their informed consent. Self- administered closed-ended questionnaire with Section A (that is, biographical information) and Section B with each question rated on the 5–point Likert scale was used. The advantages of questionnaires include a high response rate as they require less time and offer anonymity because participants’ names are not identified. The SPSS version 18 was used for statistical data analysis. The mean age was 16.83 with a standard deviation of 1.611. 44.4% of the participants were from grade 9, 33.3% from grade 10 and 22.2% from grade 11. The Chronbach alpha of 0.79 was yielded, with respect to self- esteem of adolescent males. In this study, 76.9% reported to attend church services whilst 23% indicated not to attend church services. A further 96.2% of adolescent males indicated to have good relations with guardians while only 3.8% had poorer relations. A large proportion of adolescent males (72.9%) indicated to high-quality friendship as opposed to 27.1% who reported being receiving negative guidance from peers. Other findings revealed that 81.1% of the participants’ parents do not drink alcohol, and they cope at school as 79.6% reported protective factors as attributable towards non-engagement to risky sexual practices. As a result, 81.4% of participants reported not to participate in criminal activities although 85% of the participants indicated that in their school there are drugs. It could be speculated from this study that adolescent males whose caregivers are authoritative, find purpose in life and are most likely to be socially and academically competent. This paper leads to further research interest into mental health, coping strategies and sexual decision-making skills of the youth in South Africa.

Keywords: church, mental health, school, sexual behaviour

Procedia PDF Downloads 241

Authors: Hsiao-Lin Fang

Abstract:

The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

Procedia PDF Downloads 158

Authors: Malgorzata Sekulowicz, Krystyna Boron-Krupinska, Paulina Morga, Blazej Cieslik

Abstract:

Burnout is highly prevalent in health care employees, especially in physicians. It significantly reduces the efficiency of these employees, which can have negative consequences for both physicians and patients. Resilience and mindfulness enhancing positive emotions, leading to sustainable development and personal commitment, can have a significant impact on burnout. Therefore, the aim of this study was to determine the relationship between burnout symptoms and mindfulness and resilience among physicians. The authors conducted a cross-sectional survey study among seventy-four polish physicians. Participants filled out the following psychometric tools: the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Five Facet Mindfulness Questionnaire (FFMQ), Areas of Work-Life Survey (AWS), International Personality Item Pool (IPIP), the Resilience Assessment Scale (SPP-25) and the Mini-COPE Inventory. The relationship between burnout and resilience and mindfulness was assessed with path analysis. Analyzing the relationship between MBI-HSS components and mindfulness, a significant negative correlation of the FFMQ score with emotional exhaustion (-0.50, p < 0.05) and depersonalization (-0.43, p < 0.05) and a positive correlation with personal accomplishment (0.50, p < 0.05) was demonstrated. Analyzing resilience, a statistically significant relationship of SPP-25 with all tested components of MBI-HSS was demonstrated: emotional exhaustion (-0.54, p < 0.05), depersonalization (-0.31, p < 0.05) and personal accomplishment (0.35, p < 0.05). In the group of medical doctors, the higher the level of mindfulness and resilience, the lower the risk of burnout. Furthermore, the more frequently used active coping strategies (planning, acceptance), the lower the risk of burnout, while the use of passive, evasive strategies increases the risk of burnout. It may be worth considering implementing mindfulness intervention to effectively manage burnout symptoms in this group.

Keywords: burnout, medical doctors, mindfulness, physicians, resilience

Procedia PDF Downloads 90

Authors: Aliyu Damri

Abstract:

This study analyzed the emergence of WhatsApp and how employees at the Federal Radio Corporation of Nigeria, Kaduna defined the concept base on their vast broadcasting experiences for over five decades and application of the phenomenon to the radio station. It also analyzed the nature, patterns, dimensions, features, challenges as well as the effects of WhatsApp as a social networking site with specific interest on the radio outlet. Also, the study identified how the radio organization responded to the challenges in an attempt to adapt to the new pattern of broadcasting characterized by many technological transformations. The study further explained in details such skills journalists need to function optimally using WhatsApp as well as the impacts of the WhatsApp on radio broadcasting. It used a combination of published materials, focus group discussion, in depth interviews and participant observation on the activities of the radio stations to address the research questions. The data generated provided insight to better understand the challenges posed to FRCN Kaduna as a result of WhatsApp application and how FRCN Kaduna responded to the challenges. It also provided information on the skills journalists need to function optimally in using WhatsApp application in the radio station. The interview and focus group discussion’s transcripts and the published materials were analyzed along thematic pattern related to the research questions in the study. The dominant response relied heavily on change in the radio station’s organizational and technical integration of newsrooms, the use of a multiskilled workforce, application of a flexible and user-friendly technology in all aspects of production, expansion of the station’s services in to new media such as internet and mobile phones as well as sharing of ideas across different units in the radio outfit.

Keywords: broadcasting, challenge, northern Nigeria, radio, WhatsApp application

Procedia PDF Downloads 116

Authors: S. I. Mwasha, Z. Robinson, M. Musgrave

Abstract:

Communities, especially in the global south, have been reported to have low adaptive capacity to cope with climate change impacts. As an attempt to improve adaptive capacity, most studies have focused on understanding the access of the household resources which can contribute to resilience against changes. However, little attention has been shown in uncovering how the household resources could be used and their implications to resilience against weather related shocks. By using a case study qualitative study, this project analyzed the trends in livelihoods practices and their implication to social equity. The study was done in three different villages within Kilimanjaro region. Each in different agro ecological zone. Two focus group discussions in two agro-ecological zones were done, one for women and another one for men except in the third zone where focus group participant were combined together (due to unforeseen circumstances). In the focus group discussion, several participatory rural appraisal tools were used to understand trend in crops and animal production and the use in which it is made: climate trends, soil fertility, trees and other livelihoods resources. Data were analyzed using thematic network analysis. Using an amalgam of magnitude (to note weather comments made were positive or negative) and descriptive coding (to note the topic), six basic themes were identified under social equity: individual ownership, family ownership, love and respect, women no education, women access to education as well as women access to loans. The results implied that despite mum and dad in the family providing labor in the agro pastoral activities, there were separations on who own what, as well as individual obligations in the family. Dad owned mostly income creating crops and mum, food crops. therefore, men controlled the economy which made some of them become arrogant and spend money to meet their interests sometimes not taking care of the family. Separation in ownership was reported to contribute to conflicts in the household as well as causing controversy on the use income is spent. Men were reported to use income to promote matriarchy system. However, as women were capacitated through access to education and loans they become closer to their husband and get access to own and plan the income together for the interest of the family. Joint ownership and planning on the household resources were reported to be important if families have to better adapt to climate change. The aim of this study is not to show women empowerment and joint ownership and planning as only remedy for low adaptive capacity. There is the need to understand other practices that either directly or indirectly impacts environmental integrity, food security and economic development for household resilience against changing climate.

Keywords: adaptive capacity, climate change, resilience, women empowerment

Procedia PDF Downloads 152

Authors: Norezzine Abdelaziz, Rebouh Nazih Yacer, Kezimana Parfait, Parpura D. I., Gadzhikurbanov A., Anastasios Dranidis

Abstract:

The genetic variation of Shvicezebuvides cattle from three different farms in the Tajikistan Republic was studied using 10 microsatellite markers (SSR). The trials were laid out using a multi- locus analysis system for the analysis of cattle microsatellite locus. An estimated genetic variability of the examined livestock is given in the article. The results of our SSR analysis as well as the numbers and frequencies of common alleles in studied samples, we established a high genetic similarity of studied samples. These results can also be furthermore useful in the decision making for preservation and rational genetic resources usage of the Tajik Shvicezebuvides cattle.

Keywords: genetic characteristic, frequencies of the occurrence alleles, microsatellite markers, Swiss cattle

Procedia PDF Downloads 287

Authors: Lola T. Alimkhodjaeva, Lola T. Zakirova, Soniya S. Ziyavidenova

Abstract:

Background: Breast cancer occupies the first place among the cancer in women in the world. It is urgent today to study the role of molecular markers which are capable of predicting the dynamics and outcome of the disease. The aim of this study is to define the prognostic value of the content of estrogen receptor (ER), progesterone receptor (PgR), and amplification of HER-2 / neu oncoprotein by studying 3 and 5-year overall and relapse-free survival in 470 patients with primary operable and 280 patients with locally–advanced breast cancer. Materials and methods: Study results of 3 and 5-year overall and relapse-free survival, depending on the content of RE, PgR in primary operable patients showed that ER positive (+) and PgR (+) survival was 100 (96.2%) and 97.3 (94.6%), for ER negative (-) and PgR (-) - 69.2 (60.3%) and 65.4 (57.7%), for ER positive (+) and negative PgR (-) 87.4 (80.1%) and 81.5 (79.3%), for ER negative (-) and positive PgR (+) - 97.4 (93.4%) and 90.4 (88.5%), respectively. Survival results depended also on the level of HER-2 / neu expression. In patients with HER-2 / neu negative the survival rates were as follows: 98.6 (94.7%) and 96.2 (92.3%). In group of patients with the level of HER-2 / neu (2+) expression these figures were: 45.3 (44.3%) and 45.1 (40.2%), and in group of patients with the level of HER-2 / neu (3+) expression - 41.2 (33.1%) and 34.3 (29.4%). The combination of ER negative (-), PgR (-), HER-2 / neu (-) they were 27.2 (25.4%) and 19.5 (15.3%), respectively. In patients with locally-advanced breast cancer the results of 3 and 5-year OS and RFS for ER (+) and PgR (+) were 76.3 (69.3%) and 62.2 (61.4%), for ER (-) and RP (-) 29.1 (23.7%) and 18.3 (12.6%), for ER (+) and PgR (-) 61.2 (47.2%) and 39.4 (25.6%), for ER (-) and PgR (+) 54.3 (43.1%) and 41.3 (18.3%), respectively. The level of HER-2 / neu expression also affected the survival results. Therefore, in HER-2/ neu negative patients the survival rate was 74.1 (67.6%) and 65.1 (57.3%), with the level of expression (2+) 20.4 (14.2%) and 8.6 (6.4%), with the level of expression (3+) 6.2 (3.1%) and 1.2 (1.5%), respectively. The combination for ER, PgR, HER-2 / neu negative was 22.1 (14.3%) and 8.4 (1.2%). Conclusion: Thus, the presence of steroid hormone receptors in breast tumor tissues at primary operable and locally- advanced process as the lack of HER-2/neu oncoprotein correlates with the highest rates of 3- and 5-year overall and relapse-free survival. The absence of steroid hormone receptors as well as of HER-2/neu overexpression in malignant breast tissues significantly degrades the 3- and 5-year overall and relapse-free survival. Tumors with ER, PgR and HER-2/neu negative have the most unfavorable prognostics.

Keywords: breast cancer, estrogen receptor, oncoprotein, progesterone receptor

Procedia PDF Downloads 168

Authors: Tom Ryan

Abstract:

This paper investigates the rural mobility and accessibility challenges of a specific target group - Seniors. The target group is those over 66 years of age who are entitled to use the Public Transport (PT) Free Travel Scheme in rural Ireland. The paper explores at a high level some of the projected rural PT challenges and requirements over the next 10-15 years, noting that statistical predictions show that there will be a significant population demographic shift within the Senior's age profile. Using the PESTEL framework, the literature review explored existing research concerning mobility, accessibility challenges, and the opportunities Seniors face. Twenty-seven qualitative in-depth interviews with stakeholders within the ecosystem were undertaken. The stakeholders included: rural PT customers, Local-Link managers, NTA senior management, a Minister of State, and a European parliament policymaker. Tier 1 interviewee feedback spotlights that the PT network system does not exist for rural patients to access hospital facilities. There was no evidence from the Tier 2 research findings to show that health policymakers and transport planners are working to deliver a national solution to support patients getting access to hospital appointments. Several research interviewees discussed the theme of isolation and the perceived stigma of senior males utilising PT. The findings indicated that MaaS is potentially revolutionary in the PT arena. Finally, this paper suggests several short-, medium- and long-term recommendations based on the research findings. These recommendations are a potential springboard to ensure that rural PT is suitable for future Irish generations.

Keywords: accessibility, active ageing, car dependence, isolation, seniors health issues, behavioural changes, environmental challenges, internet of things, demand responsive, mobility as a service

Procedia PDF Downloads 96

Authors: Amrit Gupta, Suchi Rani, Vineeta Agarwal, Swast Tiwari, Anup Kumar, Sachin Sharma

Abstract:

Pregnancy is a unique state in which a balance of immune tolerance and suppression is necessary to protect the fetus without compromising the mother’s health. Human papilloma virus (HPV) is viral infection which mainly gets transmitted through sexual contact. The HPV infection can cause infections in the placenta and increase the inflammatory response in the mother, affecting pregnancy outcomes. This may result in adverse maternal and neonatal outcomes. The objectives of this research are to evaluate the effect on clinical course in pregnancy and maternal outcome in pregnant women with HPV infection and to evaluate the effect on neonatal health in terms of adverse clinical effects. Methodology: The prospective cohort study was done in a tertiary care institution over two years. In this study, 250 participants were recruited. The study included pregnant women who attended the antenatal clinic for routine check-ups. Written informed consent was obtained from each participant. Participants were asked to fill out a detailed questionnaire about their lifestyle, including demographic characteristics, sexual behaviors, past gynecological history, and medical and surgical history. HPV was the preliminary screening method, and a Pap smear was done in patients who came out to be HPV positive. Samples were collected with the cotton stick or HC2 sampler brush. Cyto-brush was rotated 3–5 times in the region of ecto-cervix. After the collection of the sample, it was dissolved in PBS buffer and stored at − 80° for HPV DNA analysis. HPV DNA was detected using a hybrid capture assay (marketed as Digene HC2 high-risk HPV DNA test; Cat. No./ID: 5199–1220). The cohort was divided into two study groups: 1) those who were HPV positive and 2) those who were HPV negative. The chi-square test is used to compare categorical variables across groups. AQ5 Unpaired t-tests and independent sample tests are used to test the statistical significance of intergroup mean differences. P-values are considered significant if they are less than 0.05. In MS Windows, SPSS20 (IBM Corporation; NY, USA) was used for statistical analysis of all data. Results: Out of 228 pregnant women, 27.63% (n=63) of pregnant women were found positive for the HPV DNA test. In comparing the HPV-positive (N=63) and HPV-negative (N=165) groups using chi-square tests, several demographic variables exhibited statistically significant differences. Habitat distribution shows a significant difference (p<0.001), with 28.6% of HPV-positive individuals residing in rural areas compared to 8.5% of HPV-negative individuals. The presence of morbidity besides HPV infection differed significantly (p<0.001), with HPV-positive participants more likely to have additional morbidities (54%) compared to HPV-negative participants (32.1%). The mode of delivery showed significant differences (p<0.05), particularly in emergency lower segment cesarean section (HPV+: 41.3%, HPV-: 23.6%). Gestational age at delivery was significantly lower in the HPV-positive group (median 37.28 weeks, IQR 36.43-37.85) compared to the HPV-negative group (median 37.71 weeks, IQR 37.14-38.42), with a P-value of 0.003. Finally, birth weight was significantly lower in the HPV-positive group (median 2.75 kg, IQR 2.5-2.9425) compared to the HPV-negative group (median 2.9 kg, IQR 2.67-3.25) with a P-value of 0.001. Conclusion: In summary, our study offers valuable insights into the relationship between HPV infection during pregnancy, basic demographic factors and maternal and neonatal health outcomes.

Keywords: human papilloma virus, maternal health, fetal outcome, pregnancy

Procedia PDF Downloads 8