Search results for: public hospital unions

Authors: Philipp Sommer, Amgad Agoub

Abstract:

The construction sector significantly impacts global CO₂ emissions, particularly through the energy usage of residential buildings. To address this, various governments, including Germany's, are focusing on reducing emissions via sustainable refurbishment initiatives. This study examines the application of machine learning (ML) to estimate energy demands dynamically in residential buildings and enhance the potential for large-scale sustainable refurbishment. A major challenge in Germany is the lack of extensive publicly labeled datasets for energy performance, as energy performance certificates, which provide critical data on building-specific energy requirements and consumption, are not available for all buildings or require on-site inspections. Conversely, England and other countries in the European Union (EU) have rich public datasets, providing a viable alternative for analysis. This research adapts insights from these English datasets to the German context by developing a comprehensive data schema and calibration dataset capable of predicting building energy demand effectively. The study proposes a minimal feature set, determined through feature importance analysis, to optimize the ML model. Findings indicate that ML significantly improves the scalability and accuracy of energy demand forecasts, supporting more effective emissions reduction strategies in the construction industry. Integrating energy performance certificates into municipal heat planning in Germany highlights the transformative impact of data-driven approaches on environmental sustainability. The goal is to identify and utilize key features from open data sources that significantly influence energy demand, creating an efficient forecasting model. Using Extreme Gradient Boosting (XGB) and data from energy performance certificates, effective features such as building type, year of construction, living space, insulation level, and building materials were incorporated. These were supplemented by data derived from descriptions of roofs, walls, windows, and floors, integrated into three datasets. The emphasis was on features accessible via remote sensing, which, along with other correlated characteristics, greatly improved the model's accuracy. The model was further validated using SHapley Additive exPlanations (SHAP) values and aggregated feature importance, which quantified the effects of individual features on the predictions. The refined model using remote sensing data showed a coefficient of determination (R²) of 0.64 and a mean absolute error (MAE) of 4.12, indicating predictions based on efficiency class 1-100 (G-A) may deviate by 4.12 points. This R² increased to 0.84 with the inclusion of more samples, with wall type emerging as the most predictive feature. After optimizing and incorporating related features like estimated primary energy consumption, the R² score for the training and test set reached 0.94, demonstrating good generalization. The study concludes that ML models significantly improve prediction accuracy over traditional methods, illustrating the potential of ML in enhancing energy efficiency analysis and planning. This supports better decision-making for energy optimization and highlights the benefits of developing and refining data schemas using open data to bolster sustainability in the building sector. The study underscores the importance of supporting open data initiatives to collect similar features and support the creation of comparable models in Germany, enhancing the outlook for environmental sustainability.

Keywords: machine learning, remote sensing, residential building, energy performance certificates, data-driven, heat planning

Procedia PDF Downloads 57

Authors: Bernard Ewuoso

Abstract:

Introduction: Induction of labor (IOL) usually involves the patient moving between antenatal, labor, and postnatal wards. Delay in IOL has been defined as delay in the time it takes a woman to wait for induction after her cervix is assessed to be favorable. Opinions vary on the acceptable time the patient is allowed to wait for once the cervix is adjudged ripe for induction. What has been considered a benchmark is a delay of up to 12 hours. There is evidence that delay in IOL is associated with adverse outcomes. Aim: To determine the number of women experiencing delay in induction of labor and their outcomes. Method: This audit was retrospective and observational. It included women who had induction of labor in the month of October 2023 in two hospitals. Clinical data was collected from electronic medical records into an Excel sheet for analysis. Women had cervical ripening as inpatient or outpatient. The primary objective was to determine the number of women experiencing delay in induction of labor, while the secondary objective was to outcome these women. Result: 136 women had IOL. The least percentage of data retrieved for any parameter was 80%. The mean gestational age at IOL was 278.26 days. The mean waiting time was 905.34mins. Seventy-five women had their IOL at the Royal Infirmary of Edinburgh (RIE), fifty-seven at St. John’s Hospital (SJH), and three women were transferred from RIE to SJH. The preferred method of cervical ripening was balloon closely followed by prostaglandin. Twenty-seven women did not require cervical ripening and had their process started with amniotomy. Prostaglandin was the method of choice of cervical ripening at RIE, while balloon was preferred in SJH. Of the thirty-five women found to be suitable for outpatient cervical ripening, thirteen had outpatient ripening. There was a significant increase in the number of women undergoing outpatient cervical ripening at RIE from 10.5% in April 2022 to 42.9%. The preferred method for outpatient cervical ripening at the RIE was balloon, while it was prostaglandin for SJH. These were contradictory to the preferred method of inpatient cervical ripening at both centers. The average waiting time for IOL at RIE, 1166.92mins, is more than double that of SJH, 442.93mins, and far exceed 12hours, which is the proposed benchmark. The waiting time tends to be shorter with prostaglandin. Out of the women that had outpatient cervical ripening 63.6% had to wait for more than 12hrs before being induced while it was 36.1% for women that had inpatient cervical ripening. Overall, 38.5% women waited for more than 12 hours before having their induction. A lesser proportion of the women who waited for more than 12 hours had caesarean section, assisted vaginal delivery, and postpartum hemorrhage, whereas a greater proportion had spontaneous vaginal delivery and intrapartum or postpartum infection. Conclusion: A significant number of the women included in the study experienced delay in their induction process, and this was associated with an increased occurrence of intrapartum or postpartum infection. Outpatient cervical ripening contributed to delay.

Keywords: delay in induction of labor, inpatient, outpatient, intrapartum, postpartum, infection

Procedia PDF Downloads 22

Authors: Randa M. Mostafa, Y. Moustafa

Abstract:

During our daily life, we are continuously exposed to the extremely low frequency electromagnetic fields (ELF-EMFs) generated by electric appliances. The possible relation between exposure to (ELF-MFs) and adverse health effects has attracted and passed through long debate sessions. Extremely low frequency is a term used to describe radiation frequencies below 300 Hertz (Hz).It is very important for public health because of the widespread use of electrical power at 50-60 Hz in most countries. This study set out to investigate the impact of chronic exposure of male rats to 50- Hz, 1 mTesla (ELF-EMF) of over periods of 1, 2, and 4 weeks on concentration of serum FSH, LH, and testosterone hormones. 60 male albino rats were divided into 6 groups and were continuously exposed to 50-Hz, 1 m Tesla (ELF-EMF) generated by magnetic field chamber for periods of 1, 2, and 4 weeks. For each experimental point, sham treated group was used as a control. Assay of serum testosterone LH, and FSHwere performed. Serum testosterone showed no significant changes. FSH showed significant increase than sham exposed group after 1 week of field exposure. LH showed significant increase than sham exposed group only after 4 weeks of field exposure. A future detailed molecular studies must be carried out to figure out and may be able to explain the possible interactions between ELF-EMF and hypothalamic-pituitary gonadal axis.

Keywords: extremely low frequency electromagnetic fields, testosterone, follicular stimulating hormone, LH

Procedia PDF Downloads 460

Authors: A. T. Kassem

Abstract:

Fires areconsidered a common hazardous action that any building may face. Most buildings’ structural elements are designed, taking into consideration precautions for fire safety, using deterministic design approaches. Public and highly important buildings are commonly designed considering standard fire rating and, in many cases, contain large compartments with central domes. Real fire scenarios are not commonly brought into action in structural design of buildings because of complexities in both scenarios and analysis tools. This paper presents a modern approach towards analysis of spherical domes in real fire condition via implementation of building information modelling, and adopting a probabilistic approach. BIMhas been implemented to bridge the gap between various software packages enabling them to function interactively to model both real fire and corresponding structural response. Ventilation controlled fires scenarios have been modeled using both “Revit” and “Pyrosim”. Monte Carlo simulation has been adopted to engage the probabilistic analysis approach in dealing with various parameters. Conclusions regarding failure probability and fire endurance, in addition to the effects of various parameters, have been extracted.

Keywords: concrete, spherical domes, ventilation controlled fires, BIM, monte carlo simulation, pyrosim, revit

Procedia PDF Downloads 95

Authors: Sofia Horjales, Florencia Palma

Abstract:

Our society is currently experiencing a profound transformation, demanding a proactive response from governmental bodies and higher education institutions to empower the next generation as catalysts for change. Environmental sustainability is rooted in the critical need to maintain the equilibrium and integrity of natural ecosystems, ensuring the preservation of precious natural resources and biodiversity for the benefit of both present and future generations. It is an essential cornerstone of sustainable development, complementing social and economic sustainability. In this evolving landscape, active methodologies take a central role, aligning perfectly with the principles of the 2030 Agenda for Sustainable Development and emerging as a pivotal element of teacher education. The emphasis on active learning methods has been driven by the urgent need to nurture sustainability and instill social responsibility in our future leaders. The Universidad Tecnológica of Uruguay (UTEC) is a public, technologically-oriented institution established in 2012. UTEC is dedicated to decentralization, expanding access to higher education throughout Uruguay, and promoting inclusive social development. Operating through Regional Technological Institutes (ITRs) and associated centers spread across the country, UTEC faces the challenge of remote student populations. To address this, UTEC utilizes e-learning for equal opportunities, self-regulated learning, and digital skills development, enhancing communication among students, teachers, and peers through virtual classrooms. The Interdisciplinary Continuing Education Program is part of the Innovation and Entrepreneurship Department of UTEC. The main goal is to strengthen innovation skills through a transversal and multidisciplinary approach. Within this Program, we have developed a Case of Study and Project-Based Learning Virtual Course designed for university students and open to the broader UTEC community. The primary aim of this course is to establish a strong foundation for comprehending and addressing environmental sustainability issues from an interdisciplinary perspective. Upon completing the course, we expect students not only to understand the intricate interactions between social and ecosystem environments but also to utilize their knowledge and innovation skills to develop projects that offer enhancements or solutions to real-world challenges. Our course design centers on innovative learning experiences, rooted in active methodologies. We explore the intersection of these methods with sustainability and social responsibility in the education of university students. A paramount focus lies in gathering student feedback, empowering them to autonomously generate ideas with guidance from instructors, and even defining their own project topics. This approach underscores that when students are genuinely engaged in subjects of their choice, they not only acquire the necessary knowledge and skills but also develop essential attributes like effective communication, critical thinking, and problem-solving abilities. These qualities will benefit them throughout their lifelong learning journey. We are convinced that education serves as the conduit to merge knowledge and cultivate interdisciplinary collaboration, igniting awareness and instigating action for environmental sustainability. While systemic changes are undoubtedly essential for society and the economy, we are making significant progress by shaping perspectives and sparking small, everyday actions within the UTEC community. This approach empowers our students to become engaged global citizens, actively contributing to the creation of a more sustainable future.

Keywords: active learning, environmental education, project-based learning, soft skills development

Procedia PDF Downloads 71

Authors: Ruoya Huang, Ruoxian Huang, Edgar Huang

Abstract:

Based on a convenience sample of 2,092 participants from across all 50 states of the United States, a survey was conducted to explore Americans’ mask-wearing behaviors during COVID-19 according to their political convictions, religious beliefs, and ethnic cultures from late July to early September, 2020. The purpose of the study is to provide evidential support for government policymaking so as to drive up more effective public policies by taking into consideration the variance in these social factors. It was found that the respondents’ party affiliation or preference, religious belief, and ethnicity, in addition to their health condition, gender, level of concern of contracting COVID-19, all affected their mask-wearing habits both in March, the initial coronavirus outbreak stage, and in August, when mask-wearing had been made mandatory by state governments. The study concludes that pandemic awareness campaigns must be run among all citizens, especially among African Americans, Muslims, and Republicans, who have the lowest rates of wearing masks, in order to protect themselves and others. It is recommended that complementary cognitive bias awareness programs should be implemented in non-Black and non-Muslim communities to eliminate social concerns that deter them from wearing masks.

Keywords: COVID-19 pandemic, ethnicity, mask-wearing, policymaking implications, political affiliations, religious beliefs, United States

Procedia PDF Downloads 233

Authors: Tareq M. Aziz Elven

Abstract:

The issue of Human Rights enforcement in Southeast Asia has become the serious problem and attract the attention of international community. Principally, Association of Southeast Asian Nations (ASEAN) has mentioned the Human Rights as one of the focus and be a part of the ASEAN Charter in 2008. It was followed by the establishment of ASEAN Inter-Governmental Commission on Human Rights (AICHR). AICHR is the commission of Human Rights enforcement in Southeast Asia which has a duty, function, and an authority to conduct dissemination and protection of Human Rights. In the end of 2016, however, the function of protection mandated to AICHR have not achieved yet. It can be proved by several cases of Human Rights violation which still exist and have not settled yet. One of case which attracts the public attention recently is human rights violation towards Rohingya in Myanmar. Using the juridical-normative method, the research aims to examine the urgency of Human Rights court establishment in Southeast Asia region which able to issue the decision that binds the ASEAN members or the violating parties. The data shows that ASEAN needs to establish a regional court which intended to settle the Human Rights violations in ASEAN region. Furthermore, the research also highlights three strong factors should be settled by ASEAN for establishing human rights court i.e. the significant distinction of democracy and human rights development among the members, the strong implementation of non-intervention principle, and the financial matter to sustain the court.

Keywords: AICHR, ASEAN, human rights, human rights court

Procedia PDF Downloads 346

Authors: Louise Ödlund, Danica Djuric Ilic

Abstract:

From a system perspective, there are several benefits of DH. A possibility to utilize the excess heat from waste incineration and biomass-based combined heat and power (CHP) production (e.g. possibility to utilize the excess heat from electricity production) are two examples. However, in a future sustainable society, the benefits of DH may be less obvious. Due to the climate changes and increased energy efficiency of buildings, the demand for space heating is expected to decrease. Due to the society´s development towards circular economy, a larger amount of the waste will be material recycled, and the possibility for DH production by the energy recovery through waste incineration will be reduced. Furthermore, the benefits of biomass-based CHP production will be less obvious since the marginal electricity production will no longer be linked to high greenhouse gas emissions due to an increased share of renewable electricity capacity in the electricity system. The purpose of the study is (1) to provide an overview of the possible development of other sectors which may influence the DH in the future and (2) to detect new business strategies which would enable for DH to adapt to the future conditions and remain competitive to alternative heat production in the future. A system approach was applied where DH is seen as a part of an integrated system which consists of other sectors as well. The possible future development of other sectors and the possible business strategies for DH producers were searched through a systematic literature review In order to remain competitive to the alternative heat production in the future, DH producers need to develop new business strategies. While the demand for space heating is expected to decrease, the space cooling demand will probably increase due to the climate changes, but also due to the better insulation of buildings in the cases where the home appliances are the heat sources. This opens up a possibility for applying DH-driven absorption cooling, which would increase the annual capacity utilization of the DH plants. The benefits of the DH related to the energy recovery from the waste incineration will exist in the future since there will always be a need to take care of materials and waste that cannot be recycled (e.g. waste containing organic toxins, bacteria, such as diapers and hospital waste). Furthermore, by operating central controlled heat pumps, CHP plants, and heat storage depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid. DH producers can also enable development of local biofuel supply chains and reduce biofuel production costs by integrating biofuel and DH production in local DH systems.

Keywords: district heating, sustainable business strategies, sustainable development, system approach

Procedia PDF Downloads 84

Authors: Rufat Nuriyev

Abstract:

Located in the eastern part of the Republic of Azerbaijan and on the western shore of the Caspian Sea, Gobustan National Reserve was inscribed as Gobustan Rock Art Cultural Landscape into the World Heritage List in 2007. Gobustan is an outstanding rock art landscape, where over 6000 rock engravings were found and registered, since the end of Upper Paleolithic up to the Middle Ages. Being a rock art center, the Gobustan seeks to stimulate public awareness and disseminate knowledge of prehistoric art to enrich educational, cultural and artistic communities regionally, nationally and internationally. Due to the Decree of the President of the Republic of Azerbaijan and the “Action Plan” , planned actions started to realize. Some of them implemented before of stipulated date. For the attraction of visitors and improvement of service quality in the museum-reserve, various activities are organized. The building of a new museum center at the foot of the Beyukdash Mountain has been completed in 2011. Main aims of the new museum building and exhibition was to provide better understanding of the importance of this monument for local community, Azerbaijanian culture and the world. In the Petroglyph Museum at Gobustan, digital and traditional media are closely integrated to reveal the complexity of historical, cultural and artistic meaning of prehistoric rock carvings of Gobustan. Alongside with electronic devices, the visitor gets opportunity of direct contact with artifacts and ancient rock carvings.

Keywords: Azerbaijan, Gobustan, rock art, museum

Procedia PDF Downloads 302

Authors: Abeer M. Orabi

Abstract:

Midwives are being seen as a key factor in returning birth care to a normal physiologic process that is woman-centered. On the other hand, more needs to be done to increase access for every woman to professional midwifery care. Because of the nature of the midwifery specialty, the magnitude of the effect that can result from a lack of knowledge if midwives make a mistake in their care has the potential to affect a large number of the birthing population. So, the development, running, and management of midwifery educational programs should follow international standards and come after a thorough community needs assessment. At the same time, the number of accredited midwifery educational programs needs to be increased so that larger numbers of midwives will be educated and qualified, as well as access to skilled midwifery care will be increased. Indeed, the selection of promising midwives is important for the successful completion of an educational program, achievement of the program goals, and retention of graduates in the field. Further, the number of schooled midwives in midwifery education programs, their background, and their experience constitute some concerns in the higher education industry. Basically, preceptors and clinical sites are major contributors to the midwifery education process, as educational programs rely on them to provide clinical practice opportunities. In this regard, the selection of clinical training sites should be based on certain criteria to ensure their readiness for the intended training experiences. After that, communication, collaboration, and liaison between teaching faculty and field staff should be maintained. However, the shortage of clinical preceptors and the massive reduction in the number of practicing midwives, in addition to unmanageable workloads, act as significant barriers to midwifery education. Moreover, the medicalized approach inherent in the hospital setting makes it difficult to practice the midwifery model of care, such as watchful waiting, non-interference in normal processes, and judicious use of interventions. Furthermore, creating a motivating study environment is crucial for avoiding unnecessary withdrawal and retention in any educational program. It is well understood that research is an essential component of any profession for achieving its optimal goal and providing a foundation and evidence for its practices, and midwifery is no exception. Midwives have been playing an important role in generating their own research. However, the selection of novel, researchable, and sustainable topics considering community health needs is also a challenge. In conclusion, ongoing education and research are the lifeblood of the midwifery profession to offer a highly competent and qualified workforce. However, many challenges are being faced, and barriers are hindering their improvement.

Keywords: barriers, challenges, midwifery education, educational programs

Procedia PDF Downloads 115

Authors: Hamd Ahmed

Abstract:

During the Persian Gulf War in 1991s, The confederation forces were surprised when they were being shot at by friendly forces in Iraqi desert. As obvious was the fact that they were mislead due to the lack of proper guidance and technology resulting in unnecessary loss of life and bloodshed. This unforeseen incident along with many others led the US department of defense to open the doors of GPS. In the very beginning, this technology was for military use, but now it is being widely used and increasingly popular among the public due to its high accuracy and immeasurable significance. The GPS system simply consists of three segments, the space segment (the satellite), the control segment (ground control) and the user segment (receiver). This project work is about designing a 1.57GHZ mixer for triple conversion GPS receiver .The GPS Front-End receiver based on super heterodyne receiver which improves selectivity and image frequency. However the main principle of the super heterodyne receiver depends on the mixer. Many different types of mixers (single balanced mixer, Single Ended mixer, Double balanced mixer) can be used with GPS receiver, it depends on the required specifications. This research project will provide an overview of the GPS system and details about the basic architecture of the GPS receiver. The basic emphasis of this report in on investigating general concept of the mixer circuit some terms related to the mixer along with their definitions and present the types of mixer, then gives some advantages of using singly balanced mixer and its application. The focus of this report is on how to design mixer for GPS receiver and discussing the simulation results.

Keywords: GPS , RF filter, heterodyne, mixer

Procedia PDF Downloads 323

Authors: Fei Gao, Xinyang Dong, Yisu Ge, Shufang Lu, Libo Weng

Abstract:

Vehicle color recognition plays an important role in traffic accident investigation. However, due to the influence of illumination, weather, and noise, vehicle color recognition still faces challenges. In this paper, a vehicle color classification network based on spatial cluster loss and channel attention mechanism (SCNet) is proposed for vehicle color recognition. A channel attention module is applied to extract the features of vehicle color representative regions and reduce the weight of nonrepresentative color regions in the channel. The proposed loss function, called spatial clustering loss (SC-loss), consists of two channel-specific components, such as a concentration component and a diversity component. The concentration component forces all feature channels belonging to the same class to be concentrated through the channel cluster. The diversity components impose additional constraints on the channels through the mean distance coefficient, making them mutually exclusive in spatial dimensions. In the comparison experiments, the proposed method can achieve state-of-the-art performance on the public datasets, VCD, and VeRi, which are 96.1% and 96.2%, respectively. In addition, the ablation experiment further proves that SC-loss can effectively improve the accuracy of vehicle color recognition.

Keywords: feature extraction, convolutional neural networks, intelligent transportation, vehicle color recognition

Procedia PDF Downloads 183

Authors: Ahmad Masduki Bin Selamat, Kang Chia Yang

Abstract:

The International Standard Organization (ISO) is an international consensus on good management practice. It is derived from the Greek word “isos” meaning equal. ISO is aimed to give organization guidelines on what bring quality management system that leads to continuous improvement. The need of quality product is essential these days, especially in the manufacturing and service sectors. The requirement to produce good product is demanded, hence the certification of ISO enables the company to gain the trust from the public. Due to this, organizations whether government or private sectors in Malaysia are going for the ISO certification. However recently there has been an introduction of Islamic standard known as Islamic Standard Institute 2020 (ISI 2020). The ISI standards emphasize more on values that should be in the employees’ mind. By possessing good values, employees will work only for the betterment of the company. Currently only the feelings of being paid for the job exist in the employees’ mind. The non-Malays like Chinese and others, which comprise 40% of the sample size, are not aware about the existence of any Islamic quality system. As for the Malay managers, they support the Islamic quality systems. For them such values are encouraged by religion. By imitating religion, Allah promises a better life in this world and hereafter. Even though ISI 2020 is still new but the majority of Malays would support the need of Islamic quality system. Our findings suggest that integration of these two-quality systems running parallel would bring a better result.

Keywords: International Standard Organization (ISO), Islamic standard, quality, ISI 2020

Procedia PDF Downloads 415

Authors: Muhammad Ali Khan

Abstract:

Although most Muslims are aware that Riba is a great sin in Islamic Shariah, they still do not find themselves inclined toward Islamic banking for their financial needs/activities/requirements. The main purpose of this research work is to analyse the general trend of people's views and miss conceptions among them regarding Islamic Banking and therefore suggest promoting Islamic banking. Scholars believe that Islamic finance is more stable than conventional banking because of the nature of its banking practices, which are based on real assets or partnerships. This is why Islamic banking is growing fastly worldwide, particularly in the wake of global financial crisis. Even though the scope of Islamic banking is expanding on a daily basis yet, it is not gaining the popularity it deserves. Islam declares war against Allah and his last messenger Hazrat Muhammad (PBUM) as it is a great sin and strictly forbids all interest-based transactions. Holy Quran revealed, O you who believe, do not eat up the amounts acquired through Riba (interest), doubled and multiplied. Fear Allah, so that you may be successful. Therefore a, true Muslim who believe in Judgement day always make all efforts in their life to avoid gambling and other speculative activities like Riba for themselves and their loved ones. If a Muslim does not fight against Riba to protect himself and his family, then his faith is meaningless. Allah issues warnings at numerous places in the holy Quran regarding Riba and its sin. Thus, Islamic banking is an alternative banking system where banking transactions are based on Islamic principles. The major component of Islamic Banking is Profit and loss sharing (PLS), as well as ensuring economic justice and equity.

Keywords: Islamic banking, Riba, interest, financial crises

Procedia PDF Downloads 64

Authors: Babatunde Johnson

Abstract:

The rate of diseases and death from preventable diseases among ethnic minority groups is high when compared with the wider white population in the UK. This can be due in part to the diet consumed and various cultural reasons. Changes in dietary practices and the health of ethnic minority groups can be caused by the adoption of food practices of the host culture after migration (acculturation) and generational differences among migrants. However, understanding how and why these changes occur is limited due to the challenges of data collection in research. This research utilizes the interpretive phenomenological approach, coupled with Bourdieu’s theory used as the conceptual framework, and seeks an in-depth understanding of how adult immigrant Nigerians in the UK interpret their experience of the influence of ethnic and prevailing cultures on their dietary practice. Recruiting participants from a close-knit community, such as the Nigerian population in the UK, can be complex and problematic and is determined by the accessibility to the community. Although complex, the researcher leveraged the principles of Patient and Public Involvement (PPI) in gaining access to participants within the Nigerian community. This study emphasizes the need for a culturally tailored and community-centered approach to interventions geared toward the reduction of ethnic health inequality in the UK other than the existing practice, which focuses on better healthy eating through the improvement of skills and knowledge about food groups.

Keywords: culture, dietary practice, ethnic minority, health inequality

Procedia PDF Downloads 86

Authors: Daniel Vaati Nzioka, John Oredo, Dorothy Muthoni Njiraine

Abstract:

The service delivery in academic libraries has been regressing due to the failure of Digital Librarians (DLns) to perform optimally. This study aimed at developing a proposed framework for digital librarianship in academic libraries with special emphasis to three selected public academic institutional libraries. The study’s specific objectives were to determine the roles played by the current DLns’ in academic libraries, establish job description of DLns’ in various academic libraries, ascertain DLns best practices, and to implement a viable digital librarianship conceptual framework. The study used a survey research with open-ended questionnaire designed as per the objectives of the study. A purposively selected sample of 30 Library and Information Science (LIS) professionals from the three selected academic libraries in charge of Digital Information Services (DIS) and managing electronic resources were selected and interviewed. A piloted self-administered questionnaire was used to gather information from these respondents. A total of thirty (30) questionnaires to the LIS professionals-ten from each of the three selected academic libraries were administered. The study developed a proposed conceptual framework for DLns’ that details the pertinent issues currently facing academic libraries when hiring DLns. The study recommended that the provided framework be adopted to guide library managers in identifying the needs of staff training and selecting the most adequate training method as well as settling on the best practices to be sent to staff for training and development.

Keywords: digital, academic, libraries, framework

Procedia PDF Downloads 108

Authors: Bolin Hua

Abstract:

In city governance, various data are involved, including city component data, demographic data, housing data and all kinds of business data. These data reflects different aspects of people, events and activities. Data generated from various systems are different in form and data source are different because they may come from different sectors. In order to reflect one or several facets of an event or rule, data from multiple sources need fusion together. Data from different sources using different ways of collection raised several issues which need to be resolved. Problem of data fusion include data update and synchronization, data exchange and sharing, file parsing and entry, duplicate data and its comparison, resource catalogue construction. Governments adopt statistical analysis, time series analysis, extrapolation, monitoring analysis, value mining, scenario prediction in order to achieve pattern discovery, law verification, root cause analysis and public opinion monitoring. The result of Multi-source data fusion is to form a uniform central database, which includes people data, location data, object data, and institution data, business data and space data. We need to use meta data to be referred to and read when application needs to access, manipulate and display the data. A uniform meta data management ensures effectiveness and consistency of data in the process of data exchange, data modeling, data cleansing, data loading, data storing, data analysis, data search and data delivery.

Keywords: multi-source data fusion, urban comprehensive management, information fusion, government data

Procedia PDF Downloads 393

Authors: Ratneev Kaur, Tajinder Kaur, Anupam Kaur

Abstract:

Introduction: Polycystic Ovary Syndrome (PCOS) is a heterogenous disorder of endocrine system among women of reproductive age. PCOS is characterized by hyperandrogenism, anovulation, polycystic ovaries, hirsutism, obesity, and hyperinsulinemia. Several pathways are implicated in its etiology including the metabolic pathway of steroid hormone synthesis regulatory pathways. PCOS is an androgen excess disorder, genes operating in steroidogenesis may alter pathogenesis of PCOS. The cytochrome P450scc is a cholesterol side chain cleavage enzyme coded by CYP11A1 gene and catalyzes conversion of cholesterol to pregnenolone, the initial and rate-limiting step in steroid hormone synthesis. It is postulated that polymorphisms in this gene may play an important role in the regulation of CYP11A1 expression and leading to increased or decreased androgen production. The present study will be the first study from north India to best of our knowledge, to analyse the association of CYP11A1 (rs11632698) polymorphism in women suffering from PCOS. Methodology: The present study was approved by ethical committee of Guru Nanak Dev University in consistent with declaration of Helsinki. A total of 300 samples (150 PCOS cases and 150 controls) were recruited from Hartej hospital, for the present study. Venous blood sample (3ml) was withdrawn from women diagnosed with PCOS by doctor, according to Rotterdam 2003 criteria and from healthy age matched controls only after informed consent and detailed filled proforma. For molecular genetics analysis, blood was stored in EDTA vials. After DNA isolation by organic method, PCR-RFLP approach was used for genotyping and association analysis of rs11632698 polymorphism. Statistical analysis was done to check for significance of selected polymorphism with PCOS. Results: In 150 PCOS cases, the frequency of AA, AG and GG genotype was found to be 48%, 35%, and 13% compared to 62%, 27% and 8% in 150 controls. The major allele (A) and minor allele (G) frequency was 68% and 32% in cases and 78% and 22% in controls. Minor allele frequency was higher in cases as compared to controls, as well as the distribution of genotype was observed to be statistically significant (ᵡ²=6.525, p=0.038). Odds ratio in dominant, co-dominant and recessive models observed was 1.81 (p=0.013), 1.54 (p=0.012) and 1.77 (p=0.132) respectively. Conclusion: The present study showed statistically significant association of rs11632698 with PCOS (p=0.038) in North Indian women.

Keywords: polycystic ovary syndrome, CYP11A1, rs11632698, hyperandrogenism

Procedia PDF Downloads 142

Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

Abstract:

Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

Procedia PDF Downloads 192

Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

Abstract:

Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: catchment area of healthcare, chronic disease management, Geographic information system, quality of diabetes care

Procedia PDF Downloads 282

Authors: Anis Al-Yakhiri

Abstract:

Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

Procedia PDF Downloads 82

Authors: Pedro G. Rodrigues, Maria J. Bárrios, Sara A. Ambrósio

Abstract:

The digitalisation of health is a profoundly transformative economic, political, and social process. As is often the case, such processes need to be carefully managed if misunderstandings, policy misalignments, or outright conflicts between the government and a wide gamut of stakeholders with competing interests are to be avoided. Thus, ensuring open lines of communication where all parties know what each other’s concerns are is key to good governance, as well as efficient and effective policymaking. This project aims to make a small but still significant contribution in this regard in that we seek to determine the extent to which health managers’ perceptions of what is a priority for digital health in Portugal are aligned with official policy perspectives. By applying state-of-the-art artificial intelligence technology first to the indexed literature on digital health and then to a set of official policy documents on the same topic, followed by a survey directed at health managers working in public and private hospitals in Portugal, we obtain two priority rankings that, when compared, will allow us to produce a synthesis and toolkit on digital health policy in Portugal, with a view to identifying areas of policy convergence and divergence. This project is also particularly peculiar in the sense that sophisticated digital methods related to text analytics are employed to study good governance aspects of digitalisation applied to health care.

Keywords: digital health, health informatics, text analytics, governance, natural language understanding

Procedia PDF Downloads 65

Authors: Abdelkader T. Ahmed, Ayed E. Alluqmani

Abstract:

The population growth in the KSA beside the increase in the urbanization level and standard of living improvement have resulted in the rapid growth of the country’s Municipal Solid Waste (MSW) generation. Municipalities are managing the MSW system in the KSA by collecting and getting rid of it by dumping it in nearest open landfill sites. Solid waste management is one of the main critical issues considered worldwide due to its significant impact on the environment and the public health. In this study, municipal solid waste (MSW) generation, composition and collection of Madinah city, as one of largest cities in KSA, were examined to provide an overview of current state of MSW management, an analysis of existing problem in MSW management, and recommendations for improving the waste treatment and management system in this area. These recommendations would be not specific to Madinah region, but also would be applied to other cities in KSA or any other regions with similar features. The trend of waste generation showed that current waste generation would be increased as much as two to three folds in 2030. Approximately 25% of total generated waste is disposed to a sanitary landfill, while 75% is sent to normal dumpsites. This study also investigated the environmental impacts of MSW through the Life Cycle Assessment (LCA) of waste generations and related processes. LCA results revealed that among the seven scenarios, recycling and composting are the best scenario for the solid waste management in Madinah and similar regions.

Keywords: municipal solid waste, waste recycling and land-filling, waste management, life cycle assessment

Procedia PDF Downloads 464

Authors: Fuyuan Ma, Ying Wang, Xin Wang

Abstract:

Social networks have become breeding grounds for the rapid spread of rumors and malicious information, posing threats to societal stability and causing significant public harm. Existing research focuses on simulating the spread of information and its impact on users through propagation dynamics and applies methods such as greedy approximation strategies to approximate the optimal control solution at the global scale. However, the greedy strategy at the global scale may fall into locally optimal solutions, and the approximate simulation of information spread may accumulate more errors. Therefore, we propose a multi-scale control model for network group behavior, introducing individual and group scales on top of the greedy strategy’s global scale. At the individual scale, we calculate the propagation influence of nodes based on their structural attributes to alleviate the issue of local optimality. At the group scale, we conduct precise propagation simulations to avoid introducing cumulative errors from approximate calculations without increasing computational costs. Experimental results on three real-world datasets demonstrate the effectiveness of our proposed multi-scale model in controlling network group behavior.

Keywords: influence blocking maximization, competitive linear threshold model, social networks, network group behavior

Procedia PDF Downloads 21

Authors: Ibrahim Uba Yusuf

Abstract:

Conflict is a subject or, better put, theme that primarily dominates Hausa home videos. Conflict in Hausa home videos is one of the sources of attraction to viewers, but do such films achieve anything? The Hausa home video industry in Northern Nigeria, popularly called Kannywood has been making attempts by producing cultural products for consumption within and outside the country. The ability of the industry to connect issues of concern within the region is an effort to reckon with. This paper, therefore, examines how Hausa home videos on peacebuilding can serve as a template for peacebuilding. This is coming at a time when global attention to peacebuilding is increasing. The inclusion of peacebuilding as SDG Goal suggests the need for utilizing other approaches that can enhance peace in risk societies like Nigeria. The paper based its arguments using the key proponents of the auteur theory—the director’s bias, thoughts, and sense of reasoning shape the issues emphasized in the home videos. The paper argues that Hausa home video industry is one medium amongst the many producing discourse about peacebuilding, conflict, and justice, social cohesion, education, and understanding, as well as raising social consciousness on issues of public concern. It is the conclusion of the paper that Hausa home videos produced on sustaining peacebuilding in Northern Nigeria are cultural products that have become lenses to understanding the interplay between representations or portrayal of conflict and peaceful resolutions of the conflicting issues.

Keywords: hausa home videos, peacebuilding, conflict, northern Nigeria

Procedia PDF Downloads 119

Authors: Khodi Morgan, Kasey Crowe, Amanda Morgan

Abstract:

Canadian High School Students' Attitudes & Objective: To survey Canadian high school students regarding their attitudes and perspectives towards people with disabilities and explore how age, gender, and personal experience with a disability may impact these views. Methods: A survey was developed using the standardized Attitude Toward Persons With Disability Scale as its base, with the addition of questions specifically about Autism and Attention Deficit Hyperactivity Disorder (ADHD). The survey also gathered information about the participant’s age and gender and whether or not they, or a close family member, had any disabilities. Participants were recruited at a public Canadian high school by fellow student researchers. Results: A total of 219 (N=219) students ranging from 13 - 19 years old participated in the study (m= 15.9 years of age). Gender was equally split, with 44% male, 42% female and 14% undeclared. Experience with a disability was common amongst participants, with 25% self-identifying as having a personal disability and 48% claiming to have a close family member with a disability. Exploratory trends indicated that females, people with self-identified disabilities, and people with close family members with disabilities trended towards having more positive attitudes toward persons with disabilities.

Keywords: disability, autism, ADHD, high school, adolescence, community research, acceptance

Procedia PDF Downloads 79

Authors: Shahla Ali

Abstract:

In the context of promoting green infrastructure development, new opportunities are emerging to re-examine sustainable development practices. This paper presents an initial exploration of the development of community-investor dispute prevention and facilitation mechanisms in the context of the Belt and Road Initiative (BRI) spanning Asia, Africa, and Europe. Given the widescale impact of China’s multi-jurisdictional development initiative, learning how to coordinate with local communities is vital to realizing inclusive and sustainable growth. In the 20 years since the development of the first multilateral community-investor dispute resolution mechanism developed by the International Finance Centre/World Bank, much has been learned about public facilitation, community engagement, and dispute prevention during the early stages of major infrastructure development programs. This paper will explore initial findings as they relate to initiatives underway along the BRI within the Asian Infrastructure Investment Bank and the Asian Development Bank. Given the borderless nature of sustainability concerns, insights from diverse regions are critical to deepening insights into best practices. Drawing on a case-based methodology, this paper will explore the achievements, challenges, and lessons learned in community-investor dispute prevention and resolution for major infrastructure projects in the greater China region.

Keywords: law and development, dispute prevention, sustainable development, mitigation

Procedia PDF Downloads 106

Authors: Mohamed Rasslan, Doaa Abdelrahman, Mahmoud M. Nasreldin, Ghada Farouk, Heba K. Aslan

Abstract:

Blockchain is a distributed database that endorses transparency while bitcoin is a decentralized cryptocurrency (electronic cash) that endorses anonymity and is powered by blockchain technology. Smart contracts are programs that are stored on a blockchain. Smart contracts are executed when predetermined conditions are fulfilled. Smart contracts automate the agreement execution in order to make sure that all participants immediate-synchronism of the outcome-certainty, without any intermediary's involvement or time loss. Currently, the Bitcoin market worth billions of dollars. Bitcoin could be transferred from one purchaser to another without the need for an intermediary bank. Network nodes through cryptography verify bitcoin transactions, which are registered in a public-book called “blockchain”. Bitcoin could be replaced by other coins, merchandise, and services. Rapid growing of the bitcoin market-value, encourages its counterparts to make use of its weaknesses and exploit vulnerabilities for profit. Moreover, it motivates scientists to define known vulnerabilities, offer countermeasures, and predict future threats. In his paper, we study blockchain technology and bitcoin from the attacker’s point of view. Furthermore, mitigations for the attacks are suggested, and contemporary security solutions are discussed. Finally, research methods that achieve strict security and privacy protocol are elaborated.

Keywords: Cryptocurrencies, Blockchain, Bitcoin, Smart Contracts, Peer-to-Peer Network, Security Issues, Privacy Techniques

Procedia PDF Downloads 82

Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

Abstract:

Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

Procedia PDF Downloads 136

Authors: Huilei Wang, Yuanfeng Wang

Abstract:

In the early period of China, economy developed rapidly at the cost of environment. Recently, it is generally recognized that the heavily polluted environment not only puts a brake on economic development but also paces negative impact on people’ health as well as probably next decades of generations. Accordingly, the latest Environmental Protection Law revised in 2014 makes a clear-cut division of environmental responsibility and regulates stricter penalties of breaching law. As the new environmental law is enforced gradually, environmental forensic is increasingly required in the process of ascertaining facts in judicial proceedings of environmental cases. Based on the outcomes of documentary analysis for all environmental cases judged on the basis of new environmental law, it is concluded that there still exists problems in present system of environmental forensic. Thus, this paper is aimed to make proposition on improving Chinese environmental forensic system, which involves: (i) promoting capability of environmental forensic system (EFS) to handle professional questions; (ii) develop price mechanism; (iii) multi-departments cooperate to establish unifying and complete EFS system;(iv) enhance the probative value of results of EFS. Such protocol for amending present regulation on environmental forensic is of significant importance because a quality report of environmental forensic will contributes to providing strong probative evidence of culprits’ activity of releasing contaminant into environment, degree of damages for victims and above all, causality between the behavior of public nuisance and damages.

Keywords: China, environmental cases, environmental forensic system, proposition

Procedia PDF Downloads 378