Search results for: mobile health monitoring
7542 Leveraging Artificial Intelligence to Analyze the Interplay between Social Vulnerability Index and Mobility Dynamics in Pandemics
Authors: Joshua Harrell, Gideon Osei Bonsu, Susan Garza, Clarence Conner, Da’Neisha Harris, Emma Bukoswki, Zohreh Safari
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The Social Vulnerability Index (SVI) stands as a pivotal tool for gauging community resilience amidst diverse stressors, including pandemics like COVID-19. This paper synthesizes recent research and underscores the significance of SVI in elucidating the differential impacts of crises on communities. Drawing on studies by Fox et al. (2023) and Mah et al. (2023), we delve into the application of SVI alongside emerging data sources to uncover nuanced insights into community vulnerability. Specifically, we explore the utilization of SVI in conjunction with mobility data from platforms like SafeGraph to probe the intricate relationship between social vulnerability and mobility dynamics during the COVID-19 pandemic. By leveraging 16 community variables derived from the American Community Survey, including socioeconomic status and demographic characteristics, SVI offers actionable intelligence for guiding targeted interventions and resource allocation. Building upon recent advancements, this paper contributes to the discourse on harnessing AI techniques to mitigate health disparities and fortify public health resilience in the face of pandemics and other crises.Keywords: social vulnerability index, mobility dynamics, data analytics, health equity, pandemic preparedness, targeted interventions, data integration
Procedia PDF Downloads 587541 Depression in Non Hospitalized Jordanian Patients with Coronary Artery Disease
Authors: Ibtisam Al-Zaru
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Background: Worldwide, depression among coronary artery disease (CAD) patients is considered a serious problem that may cause many complications and negative consequences; particularly serious being increased mortality and morbidity rate. Studying depression among CAD patients in Jordan has not been investigated thoroughly and thus a need for further studies has been a priority. Aims: To assess depression in non-hospitalized Jordanian patients with CAD; to describe the relationship between socio-demographic data, health related factors, and depression; and to examine the best predictors of depression in non-hospitalized Jordanian patients with CAD. Method: A cross-sectional-descriptive design was used to collect data from 174 non-hospitalized Jordanian patients diagnosed with CAD in outpatients’ cardiac clinics, using a self- administered questionnaires and Cardiac Depression Scale. Results: 53.4% of CAD patients reported mild/moderate, and severe depressive symptoms. Significant relationships between depressive symptoms and some demo-clinical characteristics (i.e. being female gender; having of chronic disease and surgical history; being physically inactive, and perceived their sexual activity, physical and psychological as poor). The preceding factors are also found to be statistically significant predictors for depression among this patients’ group. Conclusion: Jordanian patients with CAD had various levels of severity regarding their depressive symptoms. Therefore, health care providers need to introduce depression assessment and treatment in cardiac rehabilitation to control depression and its impact on the patient. Consequently, such control will reduce co-morbidity, mortality, complications and health costs among CAD patients and enhance the quality of their lives.Keywords: coronary artery disease, predictors, depression, prevalence
Procedia PDF Downloads 2677540 Epidemiological Survey of Feline Leukemia Virus in Domestic Cats on Tsushima Island, Japan: Tsushima Leopard Cats Are at Risk
Authors: Isaac Makundi, Kazuo Nishigaki
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The Tsushima leopard cat (TLC) Prionailurus bengalensis euptilurus, designated a National Natural Monument of Japan, inhabits Tsushima Island, Nagasaki Prefecture, Japan. TLC is considered a subspecies of P. bengalensis, and lives only on Tsushima Island. TLCs are threatened by various infectious diseases. Feline leukemia virus (FeLV) causes a serious infectious disease with a poor prognosis in cats. Therefore, the transmission of FeLV from Tsushima domestic cats (TDCs) to TLCs may threaten the TLC population. We investigated the FeLV infection status of both TDCs and TLCs on Tsushima Island by screening blood samples for FeLV p27 antigen and using PCR to amplify the full-length FeLV env gene. The prevalence of FeLV was 6.4% in TDCs and 0% in TLCs. We also demonstrated that the virus can replicate in the cells of TLCs, suggesting its potential cross-species transmission. The viruses in TDCs were classified as genotype I/clade 3, which is prevalent on a nearby island, based on previous studies of FeLV genotypes and FeLV epidemiology. The FeLV viruses identified on Tsushima Island can be further divided into two lineages within genotype I/clade 3, which are geographically separated in Kamijima and Shimojima, indicating that FeLV may have been transmitted to Tsushima Island at least twice. Monitoring FeLV infection in the TDC and TLC populations is highly recommended as part of the TLC surveillance and management strategy.Keywords: epidemiology, Feline leukemia virus, Tsushima Island, wildlife management
Procedia PDF Downloads 2037539 E-Governance: A Key for Improved Public Service Delivery
Authors: Ayesha Akbar
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Public service delivery has witnessed a significant improvement with the integration of information communication technology (ICT). It not only improves management structure with advanced technology for surveillance of service delivery but also provides evidence for informed decisions and policy. Pakistan’s public sector organizations have not been able to produce some good results to ensure service delivery. Notwithstanding, some of the public sector organizations in Pakistan has diffused modern technology and proved their credence by providing better service delivery standards. These good indicators provide sound basis to integrate technology in public sector organizations and shift of policy towards evidence based policy making. Rescue-1122 is a public sector organization which provides emergency services and proved to be a successful model for the provision of service delivery to save human lives and to ensure human development in Pakistan. The information about the organization has been received by employing qualitative research methodology. The information is broadly based on primary and secondary sources which includes Rescue-1122 website, official reports of organizations; UNDP (United Nation Development Program), WHO (World Health Organization) and by conducting 10 in-depth interviews with the high administrative staff of organizations who work in the Lahore offices. The information received has been incorporated with the study for the better understanding of the organization and their management procedures. Rescue-1122 represents a successful model in delivering the services in an efficient way to deal with the disaster management. The management of Rescue has strategized the policies and procedures in such a way to develop a comprehensive model with the integration of technology. This model provides efficient service delivery as well as maintains the standards of the organization. The service delivery model of rescue-1122 works on two fronts; front-office interface and the back-office interface. Back-office defines the procedures of operations and assures the compliance of the staff whereas, front-office equipped with the latest technology and good infrastructure handles the emergency calls. Both ends are integrated with satellite based vehicle tracking, wireless system, fleet monitoring system and IP camera which monitors every move of the staff to provide better services and to pinpoint the distortions in the services. The standard time of reaching to the emergency spot is 7 minutes, and during entertaining the case; driver‘s behavior, traffic volume and the technical assistance being provided to the emergency case is being monitored by front-office. Then the whole information get uploaded to the main dashboard of Lahore headquarter from the provincial offices. The latest technology is being materialized by Rescue-1122 for delivering the efficient services, investigating the flaws; if found, and to develop data to make informed decision making. The other public sector organizations of Pakistan can also develop such models to integrate technology for improving service delivery and to develop evidence for informed decisions and policy making.Keywords: data, e-governance, evidence, policy
Procedia PDF Downloads 2377538 Preparing Undergraduate Nursing and Midwifery Students for Culturally Competent Health Care: A Qualitative Study
Authors: Olayide Ogunsiji, Glenda McDonald
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Engendering cultural competence in nursing and midwifery students is germane to reducing disparities in contemporary health care settings, increasingly patronized by people from diverse background. Professional standards for registration in Australia require nurses and midwives to be culturally competent. Nursing and midwifery academics worldwide are responsible for preparing students for clinical practice, yet limited attention is paid to exploring how students are being prepared to care for a culturally diverse population. This paper provides insight into the perceptions of academics about how they are preparing undergraduate nursing and midwifery students for culturally competent health care. Academics were drawn from a tertiary educational institution in metropolitan Australia. They responded to a generic email indicating their interest in participating in the study. A total of nine academics who have taught undergraduate nursing and midwifery students in a unit that focused on health and illness perspectives for culturally diverse communities; and provided written consent to participate were included. These academics were engaged in a qualitative digitally-recorded semi-structured face-to-face or telephone interviews which lasted for about 45-60 minutes. Interview data were transcribed verbatim. Through constant comparison, three themes emerged: experiences of the teachers, strategies used for preparing students and challenges in preparing students. The participants spoke about their experiences of teaching in the unit and with the students. They faced challenges related to physical and relational space. They utilised a number of didactic approaches in teaching the unit and critiqued the adequacy of the content in preparing students for practice. This study demonstrated that didactic classroom approaches need to be supported with clinical practice and cultural immersion for a meaningful preparation of nursing and midwifery students to care for culturally diverse populations.Keywords: cultural competence, nursing students, preparation, undergraduate
Procedia PDF Downloads 1477537 Identifying Knowledge Gaps in Incorporating Toxicity of Particulate Matter Constituents for Developing Regulatory Limits on Particulate Matter
Authors: Ananya Das, Arun Kumar, Gazala Habib, Vivekanandan Perumal
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Regulatory bodies has proposed limits on Particulate Matter (PM) concentration in air; however, it does not explicitly indicate the incorporation of effects of toxicities of constituents of PM in developing regulatory limits. This study aimed to provide a structured approach to incorporate toxic effects of components in developing regulatory limits on PM. A four-step human health risk assessment framework consists of - (1) hazard identification (parameters: PM and its constituents and their associated toxic effects on health), (2) exposure assessment (parameters: concentrations of PM and constituents, information on size and shape of PM; fate and transport of PM and constituents in respiratory system), (3) dose-response assessment (parameters: reference dose or target toxicity dose of PM and its constituents), and (4) risk estimation (metric: hazard quotient and/or lifetime incremental risk of cancer as applicable). Then parameters required at every step were obtained from literature. Using this information, an attempt has been made to determine limits on PM using component-specific information. An example calculation was conducted for exposures of PM2.5 and its metal constituents from Indian ambient environment to determine limit on PM values. Identified data gaps were: (1) concentrations of PM and its constituents and their relationship with sampling regions, (2) relationship of toxicity of PM with its components.Keywords: air, component-specific toxicity, human health risks, particulate matter
Procedia PDF Downloads 3047536 Developing Telehealth-Focused Advanced Practice Nurse Educational Partnerships
Authors: Shelley Y. Hawkins
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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth
Procedia PDF Downloads 2367535 The Impact of Access to Microcredit Programme on Women Empowerment: A Case Study of Cowries Microfinance Bank in Lagos State, Nigeria
Authors: Adijat Olubukola Olateju
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Women empowerment is an essential developmental tool in every economy especially in less developed countries; as it helps to enhance women's socio-economic well-being. Some empirical evidence has shown that microcredit has been an effective tool in enhancing women empowerment, especially in developing countries. This paper therefore, investigates the impact of microcredit programme on women empowerment in Lagos State, Nigeria. The study used Cowries Microfinance Bank (CMB) as a case study bank, and a total of 359 women entrepreneurs were selected by simple random sampling technique from the list of Cowries Microfinance Bank. Selection bias which could arise from non-random selection of participants or non-random placement of programme, was adjusted for by dividing the data into participant women entrepreneurs and non-participant women entrepreneurs. The data were analyzed with a Propensity Score Matching (PSM) technique. The result of the Average Treatment Effect on the Treated (ATT) obtained from the PSM indicates that the credit programme has a significant effect on the empowerment of women in the study area. It is therefore, recommended that microfinance banks should be encouraged to give loan to women and for more impact of the loan to be felt by the beneficiaries the loan programme should be complemented with other programmes such as training, grant, and periodic monitoring of programme should be encouraged.Keywords: empowerment, microcredit, socio-economic wellbeing, development
Procedia PDF Downloads 2977534 Augmented Reality for Maintenance Operator for Problem Inspections
Authors: Chong-Yang Qiao, Teeravarunyou Sakol
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Current production-oriented factories need maintenance operators to work in shifts monitoring and inspecting complex systems and different equipment in the situation of mechanical breakdown. Augmented reality (AR) is an emerging technology that embeds data into the environment for situation awareness to help maintenance operators make decisions and solve problems. An application was designed to identify the problem of steam generators and inspection centrifugal pumps. The objective of this research was to find the best medium of AR and type of problem solving strategies among analogy, focal object method and mean-ends analysis. Two scenarios of inspecting leakage were temperature and vibration. Two experiments were used in usability evaluation and future innovation, which included decision-making process and problem-solving strategy. This study found that maintenance operators prefer build-in magnifier to zoom the components (55.6%), 3D exploded view to track the problem parts (50%), and line chart to find the alter data or information (61.1%). There is a significant difference in the use of analogy (44.4%), focal objects (38.9%) and mean-ends strategy (16.7%). The marked differences between maintainers and operators are of the application of a problem solving strategy. However, future work should explore multimedia information retrieval which supports maintenance operators for decision-making.Keywords: augmented reality, situation awareness, decision-making, problem-solving
Procedia PDF Downloads 2277533 Rabies Free Pakistan - Eliminating Rabies Through One Health Approach
Authors: Anzal Abbas Jaffari, Wajiha Javed, Naseem Salahuddin
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Rationale: Rabies, a vaccine preventable disease, continues to be a critical public health issue as it kills around 2000-5000 people annually in Pakistan. Along with the disease spread among animals, the dog population remains a victim of brutal culling practices by the local authorities, which adversely affects ecosystem (sinking of poison in the soil – affecting vegetation & contaminating water) and the disease spread. The dog population has been exponentially rising primarily because a lack of a consolidated nationwide Animal Birth Control program and awareness among the local communities in general and children in particular. This is reflected in Pakistan’s low SARE score - 1.5, which makes the country trails behind other developing countries like Bangladesh (2.5) and Philippines (3.5).According to an estimate, the province of Sindh alone is home to almost 2.5 million dogs. The clustering of dogs in Peri-Urban areas and inner cities localities leads to an increase of reported dog bite cases in these areas specifically. Objective: Rabies Free Pakistan (RFP), which is a joint venture of Getz Pharma Private Limited and Indus Hospital & Health Network (IHHN); it was established in 2018 to eliminate Rabies from Pakistan by 2030 using the One Health Approach. Methodology: The RFP team is actively working on advocacy and policy front with both the Federal & Provincial government to ensure that all stakeholders currently involved in dog culling in Pakistan have a paradigm shift towards humane methods of vaccination and ABC. Along with the federal government, RFP aims to declare Rabies as a notifiable disease. Whereas RFP closely works with the provincial government of Sindh to initiate a province wide Rabies Control Program.RFP program follows international standards and WHO approved protocols for this program in Pakistan.RFP team has achieved various milestones in the fight against Rabies after successfully scaling up project operations and has vaccinated more than 30,000 dogs and neutered around 7,000 dogs since 2018. Recommendations: Effective implementation of Rabies program (MDV and ABC) requires a concentrated effort to address a variety of structural and policy challenges. This essentially demands a massive shift in the attitude of individuals towards rabies. The two most significant challenges in implementing a standard policy at the structural level are lack of institutional capacity, shortage of vaccine, and absence of inter-departmental coordination among major stakeholders: federal government, provincial ministry of health, livestock, and local bodies (including local councils). The lack of capacity in health care workers to treat dog bite cases emerges as a critical challenge at the clinical level. Conclusion: Pakistan can learn from the successful international models of Sri Lanka and Mexico as they adopted the One Health Approach to eliminate rabies like RFP. The WHO advised One Health approach provides the policymakers with an interactive and cross-sectoral guide, which involves all the essential elements of the eco system (including animals, humans, and other components).Keywords: animal birth control, dog population, mass dog vaccination, one health, rabies elimination
Procedia PDF Downloads 1737532 Leveraging Advanced Technologies and Data to Eliminate Abandoned, Lost, or Otherwise Discarded Fishing Gear and Derelict Fishing Gear
Authors: Grant Bifolchi
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As global environmental problems continue to have highly adverse effects, finding long-term, sustainable solutions to combat ecological distress are of growing paramount concern. Ghost Gear—also known as abandoned, lost or otherwise discarded fishing gear (ALDFG) and derelict fishing gear (DFG)—represents one of the greatest threats to the world’s oceans, posing a significant hazard to human health, livelihoods, and global food security. In fact, according to the UN Food and Agriculture Organization (FAO), abandoned, lost and discarded fishing gear represents approximately 10% of marine debris by volume. Around the world, many governments, governmental and non-profit organizations are doing their best to manage the reporting and retrieval of nets, lines, ropes, traps, floats and more from their respective bodies of water. However, these organizations’ ability to effectively manage files and documents about the environmental problem further complicates matters. In Ghost Gear monitoring and management, organizations face additional complexities. Whether it’s data ingest, industry regulations and standards, garnering actionable insights into the location, security, and management of data, or the application of enforcement due to disparate data—all of these factors are placing massive strains on organizations struggling to save the planet from the dangers of Ghost Gear. In this 90-minute educational session, globally recognized Ghost Gear technology expert Grant Bifolchi CET, BBA, Bcom, will provide real-world insight into how governments currently manage Ghost Gear and the technology that can accelerate success in combatting ALDFG and DFG. In this session, attendees will learn how to: • Identify specific technologies to solve the ingest and management of Ghost Gear data categories, including type, geo-location, size, ownership, regional assignment, collection and disposal. • Provide enhanced access to authorities, fisheries, independent fishing vessels, individuals, etc., while securely controlling confidential and privileged data to globally recognized standards. • Create and maintain processing accuracy to effectively track ALDFG/DFG reporting progress—including acknowledging receipt of the report and sharing it with all pertinent stakeholders to ensure approvals are secured. • Enable and utilize Business Intelligence (BI) and Analytics to store and analyze data to optimize organizational performance, maintain anytime-visibility of report status, user accountability, scheduling, management, and foster governmental transparency. • Maintain Compliance Reporting through highly defined, detailed and automated reports—enabling all stakeholders to share critical insights with internal colleagues, regulatory agencies, and national and international partners.Keywords: ghost gear, ALDFG, DFG, abandoned, lost or otherwise discarded fishing gear, data, technology
Procedia PDF Downloads 887531 Lessons Learned from Implementation of Remote Pregnant and Newborn Care Service for Vulnerable Women and Children During COVID-19 and Political Crisis in Myanmar
Authors: Wint Wint Thu, Htet Ko Ko Win, Myat Mon San, Zaw Lin Tun, Nandar Than Aye, Khin Nyein Myat, Hayman Nyo Oo, Nay Aung Lin, Kusum Thapa, Kyaw Htet Aung
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Background: In Myanmar, the intense political instability happened to start in Feb-2021, while the COVID-19 pandemic waves are also threatening the public health system, which subsequently led to severe health sector crisis, including difficulties in accessing maternal and newborn health care for vulnerable women and children. The Remote Pregnant and Newborn Care (RPNC) uses a telehealth approach United States Agency for International Development (USAID)-funded Essential Health Project. Implementation: The Remote Pregnant and Newborn Care (RPNC) service has adapted to the MNCH needs of vulnerable pregnant women and was implemented to mitigate the risk of limited access to essential quality MNH care in Yangon, Myanmar, under women, and the project trained 13 service providers on a telehealth care package for pregnancy and newborn developed Jhpiego to ensure understanding of evidence-based MNCH care practices. The phone numbers of the pregnant women were gathered through the preexisting and functioning community volunteers, who reach the most vulnerable pregnant women in the project's targeted area. A total of 212 pregnant women have been reached by service providers for RPNC during the implementation period. The trained service providers offer quality antenatal and postnatal care, including newborn care, via telephone calls. It includes 24/7 incoming calls and time-allotted outgoing calls to the pregnant women during antenatal and postnatal periods, including the newborn care. The required data were collected daily in time with the calls, and the quality of the medical services is made assured with the track of the calls, ensuring data privacy and patient confidentiality. Lessons learned: The key lessons are 1) cost-effectiveness: RPNC service could reduce out of pocket expenditure of pregnant women as it only costs 1.6 United States dollars (USD) per one telehealth call while it costs 8 to 10 USD per one time in-person care service at private service providers, including transportation cost, 2) network of care: telehealth call could not replace the in-person antenatal and postnatal care services, and integration of telehealth calls with in-person care by local healthcare providers with the support of the community is crucial for accessibility to essential MNH services by poor and vulnerable women, and 3) sharing information on health access points: most of the women seem to have financial barriers in accessing private health facilities while public health system collapse and telehealthcare could provide information on low-cost facilities and connect women to relevant health facilities. These key lessons are important for future efforts regarding the implementation of remote pregnancy and newborn care in Myanmar, especially during the political crisis and COVID-19 pandemic situation.Keywords: telehealth, accessibility, maternal care, newborn care
Procedia PDF Downloads 917530 3D Dentofacial Surgery Full Planning Procedures
Authors: Oliveira M., Gonçalves L., Francisco I., Caramelo F., Vale F., Sanz D., Domingues M., Lopes M., Moreia D., Lopes T., Santos T., Cardoso H.
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The ARTHUR project consists of a platform that allows the virtual performance of maxillofacial surgeries, offering, in a photorealistic concept, the possibility for the patient to have an idea of the surgical changes before they are performed on their face. For this, the system brings together several image formats, dicoms and objs that, after loading, will generate the bone volume, soft tissues and hard tissues. The system also incorporates the patient's stereophotogrammetry, in addition to their data and clinical history. After loading and inserting data, the clinician can virtually perform the surgical operation and present the final result to the patient, generating a new facial surface that contemplates the changes made in the bone and tissues of the maxillary area. This tool acts in different situations that require facial reconstruction, however this project focuses specifically on two types of use cases: bone congenital disfigurement and acquired disfiguration such as oral cancer with bone attainment. Being developed a cloud based solution, with mobile support, the tool aims to reduce the decision time window of patient. Because the current simulations are not realistic or, if realistic, need time due to the need of building plaster models, patient rates on decision, rely on a long time window (1,2 months), because they don’t identify themselves with the presented surgical outcome. On the other hand, this planning was performed time based on average estimated values of the position of the maxilla and mandible. The team was based on averages of the facial measurements of the population, without specifying racial variability, so the proposed solution was not adjusted to the real individual physiognomic needs.Keywords: 3D computing, image processing, image registry, image reconstruction
Procedia PDF Downloads 1987529 Optimism, Skepticism, and Uncertainty: A Qualitative Study on the Knowledge and Perceived Impact of the Affordable Care Act among Adult Patients Seeking Care in a Free Clinic
Authors: Mike Wei, Mario Cedillo, Jiahui Lin, Carol Lorraine Storey-Johnson, Carla Boutin-Foster
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Purpose: The extent to which health insurance enrollment succeeds under the Affordable Care Act (ACA) rests heavily on the ability to reach the uninsured and motivate them to enroll. We sought to identify perceptions about the ACA among uninsured patients at a free clinic in New York City. Background: The ACA holds tremendous promise for reducing the number of uninsured Americans. As of April 2014, nearly 8 million people had signed up for health insurance through the Health Insurance Marketplace. Despite this early success, future and continued enrollment rests heavily on the degree of public awareness. Reaching eligible individuals and increasing their awareness and understanding remains a fundamental challenge to realizing the full potential of the ACA. Reaching out to uninsured patients who are seeking care through safety net facilities such as free clinics may provide important avenues for reaching potential enrollees. This project focuses on the experience at the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic (WCCC), and seeks to understand perceptions about the ACA among its patient population. Methods: This was a cross-sectional study of all patients who visited the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic, from July 2013 to May 2014. Patients who provided informed consent at their visit and completed a semi-structured questionnaire were included (N=62). The questionnaire comprised of questions about demographic characteristics and open-ended questions about their knowledge and perception of the impact of the ACA. Descriptive statistics were used to characterize the population demographics. Qualitative coding techniques were used for open-ended items. Results: Approximately one third of patients surveyed never had health insurance. Of the remaining 65%, 20% lost their insurance within the past year. Only 55% had heard about the ACA, and only 10% knew about the Health Benefits Exchange. Of those who had heard about the ACA, sentiments were tinged with optimistic misperceptions, such as “it will be free health care for all.” While optimistic, most of the responses focused on the economic implications of the ACA. Conclusions: These findings reveal the immense amount of misconception and lack of understanding with regards to the ACA. As such, the study highlights the need to educate and address the concerns of those who remain skeptical or uncertain about the implications of the ACA.Keywords: Affordable Care Act, demographics, free clinics, underserved.
Procedia PDF Downloads 3827528 Relationship between Functionality and Cognitive Impairment in Older Adult Women from the Southeast of Mexico
Authors: Estrella C. Damaris, Ingrid A. Olais, Gloria P. Uicab
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This study explores the relationship between the level of functionality and cognitive impairment in older adult women from the south-east of Mexico. It is a descriptive, cross-sectional study; performed with 172 participants in total who attended a health institute and live in Merida, Yucatan Mexico. After a non-probabilistic sampling, Barthel and Pfeiffer scales were applied. The results show statistically significant correlation between the cognitive impairment (Pfeiffer) and the levels of independence and function (Barthel) (r =0.489; p =0.001). Both determine a dependence level so they need either a little or a lot of help. Society needs that the older woman be healthy and that the professionals of mental health develop activities to prevent and rehabilitate because cognitive impairment and function are directly related with the quality of life.Keywords: functionality, cognition, routine activities, cognitive impairment
Procedia PDF Downloads 2857527 The Effect of Critical Audit Matters on Financial Information Quality: The Role of Audit Committee Expertise
Authors: Khawla Hlel
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Purpose: This study aims to examine whether critical audit matters (CAM) affect financial information quality. We also investigate the moderating role of the audit committee on the association between CAM and financial information quality. Design/Methodology/Approach: The analysis is based on GLS and GMM regressions explaining the absolute value of discretionary accruals by using 52 Tunisian listed firms on the Tunisia Stock Exchange (TSE) for the period 2017-2020. Findings: We find evidence that managers react to the CAM by increasing the quality of financial disclosures. This study provides insights into how a change in the auditor’s report model might impact the quality of financial information. It suggests that external auditors and audit committees serve as a beneficial mechanism for enhancing financial information quality by reducing information asymmetry. In addition, our results indicate that CAM is an efficient monitoring mechanism that increases financial reporting quality and supervises managers. Originality: This study is important for potential investors who should assess CAM when evaluating firms. Furthermore, the authors expect the findings to be interesting to firms, as this study highlights the effectiveness of the auditor in reducing managerial opportunistic behavior and improving information quality. The results could encourage audit regulators to ameliorate the standards, as this research reinforces the role of the auditor in increasing the quality of financial disclosure by offering the required information for shareholders.Keywords: critical audit matters, audit committee, information quality, Tunisian firms
Procedia PDF Downloads 827526 Electronic Government around the World: Key Information and Communication Technology Indicators
Authors: Isaac Kofi Mensah
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Governments around the world are adopting Information and Communication Technologies (ICTs) because of the important opportunities it provides through E-government (EG) to modernize government public administration processes and delivery of quality and efficient public services. Almost every country in the world is adopting ICT in its public sector administration (EG) to modernize and change the traditional process of government, increase citizen engagement and participation in governance, as well as the provision of timely information to citizens. This paper, therefore, seeks to present the adoption, development and implementation of EG in regions globally, as well as the ICT indicators around the world, which are making EG initiatives successful. Europe leads the world in its EG adoption and development index, followed by the Americas, Asia, Oceania and Africa. There is a gradual growth in ICT indicators in terms of the increase in Internet access and usage, increase in broadband penetration, an increase of individuals using the Internet at home and a decline in fixed telephone use, while the mobile cellular phone has been on the increase year-on-year. Though the lack of ICT infrastructure is a major challenge to EG adoption and implementation around the world, in Africa it is very pervasive, hampering the expansion of Internet access and provision of broadband, and hence is a barrier to the successful adoption, development, and implementation of EG initiatives in countries on the continent. But with the general improvement and increase in ICT indicators around the world, it provides countries in Europe, Americas, Asia, Arab States, Oceania and Africa with the huge opportunity to enhance public service delivery through the adoption of EG. Countries within these regions cannot fail their citizens who desire to enjoy an enhanced and efficient public service delivery from government and its many state institutions.Keywords: e-government development index, e-government, indicators, information and communication technologies (ICTs)
Procedia PDF Downloads 2967525 Indoor Microclimate in a Historic Library: Considerations on the Positive Effect of Historic Books on the Stability of Indoor Relative Humidity
Authors: Magda Posani, Maria Do Rosario Veiga, Vasco Peixoto De Freitas
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The presented research considers the hygrothermal data acquired in the municipal library of Porto. The library is housed in an XVIII century convent and, among all the rooms in the construction, one, in particular, was chosen for the monitoring campaign because of the presence of a great number of historic books. Temperature and relative humidity, as well as CO₂ concentration, were measured for six consecutive months, in the period December 24th - June 24th. The indoor environment of the building is controlled with a heating and cooling system that is turned on only during the opening hours of the library. The ventilation rate is low because the windows are kept closed, and there is no forced ventilation. The micro-climate is analyzed in terms of users’ comfort and degradation risks for historic books and valuable building surfaces. Through a comparison between indoor and outdoor measured hygrothermal data, indoor relative humidity appears very stable. The influence of the hygroscopicity of books on the stabilization of indoor relative humidity is therefore investigated in detail. The paper finally discusses the benefits given by the presence of historic books in libraries with intermittent heating and cooling. The possibility of obtaining a comfortable and stable indoor climate with low use of HVAC systems in these conditions, while avoiding degradation risks for books and historic building components, is further debated.Keywords: books, historic buildings, hygroscopicity, relative humidity
Procedia PDF Downloads 1447524 Novel Method of In-Situ Tracking of Mechanical Changes in Composite Electrodes during Charging-Discharging by QCM-D
Authors: M. D. Levi, Netanel Shpigel, Sergey Sigalov, Gregory Salitra, Leonid Daikhin, Doron Aurbach
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We have developed an in-situ method for tracking ions adsorption into composite nanoporous carbon electrodes based on quartz-crystal microbalance (QCM). In these first papers QCM was used as a simple gravimetric probe of compositional changes in carbon porous composite electrodes during their charging since variation of the electrode potential did not change significantly width of the resonance. In contrast, when we passed from nanoporous carbons to a composite Li-ion battery material such as LiFePO4 olivine, the change in the resonance width was comparable with change of the resonance frequency (polymeric binder PVdF was shown to be completely rigid when used in aqueous solutions). We have provided a quantitative hydrodynamic admittance model of ion-insertion processes into electrode host accompanied by intercalation-induced dimensional changes of electrode particles, and hence the entire electrode coating. The change in electrode deformation and the related porosity modify hydrodynamic solid-liquid interactions tracked by QCM with dissipation monitoring. Using admittance modeling, we are able to evaluate the changes of effective thickness and permeability/porosity of composite electrode caused by applied potential and as a function of cycle number. This unique non-destructive technique may have great advantage in early diagnostics of cycling life durability of batteries and supercapacitors.Keywords: Li-ion batteries, particles deformations, QCM-D, viscoelasticity
Procedia PDF Downloads 4347523 Creativity and Intelligence: Psychoeducational Connections
Authors: Cristina Costa-Lobo, Carla B. Vestena, Filomena E. Ponte
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Creativity and intelligence are concepts that have aroused very expressive interest in the field of educational sciences and the field of psychological science since the middle of the last century since they have a great impact on the potential and well-being of individuals. However, due to progress in cognitive and positive psychology, there has been a growing interest in the psychoeducational domain of intelligence and creativity in the last decade. In this theoretical work, are analyzed comparatively the theoretical models that relate the intelligence and the creativity, are analyzed several psychoeducational intervention programs that have been implemented with a view to the promotion of creativity and signal possibilities, realities and ironies around the psychological evaluation of intelligence and creativity. In order to reach a broad perspective on creativity, the evidence is presented that points the need to evaluate different psychological domains. The psychoeducational intervention programs addressed have, with a common characteristic, the full stimulation of the creative potential of the participants, assumed as a highly valued capacity at the present time. The results point to the systematize that all interventions in the ambit of creativity have two guiding principles: all individuals can be creative, and creativity is a capacity that can be stimulated. This work refers to the importance of stimulus creativity in educational contexts, to the usefulness and pertinence of the creation, the implementation, and monitoring of flexible curricula, adapted to the educational needs of students, promoting a collaborative work among teachers, parents, students, psychologists, managers and educational administrators.Keywords: creativity, intelligence, psychoeducational intervention programs, psychological evaluation, educational contexts
Procedia PDF Downloads 3987522 Software-Defined Networking: A New Approach to Fifth Generation Networks: Security Issues and Challenges Ahead
Authors: Behrooz Daneshmand
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Software Defined Networking (SDN) is designed to meet the future needs of 5G mobile networks. The SDN architecture offers a new solution that involves separating the control plane from the data plane, which is usually paired together. Network functions traditionally performed on specific hardware can now be abstracted and virtualized on any device, and a centralized software-based administration approach is based on a central controller, facilitating the development of modern applications and services. These plan standards clear the way for a more adaptable, speedier, and more energetic network beneath computer program control compared with a conventional network. We accept SDN gives modern inquire about openings to security, and it can significantly affect network security research in numerous diverse ways. Subsequently, the SDN architecture engages systems to effectively screen activity and analyze threats to facilitate security approach modification and security benefit insertion. The segregation of the data planes and control and, be that as it may, opens security challenges, such as man-in-the-middle attacks (MIMA), denial of service (DoS) attacks, and immersion attacks. In this paper, we analyze security threats to each layer of SDN - application layer - southbound interfaces/northbound interfaces - controller layer and data layer. From a security point of see, the components that make up the SDN architecture have a few vulnerabilities, which may be abused by aggressors to perform noxious activities and hence influence the network and its administrations. Software-defined network assaults are shockingly a reality these days. In a nutshell, this paper highlights architectural weaknesses and develops attack vectors at each layer, which leads to conclusions about further progress in identifying the consequences of attacks and proposing mitigation strategies.Keywords: software-defined networking, security, SDN, 5G/IMT-2020
Procedia PDF Downloads 907521 An Experimental Study of the External Thermal Insulation System’s (ETICS) Efficiency in Buildings during Spring Conditions
Authors: Carmen Viñas Arrebola, Antonio Rodriguez Sanchez, Sheila Varela Lujan, Mariano Gonzalez Cortina, Cesar Porras Amores
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The research group TEMA from the School of Building (UPM) is working in the line of energy efficiency and comfort in building. The need to reduce energy consumption in the building construction implies designing new constructive systems. These systems help to reduce both consumption and energy losses in order to achieve adequate thermal comfort for people in any type of building. In existing buildings the best option is the rehabilitation focused on thermal insulation. The aim of this paper is to design, monitor and analyze the first results of thermal behavior of the ETICS system in façades. This retrofitting solution consists of adding thermal insulation on the outside of the building, helping to create a continuous envelope on the façades. The analysis is done by comparing a rehabilitated part of the building with ETICS system and another part which has not been rehabilitated, and it is taken as reference. Both of them have the same characteristics. Temperature measurements were taken with type K thermocouples according to the previous design of the monitoring and in the same period of time. The pilot building of the study is situated in Benimamet Street, in San Cristobal de Los Ángeles, in the south of Madrid. It was built in the late 50s. The 51st entrance hall, which is restored, and the 47th entrance hall, in original conditions, have been studied.Keywords: comfort in building, energy efficiency in building, ETICS, thermal properties
Procedia PDF Downloads 3087520 Collective Problem Solving: Tackling Obstacles and Unlocking Opportunities for Young People Not in Education, Employment, or Training
Authors: Kalimah Ibrahiim, Israa Elmousa
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This study employed the world café method alongside semi-structured interviews within a 'conversation café' setting to engage stakeholders from the public health and primary care sectors. The objective was to collaboratively explore strategies to improve outcomes for young people not in education, employment, or training (NEET). The discussions were aimed at identifying the underlying causes of disparities faced by NEET individuals, exchanging experiences, and formulating community-driven solutions to bolster preventive efforts and shape policy initiatives. A thematic analysis of the qualitative data gathered emphasized the importance of community problem-solving through the exchange of ideas and reflective discussions. Healthcare professionals reflected on their potential roles, pinpointing a significant gap in understanding the specific needs of the NEET population and the unclear distribution of responsibilities among stakeholders. The results underscore the necessity for a unified approach in primary care and the fostering of multi-agency collaborations that focus on addressing social determinants of health. Such strategies are critical not only for the immediate improvement of health outcomes for NEET individuals but also for informing broader policy decisions that can have long-term benefits. Further research is ongoing, delving deeper into the unique challenges faced by this demographic and striving to develop more effective interventions. The study advocates for continued efforts to integrate insights from various sectors to create a more holistic and effective response to the needs of the NEET population, ensuring that future strategies are informed by a comprehensive understanding of their circumstances and challenges.Keywords: multi-agency working, primary care, public health, social inequalities
Procedia PDF Downloads 217519 Expression of Metallothionein Gen and Protein on Hepatopancreas, Gill and Muscle of Perna viridis Caused by Biotoxicity Hg, Pb and Cd
Authors: Yulia Irnidayanti , J. J. Josua, A. Sugianto
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Jakarta Bay with 13 rivers that flow into, the environment has deteriorated and is the most polluted bays in Asia. The entry of waste into the waters of the Bay of Jakarta has caused pollution. Heavy metal contamination has led to pollution levels and may cause toxicity to organisms that live in the sea, down to the cellular level and may affect the ecological balance. Various ways have been conducted to measure the impact of environmental degradation, such as by measuring the levels of contaminants in the environment, including measuring the accumulation of toxic compounds in the tissues of organisms. Biological responses or biomarkers known as a sensitive indicator but need relevant predictions. In heavy metal pollution monitoring, analysis of aquatic biota is very important from the analysis of the water itself. The content of metals in aquatic biota will usually always be increased from time to time due to the nature of metal bioaccumulation, so the aquatic biota is best used as an indicator of metal pollution in aquatic environments. The results of the content analysis results of sea water in coastal estuaries Angke, Kaliadem and Panimbang detected heavy metals cadmium, mercury, lead, but did not find zinc metal. Based on the results of protein electrophoresis methallotionein found heavy metals in the tissues hepatopancreas, gills and muscles, and also the mRNA expression of has detected.Keywords: gills, heavy metal, hepatopancreas, metallothionein, muscle
Procedia PDF Downloads 3837518 Contribution to the Study of the Use of Pesticides in the Regions of Tizi Ouzou
Authors: Ramdane Gaouir
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Farmers in the two regions of Tizi-Ouzou, DBK and Tadmait, face different crop pests, namely, fungal diseases, insect attack as well as different types of deficiencies. To fight against all these threats, they resort to the use of a wide variety of chemicals. Our survey carried out in these two regions, aims to identify the different types of pesticides used, the method of management of the packaging generated by these phytosanitary products as well as the evaluation of the effect of these products on the farmers' health and the environment. The results obtained highlighted the use of two types of pesticides with a very wide application, namely fungicides and insecticides. The two most widely identified chemical families are neonicotoids and organophosphates, which are among the most toxic and persistent pesticides in the environment. The management method of packaging and the application of products by spraying reflect the lack of training and the unawareness of farmers vis-à-vis the impact of pesticides on their health and on the environment.Keywords: farmers, crops, pesticides, fungicides, neonicotinoids, organochlorines
Procedia PDF Downloads 857517 Phenotypic and Genotypic Diagnosis of Gaucher Disease in Algeria
Authors: S. Hallal, Z. Chami, A. Hadji-Lehtihet, S. Sokhal-Boudella, A. Berhoune, L. Yargui
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Gaucher disease is the most common lysosomal storage in our population, it is due to a deficiency of β –glucosidase acid. The enzyme deficiency causes a pathological accumulation of undegraded substrate in lysosomes. This metabolic overload is responsible for a multisystemic disease with hepatosplenomegaly, anemia, thrombocytopenia, and bone involvement. Neurological involvement is rare. The laboratory diagnosis of Gaucher disease consists of phenotypic diagnosis by determining the enzymatic activity of β - glucosidase by fluorimetric method, a study by genotypic diagnosis in the GBA gene, limiting the search recurrent mutations (N370S, L444P, 84 GG); PCR followed by an enzymatic digestion. Abnormal profiles were verified by sequencing. Monitoring of treated patients is provided by the determination of chitotriosidase. Our experience spaning a period of 6 years (2007-2014) has enabled us to diagnose 78 patients out of a total of 328 requests from the various departments of pediatrics, internal medicine, neurology. Genotypic diagnosis focused on the entire family of 9 children treated at pediatric CHU Mustapha, which help define the clinical form; or 5 of them had type III disease, carrying the L444P mutation in the homozygous state. Three others were composite (N370/L444P) (N370S/other unintended mutation in our study), and only in one family no recurrent mutation has been found. This molecular study permits screening of heterozygous essential for genetic counseling.Keywords: Gaucher disease, mutations, N370S, L444P
Procedia PDF Downloads 4007516 Trace Metals in Natural Bottled Water on Montenegrin Market and Comaparison with Tap Water in Podgorica
Authors: Katarina Živković, Ivana Joksimović
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Many different chemicals may occur in drinking water and cause significant human health risks after prolonged periods of exposure. In particular concern are contaminants that have cumulative toxic properties, such as heavy metals. This investigation was done to clarify concerns about chemical quality and safety of drinking tap water in Podgorica. For comparison, all available natural bottled water on Montenegrin market were bought. All samples (bottled water and tap water from Podgorica) were analyzed using ICP –OES on contents of Al, Cd, Pb, Cu, Zn,Cr, Fe, As and Mn. All results compared with the maximum concentration levels allowed by international standards and World Health Organization (WHO) guidelines. The results of analysis showed that all trace of heavy metals were very low and in same time below MCL according to WHO and International standard.Keywords: inductively coupled plasma - optical emission spectrometry (ICP-OES), Montenegro (Podgorica), natural bottled water, tap water , trace of heavy metal
Procedia PDF Downloads 4467515 Modelling Hydrological Time Series Using Wakeby Distribution
Authors: Ilaria Lucrezia Amerise
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The statistical modelling of precipitation data for a given portion of territory is fundamental for the monitoring of climatic conditions and for Hydrogeological Management Plans (HMP). This modelling is rendered particularly complex by the changes taking place in the frequency and intensity of precipitation, presumably to be attributed to the global climate change. This paper applies the Wakeby distribution (with 5 parameters) as a theoretical reference model. The number and the quality of the parameters indicate that this distribution may be the appropriate choice for the interpolations of the hydrological variables and, moreover, the Wakeby is particularly suitable for describing phenomena producing heavy tails. The proposed estimation methods for determining the value of the Wakeby parameters are the same as those used for density functions with heavy tails. The commonly used procedure is the classic method of moments weighed with probabilities (probability weighted moments, PWM) although this has often shown difficulty of convergence, or rather, convergence to a configuration of inappropriate parameters. In this paper, we analyze the problem of the likelihood estimation of a random variable expressed through its quantile function. The method of maximum likelihood, in this case, is more demanding than in the situations of more usual estimation. The reasons for this lie, in the sampling and asymptotic properties of the estimators of maximum likelihood which improve the estimates obtained with indications of their variability and, therefore, their accuracy and reliability. These features are highly appreciated in contexts where poor decisions, attributable to an inefficient or incomplete information base, can cause serious damages.Keywords: generalized extreme values, likelihood estimation, precipitation data, Wakeby distribution
Procedia PDF Downloads 1337514 Impact of Short-Term Drought on Vegetation Health Condition in the Kingdom of Saudi Arabia Using Space Data
Authors: E. Ghoneim, C. Narron, I. Iqbal, I. Hassan, E. Hammam
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The scarcity of water is becoming a more prominent threat, especially in areas that are already arid in nature. Although the Kingdom of Saudi Arabia (KSA) is an arid country, its southwestern region offers a high variety of botanical landscapes, many of which are wooded forests, while the eastern and northern regions offer large areas of groundwater irrigated farmlands. At present, some parts of KSA, including forests and farmlands, have witnessed protracted and severe drought due to change in rainfall pattern as a result of global climate change. Such prolonged drought that last for several consecutive years is expected to cause deterioration of forested and pastured lands as well as cause crop failure in the KSA (e.g., wheat yield). An analysis to determine vegetation drought vulnerability and severity during the growing season (September-April) over a fourteen year period (2000-2014) in KSA was conducted using MODIS Terra imagery. The Vegetation Condition Index (VCI), derived from the Normalized Difference Vegetation Index (NDVI), and the Temperature Condition Index (TCI), derived from the Land Surface Temperature (LST) data was extracted from MODIS Terra Images. The VCI and TCI were then combined to compute the Vegetation Health Index (VHI). The VHI revealed the overall vegetation health for the area under investigation. A preliminary outcome of the modeled VHI over KSA, using averaged monthly vegetation data over a 14-year period, revealed that the vegetation health condition is deteriorating over time in both naturally vegetated areas and irrigated farmlands. The derived drought map for KSA indicates that both extreme and severe drought occurrences have considerably increased over the same study period. Moreover, based on the cumulative average of drought frequency in each governorate of KSA it was determined that Makkah and Jizan governorates to the east and southwest, witness the most frequency of extreme drought, whereas Tabuk to the northwest, exhibits the less extreme drought frequency. Areas where drought is extreme or severe would most likely have negative influences on agriculture, ecosystems, tourism, and even human welfare. With the drought risk map the kingdom could make informed land management decisions including were to continue with agricultural endeavors and protect forested areas and even where to develop new settlements.Keywords: drought, vegetation health condition, TCI, Saudi Arabia
Procedia PDF Downloads 3787513 Assessment of the Physico-Chemical Parameters and Heavy Metal Concentration in Water and Callinectes amnicola (Swimming Crab) in a Crude Oil Exposed Community (Bodo Creek), Rivers State, Nigeria
Authors: Ehiedu Philomina Kika, Jessica Chinonso Ehilegbu
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The exploration and production of fossil fuel particularly crude oil has led to some serious environmental damage in some oil producing communities like the Bodo Community who rely heavily on their aquatic environment for food and water. This study was therefore carried out to investigate the level of some heavy metals in water and Callinectes amnicola (Swimming Crab) in the month of August, September and October from Bodo creek, Rivers State, Nigeria. The physico-chemical parameters of the water were also analyzed in-situ. The levels of heavy metals, Lead (Pb), Cadmium (Cd), Chromium (Cr), Zinc (Zn), Copper (Cu) were analyzed in water and in Callinectes amnicola (Swimming Crab), using Atomic Absorption Spectrophotometer (AAS) after acid digestion. For the concentration of heavy metals in water, Pb ranged from 0.103 - 0.791 mg/l, Zn 0.0025 - 0.342 mg/l, Cr < 0.001 - 0.304 mg/l, Cd 0.011 - 0.116 mg/l and Cu <0.001 - 0.079 mg/l. For the concentration of heavy metals in Callinectes amnicola (Swimming Crab), the level of Pb ranged from 0.359 - 0.849 mg/l, Zn 0.134 - 0.342 mg/l, Cd 0.053 - 0.103 mg/l, Cr < 0.001 - <0.001 mg/l, Cu < 0.001 - 0.131 mg/l. The concentrations of Pb, Cd and Cr for all water and crab samples collected from the various stations were higher than permissible level suggesting serious anthropogenic influence. Thus, precaution needs to be taken to prevent further contamination and adequate purification measures need to be put in place. Therefore, there should be periodic environmental pollution monitoring, for assessment and awareness especially with regards heavy metal.Keywords: Bodo creek, crude oil, heavy metal, swimming crab
Procedia PDF Downloads 156