Search results for: American Diabetic Association
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3414

Search results for: American Diabetic Association

2934 Diet and Exercise Intervention and Bio–Atherogenic Markers for Obesity Classes of Black South Africans with Type 2 Diabetes Mellitus Using Discriminant Analysis

Authors: Oladele V. Adeniyi, B. Longo-Mbenza, Daniel T. Goon

Abstract:

Background: Lipids are often low or in the normal ranges and controversial in the atherogenesis among Black Africans. The effect of the severity of obesity on some traditional and novel cardiovascular disease risk factors is unclear before and after a diet and exercise maintenance programme among obese black South Africans with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to identify the risk factors to discriminate obesity classes among patients with T2DM before and after a diet and exercise programme. Methods: This interventional cohort of Black South Africans with T2DM was followed by a very – low calorie diet and exercise programme in Mthatha, between August and November 2013. Gender, age, and the levels of body mass index (BMI), blood pressure, monthly income, daily frequency of meals, blood random plasma glucose (RPG), serum creatinine, total cholesterol (TC), triglycerides (TG), LDL –C, HDL – C, Non-HDL, ratios of TC/HDL, TG/HDL, and LDL/HDL were recorded. Univariate analysis (ANOVA) and multivariate discriminant analysis were performed to separate obesity classes: normal weight (BMI = 18.5 – 24.9 kg/m2), overweight (BMI = 25 – 29.9 kg/m2), obesity Class 1 (BMI = 30 – 34.9 kg/m2), obesity Class 2 (BMI = 35 – 39.9 kg/m2), and obesity Class 3 (BMI ≥ 40 kg/m2). Results: At the baseline (1st Month September), all 327 patients were overweight/obese: 19.6% overweight, 42.8% obese class 1, 22.3% obese class 2, and 15.3% obese class 3. In discriminant analysis, only systolic blood pressure (SBP with positive association) and LDL/HDL ratio (negative association) significantly separated increasing obesity classes. At the post – evaluation (3rd Month November), out of all 327 patients, 19.9%, 19.3%, 37.6%, 15%, and 8.3% had normal weight, overweight, obesity class 1, obesity class 2, and obesity class 3, respectively. There was a significant negative association between serum creatinine and increase in BMI. In discriminant analysis, only age (positive association), SBP (U – shaped relationship), monthly income (inverted U – shaped association), daily frequency of meals (positive association), and LDL/HDL ratio (positive association) classified significantly increasing obesity classes. Conclusion: There is an epidemic of diabesity (Obesity + T2DM) in this Black South Africans with some weight loss. Further studies are needed to understand positive or negative linear correlations and paradoxical curvilinear correlations between these markers and increase in BMI among black South African T2DM patients.

Keywords: atherogenic dyslipidaemia, dietary interventions, obesity, south africans

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2933 The Involvement of Viruses and Fungi in the Pathogenesis of Dental Infections

Authors: Wael Khalil, Elias Rahal, Ghassan Matar

Abstract:

Tooth related infections or commonly named dental infections have been described as the most common causes of tooth loss in adults. These pathologies were mostly periodontitis, pericoronitis, and periapical infection. The involvement of various bacteria in the pathogenesis of these pathologies has been thoroughly mentioned and approved in the literature. However, the variability in the severity and prognosis of these lesions among patients suggests the association of other pathogens, like viruses and fungi, in the pathogenesis of these lesions. Several studies in the literature investigated the association of multiple viruses and fungi with the above-mentioned lesions, yet, a vast controversy was reached concerning this subject.Aim: Our study aims to fill the gap in the literature concerning the contribution of adenovirus, HPV-16, EBV, fungi, and candida in the pathogenesis of periodontitis, pericoronitis, and periapical infection. For this purpose, we utilized the quantitative PCR for pathogen detection in saliva, gingival, and lesions samples of involved subjects. Results: Some of these pathogens appeared to have an association with the investigated dental pathologies, while others showed no contribution to the pathogenesis of these lesions. Further investigation is required in order to identify the subtype of the involved pathogens in these tooth related oral pathology.

Keywords: periodontitis, pericoronitis, dental abscess, PCR, microbiology

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2932 Spatiotemporal Community Detection and Analysis of Associations among Overlapping Communities

Authors: JooYoung Lee, Rasheed Hussain

Abstract:

Understanding the relationships among communities of users is the key to blueprint the evolution of human society. Majority of people are equipped with GPS devices, such as smart phones and smart cars, which can trace their whereabouts. In this paper, we discover communities of device users based on real locations in a given time frame. We, then, study the associations of discovered communities, referred to as temporal communities, and generate temporal and probabilistic association rules. The rules describe how strong communities are associated. By studying the generated rules, we can automatically extract underlying hierarchies of communities and permanent communities such as work places.

Keywords: association rules, community detection, evolution of communities, spatiotemporal

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2931 Applying the Quad Model to Estimate the Implicit Self-Esteem of Patients with Depressive Disorders: Comparing the Psychometric Properties with the Implicit Association Test Effect

Authors: Yi-Tung Lin

Abstract:

Researchers commonly assess implicit self-esteem with the Implicit Association Test (IAT). The IAT’s measure, often referred to as the IAT effect, indicates the strengths of automatic preferences for the self relative to others, which is often considered an index of implicit self-esteem. However, based on the Dual-process theory, the IAT does not rely entirely on the automatic process; it is also influenced by a controlled process. The present study, therefore, analyzed the IAT data with the Quad model, separating four processes on the IAT performance: the likelihood that automatic association is activated by the stimulus in the trial (AC); that a correct response is discriminated in the trial (D); that the automatic bias is overcome in favor of a deliberate response (OB); and that when the association is not activated, and the individual fails to discriminate a correct answer, there is a guessing or response bias drives the response (G). The AC and G processes are automatic, while the D and OB processes are controlled. The AC parameter is considered as the strength of the association activated by the stimulus, which reflects what implicit measures of social cognition aim to assess. The stronger the automatic association between self and positive valence, the more likely it will be activated by a relevant stimulus. Therefore, the AC parameter was used as the index of implicit self-esteem in the present study. Meanwhile, the relationship between implicit self-esteem and depression is not fully investigated. In the cognitive theory of depression, it is assumed that the negative self-schema is crucial in depression. Based on this point of view, implicit self-esteem would be negatively associated with depression. However, the results among empirical studies are inconsistent. The aims of the present study were to examine the psychometric properties of the AC (i.e., test-retest reliability and its correlations with explicit self-esteem and depression) and compare it with that of the IAT effect. The present study had 105 patients with depressive disorders completing the Rosenberg Self-Esteem Scale, Beck Depression Inventory-II and the IAT on the pretest. After at least 3 weeks, the participants completed the second IAT. The data were analyzed by the latent-trait multinomial processing tree model (latent-trait MPT) with the TreeBUGS package in R. The result showed that the latent-trait MPT had a satisfactory model fit. The effect size of test-retest reliability of the AC and the IAT effect were medium (r = .43, p < .0001) and small (r = .29, p < .01) respectively. Only the AC showed a significant correlation with explicit self-esteem (r = .19, p < .05). Neither of the two indexes was correlated with depression. Collectively, the AC parameter was a satisfactory index of implicit self-esteem compared with the IAT effect. Also, the present study supported the results that implicit self-esteem was not correlated with depression.

Keywords: cognitive modeling, implicit association test, implicit self-esteem, quad model

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2930 TNF-α, TNF-β and IL-10 Gene Polymorphism and Association with Oral Lichen Planus Risk in Saudi Patients

Authors: Maha Ali Al-Mohaya, Lubna Majed Al-Otaibi, Ebtissam Nassir Al-Bakr, Abdulrahman Al-Asmari

Abstract:

Objectives: Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease. Cytokines play an important role in the pathogenesis and disease progression of OLP. The purpose of this study was to investigate the association of tumor necrosis factor (TNF)-α, TNF-β and interleukin (IL)-10 gene polymorphisms with the OLP risk. Material and Methods: Forty-two unrelated patients with OLP and 211 healthy volunteers were genotyped for TNF-α (-308 G/A), TNF-β (+252A/G), IL-10 (-1082G/A), IL-10 (-819C/T), and IL-10 (-592C/A) polymorphisms. Results: The frequencies of allele A and genotype GA of TNF-α (-308G/A) were significantly higher while allele G and GG genotypes were lower in OLP patients as compared to the controls (P < 0.001). The frequency of GA genotype of TNF-β (+252A/G) was significantly higher in patients than in controls while the AA genotype was completely absent in OLP patients. These results indicated that allele A and genotype GA of TNF-α (-308G/A) as well as the GA genotype of TNF-β (+252A/G) polymorphisms are associated with OLP risk. The frequencies of alleles and genotypes of -1082G/A, -819C/T and -592C/A polymorphisms in IL-10 gene did not differ significantly between OLP patients and controls (P > 0.05). However, haplotype ATA extracted from 1082G/A, -819C/T, -592C/A polymorphisms of IL-10 were more prevalent in OLP patients when compared to controls indicating its possible association with OLP susceptibility. Conclusion: It is concluded that TNF-α (-308G/A), TNF-β (+252A/G) and IL-10 (-1082G/A, -819C/T and -592C/A) polymorphisms are associated with the susceptibility of OLP, thus giving additional support for the genetic basis of this disease. Further studies are required using a larger sample size to confirm this association and determine the prognostic values of these findings.

Keywords: oral lichen planus, cytokines, polymorphism, genetic

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2929 Considering Climate Change in Food Security: A Sociological Study Investigating the Modern Agricultural Practices and Food Security in Bangladesh

Authors: Hosen Tilat Mahal, Monir Hossain

Abstract:

Despite being a food-sufficient country after revolutionary changes in agricultural inputs, Bangladesh still has food insecurity and undernutrition. This study examines the association between agricultural practices (as social practices) and food security concentrating on the potential impact of sociodemographic factors and climate change. Using data from the 2012 Bangladesh Integrated Household Survey (BIHS), this study shows how modifiedagricultural practices are strongly associated with climate change and different sociodemographic factors (land ownership, religion, gender, education, and occupation) subsequently affect the status of food security in Bangladesh. We used linear and logistic regression models to analyze the association between modified agricultural practices and food security. The findings indicate that socioeconomic statuses are significant predictors of determining agricultural practices in a society like Bangladesh and control food security at the household level. Moreover, climate change is adversely impactingeven the modified agricultural and food security association version. We conclude that agricultural practices must consider climate change while boosting food security. Therefore, future research should integrate climate change into the agriculture and food-related mitigation and resiliency models.

Keywords: food security, agricultural productivity, climate change, bangladesh

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2928 A Cultural Materialistic Approach to Toni Morrison’s Beloved and the Bluest Eye

Authors: Irfan Mehmood

Abstract:

The goal of this paper is to examine Toni Morrison's novels Beloved and The Bluest Eye from a cultural materialistic perspective. The history and society of African Americans provide the inspiration for the stories of Beloved and The Bluest Eye. The cultural materialist elements and characteristics of Morrison's literary text will be highlighted in this study. The topic covered in this paper will include racism, gender discrimination, social class differences, and slavery in the text. In other words, the study will focus on the underrepresented groups in society, including women, slaves, and Afro-Americans. In this aspect, Toni Morrison is a fantastic writer whose works are full of diverse races. Morrison uses her incredibly well-informed language and well-produced stories to attempt to illuminate many facets of American life. She establishes a distinctive style of writing that sharply contrasts the suffering and enslavement of Afro-Americans with the traditional writings of Euro-American authors. Morrison shows a profound understanding of the exploitation of Afro-Americans in terms of race, gender, and class conflict in Beloved and The Bluest Eye. A unique culture and the history of a typically ignored set of people whose minds and societies have been permanently changed by class, racial, and gender discrimination were introduced through the study of Morrison's chosen novels. Toni Morrison places a lot of emphasis on the marginalized members of society, particularly in terms of class, ethnicity, and gender, because the majority of the key characters in her book are black. Therefore, the purpose of this essay is to concentrate on the culturally materialistic elements of Morrison's Beloved and The Bluest Eye and to ascertain the author's position on these minorities.

Keywords: race, slavery, social class, Toni Morrison, African American culture

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2927 A Multidisciplinary Team Approach for Limb Salvage in a Rare Case of Pyoderma Gangrenosum in a Significant Circumferential Lower Extremity Wound Complicated by Diabetes and End-stage Renal Disease

Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

Abstract:

Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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2926 Impact of Physiotherapy on COVID-19 and Post COVID-19 Patients, (Expert Physiotherapy and American Hospital, Case Study)

Authors: Jonida Hasanaj

Abstract:

Abstract: Four years after the pandemic, numerous studies discuss the long-term effects of COVID-19 on patients, with chronic fatigue syndrome being a prominent concern. Understanding the mechanisms behind this syndrome is crucial for developing prevention, treatment, and rehabilitation strategies. The appropriateness of physiotherapeutic treatment in covid 19 and post-COVID-19 patients has remained uncertain due to inconsistent diagnostic criteria, highlighting the need for further research. This paper intends to offer guidelines and specific suggestions for hospital-based physical therapists managing COVID-19 hospitalized patients at ‘’Expert Physiotherapy’ and ’American Hospital’ in Albania using a national approach in accordance with worldwide initiatives. Several studies indicate that chronic tiredness syndrome and high intracranial pressure could result from failure of the post-Covid-19 lymphatic system. Enabling the patient to intensify their physical activity and enhance their ability to move, exercise, and even resume a regular life cycle is the aim of physiotherapy treatment.

Keywords: mobility, physiotherapy, post-covid 19, rehabilitation, results

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2925 Hydrogeochemical Assessment of Groundwater in Selected Part of Benue State Southern, Nigeria

Authors: Moses Oghenenyoreme Eyankware, Christian Ogubuchi Ede

Abstract:

Groundwater is the principal source for various uses in this study area. The quality and availability of groundwater depend on rock formation within the study area. To effectively study the quality of groundwater, 24 groundwater samples were collected. The study was aimed at investigating the hydrogeochemistry of groundwater, and additionally its suitability for drinking and irrigation purposes. The following parameters were analyzed using the American Public Health Association standard method: pH, turbidity, Ec, TDS, Mg2+, SO42-, NO3¯, Cl-, HCO3¯, K+, Na2+ and Ca2+. Results obtained from Water Quality Index revealed that the groundwater sample fell within good water quality that implies that groundwater is considered fit for drinking purposes. Deduced results obtained from irrigation indices revealed that Permeability Index (PI), Soluble Sodium Percentage (SSP), Sodium Percentage (Na %), Sodium Absorption Ratio (SAR), Kelly Ratio (KR), Magnesium Hazard (MH) ranges from 0.00 to 0.01, 4.04 to 412.9, 0.63 to 257.7, 0.15 to 2.34, 0.09 to 2.57 and 6.84 to 84.55 respectively. Findings from Total hardness revealed that groundwater fell within soft, moderately hard and hard categories. Estimated results obtained from CSMR, RI and LSI showed that groundwater showed corrosion tendency, salinization influenced groundwater at certain sampling points and chloride and sulfate unlikely to interfere with natural formation film.

Keywords: water, quality, suitability, anthropogenic, Nigeria

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2924 Anthropometric Indices of Obesity and Coronary Artery Atherosclerosis: An Autopsy Study in South Indian population

Authors: Francis Nanda Prakash Monteiro, Shyna Quadras, Tanush Shetty

Abstract:

The association between human physique and morbidity and mortality resulting from coronary artery disease has been studied extensively over several decades. Multiple studies have also been done on the correlation between grade of atherosclerosis, coronary artery diseases and anthropometrical measurements. However, the number of autopsy-based studies drastically reduces this number. It has been suggested that while in living subjects, it would be expensive, difficult, and even harmful to subject them to imaging modalities like CT scans and procedures involving contrast media to study mild atherosclerosis, no such harm is encountered in study of autopsy cases. This autopsy-based study was aimed to correlate the anthropometric measurements and indices of obesity, such as waist circumference (WC), hip circumference (HC), body mass index (BMI) and waist hip ratio (WHR) with the degree of atherosclerosis in the right coronary artery (RCA), main branch of the left coronary artery (LCA) and the left anterior descending artery (LADA) in 95 South Indian origin victims of both the genders between the age of 18 years and 75 years. The grading of atherosclerosis was done according to criteria suggested by the American Heart Association. The study also analysed the correlation of the anthropometric measurements and indices of obesity with the number of coronaries affected with atherosclerosis in an individual. All the anthropometric measurements and the derived indices were found to be significantly correlated to each other in both the genders except for the age, which is found to have a significant correlation only with the WHR. In both the genders severe degree of atherosclerosis was commonly observed in LADA, followed by LCA and RCA. Grade of atherosclerosis in RCA is significantly related to the WHR in males. Grade of atherosclerosis in LCA and LADA is significantly related to the WHR in females. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in males. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in females. Anthropometric measurements/indices of obesity can be an effective means to identify high risk cases of atherosclerosis at an early stage that can be effective in reducing the associated cardiac morbidity and mortality. A person with anthropometric measurements suggestive of mild atherosclerosis can be advised to modify his lifestyle, along with decreasing his exposure to the other risk factors. Those with measurements suggestive of higher degree of atherosclerosis can be subjected to confirmatory procedures to start effective treatment.

Keywords: atherosclerosis, coronary artery disease, indices, obesity

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2923 Effects of Obesity and Family History of Diabetes on the Association of Cholesterol Ester Transfer Protein Gene with High-Density Lipoprotein Cholesterol Levels in Korean Population

Authors: Jae Woong Sull

Abstract:

Lipid levels are related to the risk of cardiovascular diseases. Cholesterol ester transfer protein (CETP) gene is one of the candidate genes of cardiovascular diseases. A total of 2,304 persons were chosen from a Hospital (N=4,294) in South Korea. Female subjects with the CG/GG genotype had a 2.03 -fold (p=0.0001) higher risk of having abnormal HDL cholesterol levels (<40 mg/dL) than subjects with the CC genotype. Male subjects with the CG/GG genotype had a 1.34 -fold (p=0.0019) higher risk than subjects with the CC genotype. When analyzed by body mass index, the association with CETP was much stronger in male subjects with BMI>=25.69 (OR=1.55, 95% CI: 1.15-2.07, P=0.0037) than in male lean subjects. When analyzed by family history of diabetes, the association with CETP was much stronger in male subjects with positive family history of low physical activity (OR=4.82, 95% CI: 1.86-12.5, P=0.0012) than in male subjects with negative family history of diabetes. This study clearly demonstrates that genetic variants in CETP influence HDL cholesterol levels in Korean adults.

Keywords: CETP, diabetes, obesity, polymorphisms

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2922 Optimal Seismic Design of Reinforced Concrete Shear Wall-Frame Structure

Authors: H. Nikzad, S. Yoshitomi

Abstract:

In this paper, the optimal seismic design of reinforced concrete shear wall-frame building structures was done using structural optimization. The optimal section sizes were generated through structural optimization based on linear static analysis conforming to American Concrete Institute building design code (ACI 318-14). An analytical procedure was followed to validate the accuracy of the proposed method by comparing stresses on structural members through output files of MATLAB and ETABS. In order to consider the difference of stresses in structural elements by ETABS and MATLAB, and to avoid over-stress members by ETABS, a stress constraint ratio of MATLAB to ETABS was modified and introduced for the most critical load combinations and structural members. Moreover, seismic design of the structure was done following the International Building Code (IBC 2012), American Concrete Institute Building Code (ACI 318-14) and American Society of Civil Engineering (ASCE 7-10) standards. Typical reinforcement requirements for the structural wall, beam and column were discussed and presented using ETABS structural analysis software. The placement and detailing of reinforcement of structural members were also explained and discussed. The outcomes of this study show that the modification of section sizes play a vital role in finding an optimal combination of practical section sizes. In contrast, the optimization problem with size constraints has a higher cost than that of without size constraints. Moreover, the comparison of optimization problem with that of ETABS program shown to be satisfactory and governed ACI 318-14 building design code criteria.

Keywords: structural optimization, seismic design, linear static analysis, etabs, matlab, rc shear wall-frame structures

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2921 Investigating the Associative Network of Color Terms among Turkish University Students: A Cognitive-Based Study

Authors: R. Güçlü, E. Küçüksakarya

Abstract:

Word association (WA) gives the broadest information on how knowledge is structured in the human mind. Cognitive linguistics, psycholinguistics, and applied linguistics are the disciplines that consider WA tests as substantial in gaining insights into the very nature of the human cognitive system and semantic knowledge. In this study, Berlin and Kay’s basic 11 color terms (1969) are presented as the stimuli words to a total number of 300 Turkish university students. The responses are analyzed according to Fitzpatrick’s model (2007), including four categories, namely meaning-based responses, position-based responses, form-based responses, and erratic responses. In line with the findings, the responses to free association tests are expected to give much information about Turkish university students’ psychological structuring of vocabulary, especially morpho-syntactic and semantic relationships among words. To conclude, theoretical and practical implications are discussed to make an in-depth evaluation of how associations of basic color terms are represented in the mental lexicon of Turkish university students.

Keywords: color term, gender, mental lexicon, word association task

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2920 Geochemical Evaluation Assessment of Groundwater in Selected Part of Benue State Southern, Nigeria

Authors: Moses Oghnennyoreme Eyankware, Christian Ogubuchi Ede

Abstract:

Groundwater is the principal source for various uses in this study area. The quality and availability of groundwater depend on rock formation within the study area. To effectively study the quality of groundwater, 24 groundwater samples were collected. The study was aimed at investigating the hydrogeochemistry of groundwater, and additionally its suitability for drinking and irrigation purposes. The following parameters were analyzed using the American Public Health Association standard method: pH, turbidity, Ec, TDS, Mg2+, SO42-, NO3¯, Cl-, HCO3¯, K+, Na2+ and Ca2+. Results obtained from Water Quality Index revealed that the groundwater sample fell within good water quality that implies that groundwater is considered fit for drinking purposes. Deduced results obtained from irrigation indices revealed that Permeability Index (PI), Soluble Sodium Percentage (SSP), Sodium Percentage (Na %), Sodium Absorption Ratio (SAR), Kelly Ratio (KR), Magnesium Hazard (MH) ranges from 0.00 to 0.01, 4.04 to 412.9, 0.63 to 257.7, 0.15 to 2.34, 0.09 to 2.57 and 6.84 to 84.55 respectively. Findings from Total hardness revealed that groundwater fell within soft, moderately hard and hard categories. Estimated results obtained from CSMR, RI and LSI showed that groundwater showed corrosion tendency, salinization influenced groundwater at certain sampling points and chloride and sulfate unlikely to interfere with natural formation film.

Keywords: water, quality, suitability, anthropogenic, Nigeria

Procedia PDF Downloads 162
2919 A Study on Hierarchy and Popularity of Foreign TV Series with Different Origin Countries among Chinese Audiences from a Uses and Gratification Perspective

Authors: Terigele

Abstract:

Cultural products are always shelved into different classes of a hierarchy that separates so-called highbrow and lowbrow cultures. This study illustrated that audiences might even construct a hierarchy according to the origin countries when consuming certain products. Chinese audiences now have access to TV series from all around the world thanks to the internet. TV series from different origin countries show some particular features in terms of length, theme, plots, accessibility, seriousness etc. Their audiences were therefore stereotyped because of what they watch. Based on in-depth interviews with 20 participants, this research has following findings: 1) Most popular origin countries of foreign TV series in China are Korea, the United States, the United Kingdom, Japan and European countries in a descending order. Korean TV series are most popular because they are less serious and more accessible compared to others. 2) In the hierarchy of the TV series, European TV series stand on the top followed by British and American TV series. Japanese TV series are also categorized into highbrow class. Korean TV series are at the bottom and always seen as lowbrow cultural products. 3) Most audiences consume TV series from more than one origin countries and have different needs when watching them. Participants reported that they watch European TV series because those TV series are more artistic than their counterparts and of great quality. They watch British and American TV series mainly to improve their English and to learn about the culture. They find Japanese TV series very enjoyable with a large variety of themes and impressive lines. Audiences watch Korean TV series mostly to entertain and kill time. 4) Audiences do care about cultural taste. Especially those who watch European, British and American TV series usually tend to consider audiences who watch nothing but Korean TV series to be shallow. On the other hand, Korean TV series’ audiences seem to care less about the hierarchy of the TV series. Even when they discuss the hierarchy, they tend to accept the judgments with ironies and jokes. Future studies can dig deeply into the genre and content of TV series with different origin countries and also investigate more about the psychology of audiences regarding the gender, age, education, socioeconomic status etc.

Keywords: foreign TV series, hierarchy, popularity, uses and gratification

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2918 Genome Sequencing and Analysis of the Spontaneous Nanosilver Resistant Bacterium Proteus mirabilis Strain scdr1

Authors: Amr Saeb, Khalid Al-Rubeaan, Mohamed Abouelhoda, Manojkumar Selvaraju, Hamsa Tayeb

Abstract:

Background: P. mirabilis is a common uropathogenic bacterium that can cause major complications in patients with long-standing indwelling catheters or patients with urinary tract anomalies. In addition, P. mirabilis is a common cause of chronic osteomyelitis in diabetic foot ulcer (DFU) patients. Methodology: P. mirabilis SCDR1 was isolated from a diabetic ulcer patient. We examined P. mirabilis SCDR1 levels of resistance against nano-silver colloids, the commercial nano-silver and silver containing bandages and commonly used antibiotics. We utilized next generation sequencing techniques (NGS), bioinformatics, phylogenetic analysis and pathogenomics in the identification and characterization of the infectious pathogen. Results: P. mirabilis SCDR1 is a multi-drug resistant isolate that also showed high levels of resistance against nano-silver colloids, nano-silver chitosan composite and the commercially available nano-silver and silver bandages. The P. mirabilis-SCDR1 genome size is 3,815,621 bp with G+C content of 38.44%. P. mirabilis-SCDR1 genome contains a total of 3,533 genes, 3,414 coding DNA sequence genes, 11, 10, 18 rRNAs (5S, 16S, and 23S), and 76 tRNAs. Our isolate contains all the required pathogenicity and virulence factors to establish a successful infection. P. mirabilis SCDR1 isolate is a potential virulent pathogen that despite its original isolation site, wound, it can establish kidney infection and its associated complications. P. mirabilis SCDR1 contains several mechanisms for antibiotics and metals resistance including, biofilm formation, swarming mobility, efflux systems, and enzymatic detoxification. Conclusion: P. mirabilis SCDR1 is the spontaneous nano-silver resistant bacterial strain. P. mirabilis SCDR1 strain contains all reported pathogenic and virulence factors characteristic for the species. In addition, it possesses several mechanisms that may lead to the observed nano-silver resistance.

Keywords: Proteus mirabilis, multi-drug resistance, silver nanoparticles, resistance, next generation sequencing techniques, genome analysis, bioinformatics, phylogeny, pathogenomics, diabetic foot ulcer, xenobiotics, multidrug resistance efflux, biofilm formation, swarming mobility, resistome, glutathione S-transferase, copper/silver efflux system, altruism

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2917 Assessing the Effects of Sub-Concussive Head Impacts on Clinical Measures of Neurologic Function

Authors: Gianluca Del Rossi

Abstract:

Sub-concussive impacts occur frequently in collision sports such as American tackle football. Sub-concussive level impacts are defined as hits to the head that do not result in the clinical manifestation of concussion injury. Presently, there is limited information known about the short-term effects of repeated sub-concussive blows to the head. Therefore, the purpose of this investigation was to determine if standard clinical measures could detect acute impairments in neurologic function resulting from the accumulation of sub-concussive impacts throughout a season of high school American tackle football. Simple reaction time using the ruler-drop test, and oculomotor performance using the King-Devick (KD) test, were assessed in 15 athletes prior to the start of the athletic season, then repeated each week of the season, and once following its completion. The mean reaction times and fastest KD scores that were recorded or calculated from each study participant and from each test session were analyzed to assess for change in reaction time and oculomotor performance over the course of the American tackle football season. Analyses of KD data revealed improvements in oculomotor performance from baseline measurements (i.e., decreased time), with most weekly comparisons to baseline being significantly different. Statistical tests performed on the mean reaction times obtained via the ruler-drop test throughout the season revealed statistically significant declines (i.e., increased time) between baseline and weeks 3, 4, 10, and 12 of the athletic season. The inconsistent and contrasting findings between KD data and reaction time demonstrate the need to identify more robust clinical measures to definitively assess if repeated sub-concussive impacts to the head are acutely detrimental to patients.

Keywords: head injury, mTBI and sport, subclinical head trauma, sub-concussive impacts

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2916 Total Longitudinal Displacement (tLoD) of the Common Carotid Artery (CCA) Does Not Differ between Patients with Moderate or High Cardiovascular Risk (CV) and Patients after Acute Myocardial Infarction (AMI)

Authors: P. Serpytis, K. Azukaitis, U. Gargalskaite, R. Navickas, J. Badariene, V. Dzenkeviciute

Abstract:

Purpose: Total longitudinal displacement (tLoD) of the common carotid artery (CCA) wall is a novel ultrasound marker of vascular function that can be evaluated using modified speckle tracking techniques. Decreased CCA tLoD has already been shown to be associated with diabetes and was shown to predict one year cardiovascular outcome in patients with suspected coronary artery disease (CAD) . The aim of our study was to evaluate if CCA tLoD differ between patients with moderate or high cardiovascular (CV) risk and patients after recent acute myocardial infarction (AMI). Methods: 49 patients (54±6 years) with moderate or high CV risk and 42 patients (58±7 years) after recent AMI were included. All patients were non-diabetic. CCA tLoD was evaluated using GE EchoPAC speckle tracking software and expressed as mean of both sides. Data on systolic blood pressure, total and high density lipoprotein (HDL) cholesterol levels, high sensitivity C-reactive protein (hsCRP) level, smoking status and family history of early CV events was evaluated and assessed for association with CCA tLoD. Results: tLoD of CCA did not differ between patients with moderate or high CV risk and patients with very high CV risk after MI (0.265±0.128 mm vs. 0.237±0.103 mm, p>0.05). Lower tLoD was associated with lower HDL cholesterol levels (r=0.211, p=0.04) and male sex (0.228±0.1 vs. 0.297±0.134, p=0.01). Conclusions: tLoD of CCA did not differ between patients with moderate or high CV risk and patients with very high CV risk after AMI. However, lower CCA tLoD was significantly associated with low HDL cholesterol levels and male sex.

Keywords: total longitudinal displacement, carotid artery, cardiovascular risk, acute myocardial infarction

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2915 Dietary Practices of Adult Type 2 Diabetes Mellitus Patients Attending Kitui Out Patient Clinic at Kitui County, Kenya

Authors: Alice W. Theuri, Anselimo O. Makokha, Florence M. Kyallo

Abstract:

Type 2 diabetes mellitus (T2DM) is a serious metabolic disorder whose prevalence among adults has been increasing in the last decade. It is estimated that by 2030, the number of cases in Africa will almost double. Diet and lifestyle modifications are considered the cornerstone for the treatment and management of T2DM. Despite this, there is minimum literature assessing the dietary practices and glycemic control in a semi arid region context in Kenya. The objective of this study was to determine the dietary practices of adult T2DM patients attending Kitui out patient clinic in Kitui County. This was a cross sectional study design where every consenting second patient attending diabetic clinic was interviewed. A total of 138 T2DM patients were interviewed using a structured interview guide on socio-economic and dietary practices administered. The study was carried out in April and May 2017. There were more female (64%) than male (36%) in this study with majority being unemployed (38.4%). Forty seven percent (47.6%) had elevated HbA1c. Majority took three meals per day while DDS was 4.3 ± 1.09. The mean energy intake for men and women was 2823.8 ± 82.45 and 2766.3.30 ± 76.74 respectively. There was a non significant positive relationship (r= 131; P value = 0.124) between amount energy consumed and glycemic control. There were suboptimal dietary practices leading to poor glycemic control among T2DM patients attending diabetic clinic at Kitui District Hospital.

Keywords: adults, dietary practices, semi arid region, T2DM

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2914 Diabetes Mellitus and Food Balance in the Kingdom of Saudi Arabia

Authors: Aljabryn Dalal Hamad

Abstract:

The present explanatory study concerns with the relation between Diabetes Mellitus and Food Balance in the Kingdom of Saudi Arabia during 2005-2010, using published data. Results illustrated that Saudi citizen daily protein consumption (DPC) during 2005-2007 (g/capita/day) is higher than the average global consumption level of protein with 15.27%, daily fat consumption (DFC) with 24.56% and daily energy consumption (DEC) with 16.93% and increases than recommended level by International Nutrition Organizations (INO) with 56% for protein, 60.49% for fat and 27.37% for energy. On the other hand, DPC per capita in Saudi Arabia decreased during the period 2008-2010 from 88.3 to 82.36 gram/ day. Moreover, DFC per capita in Saudi Arabia decreased during the period 2008-2010 from 3247.90 to 3176.43 Cal/capita/ day, and daily energy consumption (DEC) of Saudi citizen increases than world consumption with 16.93%, while increases with 27.37% than INO. Despite this, DPC, DFC and DEC per capita in Saudi Arabia still higher than world mean. On the other side, results illustrated that the number of diabetic patients in Saudi Arabia during the same period (2005-2010). The curve of diabetic patient’s number in Saudi Arabia during 2005-2010 is regular ascending with increasing level ranged between 7.10% in 2005 and 12.44% in 2010. It is essential to devise Saudi National programs to educate the public about the relation of food balances and diabetes so it could be avoided, and provide citizens with healthy dietary balances tables.

Keywords: Diabetes mellitus, food balance, energy, fat, protein, Saudi Arabia

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2913 A CD40 Variant is Associated with Systemic Bone Loss Among Patients with Rheumatoid Arthritis

Authors: Rim Sghiri, Samia Al Shouli, Hana Benhassine, Nejla Elamri, Zahid Shakoor, Foued Slama, Adel Almogren, Hala Zeglaoui, Elyes Bouajina, Ramzi Zemni

Abstract:

Objectives: Little is known about genes predisposing to systemic bone loss (SBL) in rheumatoid arthritis (RA). Therefore, we examined the association between SBL and a variant of CD40 gene, which is known to play a critical role in both immune response and bone homeostasis among patients with RA. Methods: CD40 rs48104850 was genotyped in 176 adult RA patients. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Results: Low BMD was observed in 116 (65.9%) patients. Among them, 60 (34.1%) had low femoral neck (FN) Z score, 72 (40.9%) had low total femur (TF) Z score, and 105 (59.6%) had low lumbar spine (LS) Z score. CD40 rs4810485 was found to be associated with reduced TF Z score with the CD40 rs4810485 T allele protecting against reduced TF Z score (OR = 0.40, 95% CI = 0.23-0.68, p = 0.0005). This association was confirmed in the multivariate logistic regression analysis (OR=0.31, 95% CI= 0.16-0.59, p=3.84 x 10₋₄). Moreover, median FN BMD was reduced among RA patients with CD40 rs4810485 GG genotype compared to RA patients harbouring CD40 rs4810485 TT and GT genotypes (0.788± 0.136 versus 0.826± 0.146g/cm², p=0.001). Conclusion: This study, for the first time ever, demonstrated an association between a CD40 genetic variant and SBL among patients with RA.

Keywords: rheumatoid arthritis, CD40 gene, bone mineral density, systemic bone loss, rs48104850

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2912 Effects of Corruption and Logistics Performance Inefficiencies on Container Throughput: The Latin America Case

Authors: Fernando Seabra, Giulia P. Flores, Karolina C. Gomes

Abstract:

Trade liberalizations measures, as import tariff cuts, are not a sufficient trigger for trade growth. Given that price margins are narrow, traders and cargo operators tend to opt out of markets where the process of goods clearance is slow and costly. Excess paperwork and slow customs dispatch not only lead to institutional breakdowns and corruption but also to increasing transaction cost and trade constraints. The objective of this paper is, therefore, two-fold: First, to evaluate the relationship between institutional and infrastructural performance indexes and trade growth in container throughput; and, second, to investigate the causes for differences in container demurrage and detention fees in Latin American countries (using other emerging countries as benchmarking). The analysis is focused on manufactured goods, typically transported by containers. Institutional and infrastructure bottlenecks and, therefore, the country logistics efficiency – measured by the Logistics Performance Index (LPI, World Bank-WB) – are compared with other indexes, such as the Doing Business index (WB) and the Corruption Perception Index (Transparency International). The main results based on the comparison between Latin American countries and the others emerging countries point out in that the growth in containers trade is directly related to LPI performance. It has also been found that the main hypothesis is valid as aspects that more specifically identify trade facilitation and corruption are significant drivers of logistics performance. The exam of port efficiency (demurrage and detention fees) has demonstrated that not necessarily higher level of efficiency is related to lower charges; however, reductions in fees have been more significant within non-Latin American emerging countries.

Keywords: corruption, logistics performance index, container throughput, Latin America

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2911 Association of Lipoprotein Lipase Gene (HindIII rs320) Polymorphisms with Moderate Hypertriglyceridemia Secondary to Metabolic Syndrome

Authors: Meryem Abi-Ayad, Biagio Arcidiacono, Eusebio Chiefari, Daniela Foti, Mohamed Benyoucef, Antonio Brunetti

Abstract:

Lipoprotein Lipase (LPL) is a key enzyme for lipid metabolism; its genetic polymorphism can be a candidate for modulating lipids parameters in metabolic syndrome. The objective of the present study was to determine whether lipoproteins lipase polymorphisMetS (LPL-HindIII) could be associated with moderate hypertriglyceridemia (secondary to metabolism syndrome). The polymorphism Hind III (rs320) was assessed by PCR-RFLP in 51 MetS patients and 17 healthy controls from the hospital in Tlemcen. The logistic regression analyses showed no significant association with Hind III genotype and hypertriglyceridemia (TG ≥ 1,5g/l or TG lower treatment) (P=0,455), metabolic syndrome (P=0,455), hypertension (P=0,802) and type 2 diabetes (P=0,144). In terms of plasma biomarkers, although not statistically significant, there was a difference in TG levels (P > 0,05), which was lowest among carriers of the homogenous mutant allele (H-). In this study, there was no association between the rare allele (H-) and disease protection, and between the frequent allele (H+) and disease prevalence (hypertriglyceridemia, metabolic syndrome, hypertension, type 2 diabetes).

Keywords: moderate secondary hypertriglyceridemia, metabolic syndrome, lipids, polymorphism lipoprotein lipase, HindIII(rs320)

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2910 Investigating Associations Between Genes Linked to Social Behavior and Early Covid-19 Spread Using Multivariate Linear Regression Analysis

Authors: Gwenyth C. Eichfeld

Abstract:

Variation in global COVID-19 spread is partly explained by social and behavioral factors. Many of these behaviors are linked to genetics. The short polymorphism of the 5-HTTLPR promoter region of the SLC6A4 gene is linked to collectivism. The seven-repeat polymorphism of the DRD4 gene is linked to risk-taking, migration, sensation-seeking, and impulsivity. Fewer CAG repeats in the androgen receptor gene are linked to impulsivity. This study investigates an association between the country-level frequency of these variants and early Covid-19 spread. Results of regression analysis indicate a significant association between increased country-wide prevalence of the short allele of the SLC6A4 gene and decreased COVID-19 spread when other factors that have been linked to COVID-19 are controlled for. Additionally, results show that the short allele of the SLC6A4 gene is associated with COVID-19 spread through GDP and percent urbanization rather than collectivism. Results showed no significant association between the frequency of the DRD4 polymorphism nor the androgen receptor polymorphism with early COVID-19 spread.

Keywords: neuroscience, genetics, population sciences, Covid-19

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2909 A Study of Inter-Media Discourse Construction on Sino-US Trade Friction Based on Network Agenda Setting Theory

Authors: Wanying Xie

Abstract:

Under the background of the increasing Sino-US trade friction, the two nations pay more attention to the medias’ words. This paper mainly studies the causality, effectiveness, and influence of discourse construction between traditional media and social media. Based on the Network Agenda Setting theory, a kind of associative memory pattern in Psychology, who focuses on how media affect audiences’ cognition of issues and attributes, as well as the significance of the relation between people and matters. The date of the sample chosen in this paper ranges from March 23, 2018, to April 30, 2019. A total of 395 Tweets of Donald Trump are obtained, and 731 related reports are collected from the mainstream American newspapers including New York Times, the Washington Post and the Washington Street, by using Factiva and other databases. The sample data are processed by MAXQDA while the media discourses are analyzed by SPSS and Cite Space, with an aim to study: 1) whether the inter-media discourse construction exists; 2) which media (traditional media V.S. social media) is dominant; 3) the causality between two media. The results show: 1) the discourse construction between three American mainstream newspapers and Donald Trump's Twitter is proved in some periods; 2) the dominant position is extremely depended on the events; 3) the causality between two media is decided by many reasons. New media technology shortens the time of agenda-setting effect to one day or less. By comparing the specific relation between the three major American newspapers and Donald Trump’s Twitter, whose popularity and influence could be reflected. Hopefully, this paper could enable readers to have a more comprehensive understanding of the international media language and political environment.

Keywords: discourse construction, media language, network agenda-setting theory, sino-us trade friction

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2908 Fatty Acid Composition, Total Sugar Content and Anti-Diabetic Activity of Methanol and Water Extracts of Nine Different Fruit Tree Leaves Collected from Mediterranean Region of Turkey

Authors: Sengul Uysal, Gokhan Zengin, Abdurrahman Aktumsek, Sukru Karatas

Abstract:

In this research, we determined the total sugar content, fatty acid compositions and α-amylase and α-glucosidase inhibitory activity of methanolic and water extracts of nine different fruit tree leaves. α-amylase and α-glycosidase inhibitory activity were determined by using Caraway-Somogyi–iodine/potassium iodide (IKI) and 4-nitrophenyl-α-D-glucopyranoside (PNPG) as substrate, respectively. Total sugar content of the nine different fruit tree leaves varies from 281.02 mg GE/g (glucose equivalents) to 643.96 mg GE/g. Methanolic extract from avocado leaves had the strongest in α-amylase and α-glucosidase inhibitory activity, 69.21% and 96.26 %, respectively. Fatty acid composition of nine fruit tree leaves was characterized by GC (gas chromatography) and twenty-four components were identified. Among the tested fruit tree leaves, the main component was linolenic acid (49.09%). The level of essential fatty acids are over 50% in mulberry, grape and loquat leaves. PUFAs (polyunsaturated fatty acids) were major group of fatty acids present in oils of mulberry, fig, pomegranate, grape, and loquat leaves. Therefore, these oils can be considered as a good source of polyunsaturated fatty acids. Furthermore, avocado can be regarded as a new source for diabetic therapies.

Keywords: fatty acid compositions, total sugar contents, α-amylase, α-glucosidase, fruit tree leaves, Turkey

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2907 Chinese College Students’ Intercultural Competence and Culture Learning Through Telecollaboration

Authors: Li Yuqing

Abstract:

Fostering the development of intercultural (communicative) competence (IC) is one way to equip our students with the linguistic and cultural skills to communicate effectively with people from diverse backgrounds, particularly English majors who are most likely to encounter multicultural work environments in the future. The purpose of this study is to compare the English majors' intercultural competence in terms of cognitive, affective, and behavioral aspects before and after a ten-week telecollaboration program between 23 English majors at a Chinese university and 23 American students enrolled in a Chinese class at an American university, and analyze their development during the program. The results indicate that subjects' cognitive, affective, and behavioral perceptions of IC improved significantly over time. In addition, the program had significant effects on the participants' “Interaction Confidence,” “Interaction Engagement,” and “Interaction Enjoyment” - three components of intercultural sensitivity - as well as their overall intercultural effectiveness (except for “Message Skills”). With the widespread use of the internet, this type of online cultural exchange has a promising future, as suggested by the findings of the current study.

Keywords: intercultural competence, English majors, computer-mediated communication, telecollaboration

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2906 The American Theater: Latinos Performing as American Citizens by Supporting Trump's Ideals

Authors: Mariana Anaya Villafana

Abstract:

The sudden change of a significant percentage of the Latino community in the United States elections towards a Republican political orientation was reflected during the 2016 presidential election. This moment represented a radical change that is happening inside the Latino community in the United States, the support they have given to Trump's campaign only demonstrates their support for new anti-immigration regulations and conservative values, which are causing a division of ideologies inside the Latino community. One of the main goals of the following research is to understand the whole phenomenon 'Why would people join their own oppressor?' Align themselves with the politics that prevent many of their relatives to come to the United States and made the assimilation process difficult for their parents. It is important to prove that a change in the identity has happened, through the use of power relations and the attachment to the desired object. A group of Hispanics/Latinos have decided to vote for Trump in order to belong to a society that hasn’t been able to fully include them within it, an action that can result on the non-intentional harm of the values and aims of the rest of the Latino/Hispanic community. In order to understand their new political beliefs, it is necessary to use the method of discourse analysis to comprehend those comments and interviews that are published on web sites such as: 'Latinos for Trump' and 'GOP Hispanic Division'. Among the results that the research has shown, the notion of the 'American Dream' can be considered as a determinant object for the construction of a new identity that is rooted in hard work and legality. One that is proud of the Latino heritage but still wants to maintain the boundaries between legality and illegality in relation to the immigrants. This discourse results on a contradiction to most of the cases because they mention that their families came to the U.S. as immigrants; the only difference is that they work hard to obtain legal citizenship.

Keywords: populism, identity, Latino Community, migration

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2905 A Destination Marketing Study on Capitalising on the Cultural Link between Ireland and North America Using Social Media

Authors: Colm Barcoe, Garvan Whelan

Abstract:

This study examines how a destination marketing organisation can use social media channels to engage the interests of the US and Canadian markets in a way that maximises the number of visits (and revisits) to Ireland. The research reveals how the cultural link between Ireland and North America is exploited through the use of social media strategies. The findings are based on quantitative and qualitative empirical data obtained through a survey of North American holidaymakers in the pre, during and post trip phases coupled with in-depth interviews of 20 industry experts who are responsible for the implementation of relationship marketing strategies for this segment. The qualitative data was analysed using Netnography in order to provide insights into the effectiveness of various social media channels in developing cultural links between Ireland and North American tourists. The findings of this investigation will extend an under-researched body of literature pertaining to Ireland and North America. The empirical evidence of this study will be of value to both academics and industry practitioners.

Keywords: Ireland, marketing, North America, relationship, strategies

Procedia PDF Downloads 180