Search results for: successful treatment
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10199

Search results for: successful treatment

4709 Defining Heritage Language Learners of Arabic: Linguistic and Cultural Factors

Authors: Rasha Elhawari

Abstract:

Heritage language learners (HLL) are part of the linguistic reality in Foreign Language Learning (FLL). These learners present several characteristics that are different from non-heritage language learners. They have a personal connection with the language and their motivation to learn the language is partly because of this personal connection. In Canada there is a large diversity in the foreign language learning classroom; the Arabic language classroom is no exception. The Arabic HLL is unique for more than one reason. First, is the fact that the Arabic language is spoken across twenty-two Arab countries across the Arab World. Across the Arab World there is a standard variation and a local dialect that co-exist side by side, i.e. diaglossia exists in a strong and unique way as a feature of Arabic. Second, Arabic is the language that all Muslims across the Muslim World use for their prayers. This raises a number of points when we consider Arabic as a Heritage Language; namely the role of diaglossia, culture and religion. The fact that there is a group of leaners that can be regarded as HLL who are not of Arabic speaking background but are Muslims and use the language for religious purposes is unique, thus course developers and language instructors need take this into consideration. The paper takes a closer look at this distinction and establishes sub-groups the Arabic HLLs in a language and/or culture specific way related mainly to the Arabic HLL. It looks at the learners at the beginners’ Arabic class at the undergraduate university level over a period of three years in order to define this learner. Learners belong to different groups and backgrounds but they all share common characteristics. The paper presents a detailed look at the learner types present at this class in order to help prepare and develop material for this specific learner group. The paper shows that separate HLL and non-HLL courses, especially at the introductory and intermediate level, is successful in resolving some of the pedagogical problems that occur in the Arabic as a Foreign Language classroom. In conclusion, the paper recommends the development of HLL courses at the early levels of language learning. It calls for a change in the pedagogical practices to overcome some of the challenges learner in the introductory Arabic class can face.

Keywords: Arabic, Heritage Language, langauge learner, teaching

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4708 The Use of Microorganisms in the Bioleaching of Soils Polluted with Heavy Metals

Authors: I. M. Sur, A. M. Chirila-Babau, T. Gabor, V. Micle

Abstract:

This paper shows researches in order to extract Cr, Cu and Ni from the polluted soils. Research is based on preliminary studies regarding the usage of Thiobacillus ferrooxidans bacterium (9K medium) for bioleaching of soil polluted with heavy metal (Cu, Cr and Ni). The microorganisms (Thiobacillus ferooxidans) selected directly from polluted soil samples were used in this experimental work. Soil samples used in the experimental research were taken from an area polluted with heavy metals from Romania. The soil samples are subjected to the cleaning process using the 9K medium solution (20 mL and 40 mL, respectively), stirred 200 rpm for 20 hours at a controlled temperature (30 ˚C). During the experiment (0, 2, 4, 8 and 20 h), liquid samples have been extracted and analyzed using the Atomic Absorption Spectrophotometer AA-6800 (AAS) in order to determine the Cr, Cu and Ni concentration. Experiments led to the conclusion that these soils can be depolluted by bioleaching, being a biological treatment method involving the use of microorganisms to favor the extraction of Cr, Cu and Ni from polluted soils.

Keywords: bioleaching, extraction, microorganisms, soil, polluted, Thiobacillus ferooxidans

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4707 High Temperature Oxidation Behavior of Aluminized Steel by Arc Spray and Cementation Techniques

Authors: Minoo Tavakoli, Alireza Kiani Rashid, Abbas Afrasiabi

Abstract:

An aluminum coating deposited on mild steel substrate by electric arc spray and diffused to the base steel material by diffusion treatment at 800 and 900°C for 1 and 3 hours in a static air. Alloy layers formed by diffusion at both temperatures were investigated, and their features were compared with those of pack cementation aluminized steel. High-temperature oxidation tests were carried out in air at 600 °C for 145 hours. Results indicated that the aluminide coatings obtained from this process have significantly improved the high-temperature oxidation resistance in both methods due to the Al2O3 scale formation. Furthermore, it showed that the isothermal oxidation resistance of arc spray technique is better than pack cementation method. This can be attributed to voids that formed at the intermetallic layer /Al layer interface which is increased in the pack cementation method.

Keywords: electric arc spray, pack cementation, oxidation resistance, aluminized steel

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4706 Polyurethane Membrane Mechanical Property Study for a Novel Carotid Covered Stent

Authors: Keping Zuo, Jia Yin Chia, Gideon Praveen Kumar Vijayakumar, Foad Kabinejadian, Fangsen Cui, Pei Ho, Hwa Liang Leo

Abstract:

Carotid artery is the major vessel supplying blood to the brain. Carotid artery stenosis is one of the three major causes of stroke and the stroke is the fourth leading cause of death and the first leading cause of disability in most developed countries. Although there is an increasing interest in carotid artery stenting for treatment of cervical carotid artery bifurcation therosclerotic disease, currently available bare metal stents cannot provide an adequate protection against the detachment of the plaque fragments over diseased carotid artery, which could result in the formation of micro-emboli and subsequent stroke. Our research group has recently developed a novel preferential covered-stent for carotid artery aims to prevent friable fragments of atherosclerotic plaques from flowing into the cerebral circulation, and yet retaining the ability to preserve the flow of the external carotid artery. The preliminary animal studies have demonstrated the potential of this novel covered-stent design for the treatment of carotid therosclerotic stenosis. The purpose of this study is to evaluate the biomechanical property of PU membrane of different concentration configurations in order to refine the stent coating technique and enhance the clinical performance of our novel carotid covered stent. Results from this study also provide necessary material property information crucial for accurate simulation analysis for our stents. Method: Medical grade Polyurethane (ChronoFlex AR) was used to prepare PU membrane specimens. Different PU membrane configurations were subjected to uniaxial test: 22%, 16%, and 11% PU solution were made by mixing the original solution with proper amount of the Dimethylacetamide (DMAC). The specimens were then immersed in physiological saline solution for 24 hours before test. All specimens were moistened with saline solution before mounting and subsequent uniaxial testing. The specimens were preconditioned by loading the PU membrane sample to a peak stress of 5.5 Mpa for 10 consecutive cycles at a rate of 50 mm/min. The specimens were then stretched to failure at the same loading rate. Result: The results showed that the stress-strain response curves of all PU membrane samples exhibited nonlinear characteristic. For the ultimate failure stress, 22% PU membrane was significantly higher than 16% (p<0.05). In general, our preliminary results showed that lower concentration PU membrane is stiffer than the higher concentration one. From the perspective of mechanical properties, 22% PU membrane is a better choice for the covered stent. Interestingly, the hyperelastic Ogden model is able to accurately capture the nonlinear, isotropic stress-strain behavior of PU membrane with R2 of 0.9977 ± 0.00172. This result will be useful for future biomechanical analysis of our stent designs and will play an important role for computational modeling of our covered stent fatigue study.

Keywords: carotid artery, covered stent, nonlinear, hyperelastic, stress, strain

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4705 Green Synthesis of Nicotine Analogues via Cycloaddition Reactions

Authors: Agnieszka Fryźlewicz, Jowita Kras, Mikołaj Sadowski, Agnieszka Łapczuk-Krygier, Agnieszka Kącka-Zych Radomir Jasiński

Abstract:

Nicotines are a group of compounds containing conjugated pyridine and pyrrolidine molecular segments. They are widely applied in medicine, pharmacy, and agriculture. Namely as researched treatment of Alzheimer, depression, Parkinson's, Tourette syndrome, general nervous and mental disorders. Furthermore, nicotine itself is used as a stimulant, animal repellent and was widely applied as an insecticide. In our work, we obtained nicotine analogues with possible applications in agriculture. The synthesis employed [3+2] cycloaddition (32CA) reactions, occurring between pirydyl-functionalised nitrones and conjugated nitroalkenes, that allowed us to fully regio- and stereoselectively obtain product. Moreover, cycloaddition reaction realizes rapidly in mild conditions with the full atomic economy, thus fitting into “green chemistry” trends.

Keywords: nicotine, isoxazolidine, 1-3-dipolar cycloaddition, green chemistry, biological and pharmacological activity

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4704 Consumption Insurance against the Chronic Illness: Evidence from Thailand

Authors: Yuthapoom Thanakijborisut

Abstract:

This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: consumption insurance, chronic illness, health care, Thailand

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4703 Remote Patient Monitoring for Covid-19

Authors: Launcelot McGrath

Abstract:

The Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, resulting in high mortality rates and very large numbers of people requiring medical treatment in ICU. Management of patient hospitalisation is a critical aspect to control this disease and reduce chaos in the healthcare systems. Remote monitoring provides a solution to protect vulnerable and elderly high-risk patients. Continuous remote monitoring of oxygen saturation, respiratory rate, heart rate, and temperature, etc., provides medical systems with up-to-the-minute information about their patients' statuses. Remote monitoring also limits the spread of infection by reducing hospital overcrowding. This paper examines the potential of remote monitoring for Covid-19 to assist in the rapid identification of patients at risk, facilitate the detection of patient deterioration, and enable early interventions.

Keywords: remote monitoring, patient care, oxygen saturation, Covid-19, hospital management

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4702 The Relationship between Wasting and Stunting in Young Children: A Systematic Review

Authors: Susan Thurstans, Natalie Sessions, Carmel Dolan, Kate Sadler, Bernardette Cichon, Shelia Isanaka, Dominique Roberfroid, Heather Stobagh, Patrick Webb, Tanya Khara

Abstract:

For many years, wasting and stunting have been viewed as separate conditions without clear evidence supporting this distinction. In 2014, the Emergency Nutrition Network (ENN) examined the relationship between wasting and stunting and published a report highlighting the evidence for linkages between the two forms of undernutrition. This systematic review aimed to update the evidence generated since this 2014 report to better understand the implications for improving child nutrition, health and survival. Following PRISMA guidelines, this review was conducted using search terms to describe the relationship between wasting and stunting. Studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting, as well as the association between the two, were included. Risk of bias was assessed in all included studies using SIGN checklists. 45 studies met the inclusion criteria- 39 peer reviewed studies, 1 manual chapter, 3 pre-print publications and 2 published reports. The review found that there is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Possible interconnected physiological processes and common risk factors drive an accumulation of vulnerabilities. Peak incidence of both wasting and stunting was found to be between birth and three months. A significant proportion of children experience concurrent wasting and stunting- Country level data suggests that up to 8% of children under 5 may be both wasted and stunted at the same time, global estimates translate to around 16 million children. Children with concurrent wasting and stunting have an elevated risk of mortality when compared to children with one deficit alone. These children should therefore be considered a high-risk group in the targeting of treatment. Wasting, stunting and concurrent wasting and stunting appear to be more prevalent in boys than girls and it appears that concurrent wasting and stunting peaks between 12- 30 months of age with younger children being the most affected. Seasonal patterns in prevalence of both wasting and stunting are seen in longitudinal and cross sectional data and in particular season of birth has been shown to have an impact on a child’s subsequent experience of wasting and stunting. Evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z-score might effectively identify children most at risk of near-term mortality, including those concurrently wasted and stunted. Wasting and stunting frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence suggests there is a process of accumulation of nutritional deficits and therefore risk over the life course of a child demonstrates the need for a more integrated approach to prevention and treatment strategies to interrupt this process. To achieve this, undernutrition policies, programmes, financing and research must become more unified.

Keywords: Concurrent wasting and stunting, Review, Risk factors, Undernutrition

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4701 Screening of Nickel-Tolerant Genotype of Mung Bean (Vigna radiata) Based on Photosynthesis and Antioxidant System

Authors: Mohammad Yusuf, Qazi Fariduddin

Abstract:

The main aim of this study was to explore the different cultivars of Vigna radiata on basis of photosynthesis, antioxidants and proline to assess Ni-sensitive and Ni-tolerant cultivar. Seeds of five different cultivars were sown in soil amended with different levels of Ni (0, 50, 100, or 150 mg kg 1). At 30 d stage, plants were harvested to assess the various parameters. The Ni treatment diminished growth, leaf water potential, chlorophyll content and net photosynthesis along with nitrate reductase and carbonic anhydrase activities in the concentration dependent manner whereas, it enhanced proline content and various antioxidant enzymes. The varieties T-44 found least affected, whereas PDM-139 experienced maximum damage at 150 mg kg-1 of Ni. Moreover, T-44 possessed maximum activity of antioxidant enzymes and proline content at all the levels of metal whereas PDM-139 possessed minimum values. Therefore, T-44 and PDM-139 were established as the most resistant and sensitive varieties, respectively.

Keywords: Vigna radiata, antioxidants, nickel, photosynthesis, proline

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4700 Development of Fixture for Pipe to Pipe Friction Stir Welding of Dissimilar Materials

Authors: Aashutosh A. Tadse, Kush Mehta, Hardik Vyas

Abstract:

Friction Stir Welding is a process in which an FSW tool produces friction heat and thus penetrates through the junction and upon rotation carries out the weld by exchange of material within the 2 metals being welded. It involves holding the workpieces stiff enough to bear the force of the tool moving across the junction to carry out a successful weld. The weld that has flat plates as workpieces, has a quite simpler geometry in terms of fixture holding them. In the case of FSW of pipes, the pipes need to be held firm with the chucks and jaws according to the diameter of the pipes being welded; the FSW tool is then revolved around the pipes to carry out the weld. Machine requires a larger area and it becomes more costly because of such a setup. To carry out the weld on the Milling machine, the newly designed fixture must be set-up on the table of milling machine and must facilitate rotation of pipes by the motor being shafted to one end of the fixture, and the other end automatically rotated because of the rotating jaws held tight enough with the pipes. The set-up has tapered cones as the jaws that would go in the pipes thus holding it with the help of its knurled surface providing the required grip. The process has rotation of pipes with the stationary rotating tool penetrating into the junction. The FSW on pipes in this process requires a very low RPM of pipes to carry out a fine weld and the speed shall change with every combination of material and diameter of pipes, so a variable speed setting motor shall serve the purpose. To withstand the force of the tool, an attachment to the shaft is provided which will be diameter specific that will resist flow of material towards the center during the weld. The welded joint thus carried out will be proper to required standards and specifications. Current industrial requirements state the need of space efficient, cost-friendly and more generalized form of fixtures and set-ups of machines to be put up. The proposed design considers every mentioned factor and thus proves to be positive in the same.

Keywords: force of tool, friction stir welding, milling machine, rotation of pipes, tapered cones

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4699 Effective Microorganisms as a Sustainable Environment Product and Their Application: A Study in Pakistan

Authors: Jaffar Hussain, Farman Ali Shah

Abstract:

As we know that Pakistan is the developing country so it adopts new technologies for progress. In last three decays, some new technologies were introduced in the world in which Effective Microorganism was one of them. Microorganisms are one of the most power full living forces on earth. Originally, EM was developed as an odor control, farm, and animal health, human health many industrial treatments. Effective Microorganism is an organic fertilizer that contains a mixture of co-existing valuable microorganism composed from the environment. There are vast application of the EM in the world in which the researchers are explained in literature .In Pakistan work on EM technologies are under process, researcher are doing work to make them most valuable. At that time the application of EM are in agriculture, water treatment, to increase Cement strength, improving saline soil etc. Effective microorganisms are environmentally friendly , not-naturally organized, not chemically synthesized, not dangerous and not pathogenic.

Keywords: developing country, technologies, effective microorganism, researchers, Pakistan, agriculture

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4698 Outcome Evaluation of a Blended-Learning Mental Health Training Course in South African Public Health Facilities

Authors: F. Slaven, M. Uys, Y. Erasmus

Abstract:

The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

Procedia PDF Downloads 107
4697 Implant Guided Surgery and Immediate Loading

Authors: Omid Tavakol, Mahnaz Gholami

Abstract:

Introduction : In this oral presentation the main goal is discussing immediate loading in dental implants , from treatment planning and surgical guide designing to delivery , follow up and occlusal consideration . Methods and materials : first of all systematic reviews about immediate loading will be considered . besides , a comparison will be made between immediate loading and conventional loading in terms of success rate and complications . After that different methods , prosthetic options and materials best used in immediate loading will be explained. Particularly multi unit abutments and their mechanism of function will be explained .Digital impressions and designing the temporaries is the next topic we are to explicate .Next issue is the differences between single unit , multiple unit and full arch implantation in immediate loading .Following we are going to describe methods for tissue engineering and papilla formation after extraction . Last slides are about a full mouth rehabilitation via immediate loading technique from surgical designing to follow up .At the end we would talk about potential complications , how to prevent from occurrence and what to do if we face up with .

Keywords: guided surgery, digital implantology, immediate loading, digital dentistry

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4696 Anaerobic Co-Digestion of Duckweed (Lemna gibba) and Waste Activated Sludge in Batch Mode

Authors: Rubia Gaur, Surindra Suthar

Abstract:

The present study investigates the anaerobic co-digestion of duckweed (Lemna gibba) and waste activated sludge (WAS) of different proportions with acclimatized anaerobic granular sludge (AAGS) as inoculum in mesophilic conditions. Batch experiments were performed in 500 mL capacity reagent bottles at 300C temperature. Varied combinations of pre-treated duckweed biomass with constant volume of anaerobic inoculum (AAGS - 100 mL) and waste activated sludge (WAS - 22.5 mL) were devised into five batch tests. The highest methane generation was observed with batch study, T4. The Gompertz model fits well on the experimental data of the batch study, T4. The values of correlation coefficient were achieved relatively higher (R2 ≥ 0.99). The co-digestion without pre-treatment of both duckweed and WAS shows poor generation of methane gas.

Keywords: aquatic weed, biogas, biomass, Gompertz equation, waste activated sludge

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4695 MicroRNA 200c-3p Regulates Autophagy Mediated Upregulation of Endoplasmic Reticulum Stress in PC-3 Cells

Authors: Eun Jung Sohn, Hwan Tae Park

Abstract:

Autophagy is a cellular response to stress or environment on cell survival. Here, we investigated the role of ectopic expression of miR 200c-3p in autophagy. Ectopic expression of miR 200c-3p increased the expression of IRE1alpha, ATF6 and CHOP by western blot and RT-qPCR. Furthermore, the level of microRNA 200c-3p was enhanced by treatment of TG or overexpression of GRP 78. Also, ectopic expression of miR200c-3p increased the LC3 II expression by western blot and RT-qPCR. Also, we found that western blot assay showed that miR200c-3p inhibitor was blocked the starvation–induced LC3II levels. Furthermore, starvation stress increased the level of miR200c-3p in different kinetics. Ectopic expression of miR200c-3p attenuated LC3II expression in IRE1 siRNA transfected PC3 cells. Here, we first demonstrate that miR200c-3p regulates autophagy via ER stress pathway.

Keywords: Autophagy, ER stress, LC3II, miR200c-3p

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4694 Flowsheet Development, Simulation and Optimization of Carbon-Di-Oxide Removal System at Natural Gas Reserves by Aspen–Hysys Process Simulator

Authors: Mohammad Ruhul Amin, Nusrat Jahan

Abstract:

Natural gas is a cleaner fuel compared to the others. But it needs some treatment before it is in a state to be used. So natural gas purification is an integral part of any process where natural gas is used as raw material or fuel. There are several impurities in natural gas that have to be removed before use. CO2 is one of the major contaminants. In this project we have removed CO2 by amine process by using MEA solution. We have built up the whole amine process for removing CO2 in Aspen Hysys and simulated the process. At the end of simulation we have got very satisfactory results by using MEA solution for the removal of CO2. Simulation result shows that amine absorption process enables to reduce CO2 content from NG by 58%. HYSYS optimizer allowed us to get a perfect optimized plant. After optimization the profit of existing plant is increased by 2.34 %.Simulation and optimization by Aspen-HYSYS simulator makes available us to enormous information which will help us to further research in future.

Keywords: Aspen–Hysys, CO2 removal, flowsheet development, MEA solution, natural gas optimization

Procedia PDF Downloads 488
4693 Medical/Surgical Skills Day Improves Nurse Competence and Satisfaction

Authors: Betsy Hannam

Abstract:

Background: Staff nurses felt overwhelmed to learn new skills or complete competencies during their shift. Med/Surg units need to provide dedicated, uninterrupted time to complete training and mandatory competencies and practice skills. Purpose: To improve nurse satisfaction and competence by creating a Skills Day with uninterrupted time to complete competencies, brush up on skills, and evaluate skills learned through pre- and post-tests. Methods: The USL and CNL interviewed nurses to obtain input regarding skills needing reinforcement and included mandatory competencies relevant to Med/Surg to create the Skills Day agenda. Content experts from multiple disciplines were invited to educate staff to help address knowledge gaps. To increase attendance, multiple class days were offered. Results: 2018 Skills Day was held for an inpatient unit with 95% participation (n=35 out of 37RNs). The average pretest score, comprised of content questions from topics discussed, was 57%, and post test scoresaveraged 80%. 94% of test scores improved or remained the same. RNs were given an evaluation at the end of the day, where100% of staff noted Skills Day as beneficial, and 97% requested to repeat next year. Another Med/Surg unit asked to join Skills Day in 2019. In 2019, with 89% participation (n=57 out 64 RNs), the average pretest score was 68%, and the average post test score was 85%. 97% of scores improved or remained the same. 98% reported the class as beneficial, and 96% requested to repeat next year. Skills Day 2020-2022 on hold due to COVID. Looking forward to Skills Day 2023. Conclusion: Skills Day allows nurses to maintain competencies and improve knowledge in areas of interest without the stress of a patient assignment. Having unit leaders organize Skills Day, with the involvement of content experts from multiple disciplines, showed to be a successful and innovative team approach to support professional development.

Keywords: education, competency, skills day, medical/surgical

Procedia PDF Downloads 93
4692 Treatment and Diagnostic Imaging Methods of Fetal Heart Function in Radiology

Authors: Mahdi Farajzadeh Ajirlou

Abstract:

Prior evidence of normal cardiac anatomy is desirable to relieve the anxiety of cases with a family history of congenital heart disease or to offer the option of early gestation termination or close follow-up should a cardiac anomaly be proved. Fetal heart discovery plays an important part in the opinion of the fetus, and it can reflect the fetal heart function of the fetus, which is regulated by the central nervous system. Acquisition of ventricular volume and inflow data would be useful to quantify more valve regurgitation and ventricular function to determine the degree of cardiovascular concession in fetal conditions at threat for hydrops fetalis. This study discusses imaging the fetal heart with transvaginal ultrasound, Doppler ultrasound, three-dimensional ultrasound (3DUS) and four-dimensional (4D) ultrasound, spatiotemporal image correlation (STIC), glamorous resonance imaging and cardiac catheterization. Doppler ultrasound (DUS) image is a kind of real- time image with a better imaging effect on blood vessels and soft tissues. DUS imaging can observe the shape of the fetus, but it cannot show whether the fetus is hypoxic or distressed. Spatiotemporal image correlation (STIC) enables the acquisition of a volume of data concomitant with the beating heart. The automated volume accession is made possible by the array in the transducer performing a slow single reach, recording a single 3D data set conforming to numerous 2D frames one behind the other. The volume accession can be done in a stationary 3D, either online 4D (direct volume scan, live 3D ultrasound or a so-called 4D (3D/ 4D)), or either spatiotemporal image correlation-STIC (off-line 4D, which is a circular volume check-up). Fetal cardiovascular MRI would appear to be an ideal approach to the noninvasive disquisition of the impact of abnormal cardiovascular hemodynamics on antenatal brain growth and development. Still, there are practical limitations to the use of conventional MRI for fetal cardiovascular assessment, including the small size and high heart rate of the mortal fetus, the lack of conventional cardiac gating styles to attend data accession, and the implicit corruption of MRI data due to motherly respiration and unpredictable fetal movements. Fetal cardiac MRI has the implicit to complement ultrasound in detecting cardiovascular deformations and extracardiac lesions. Fetal cardiac intervention (FCI), minimally invasive catheter interventions, is a new and evolving fashion that allows for in-utero treatment of a subset of severe forms of congenital heart deficiency. In special cases, it may be possible to modify the natural history of congenital heart disorders. It's entirely possible that future generations will ‘repair’ congenital heart deficiency in utero using nanotechnologies or remote computer-guided micro-robots that work in the cellular layer.

Keywords: fetal, cardiac MRI, ultrasound, 3D, 4D, heart disease, invasive, noninvasive, catheter

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4691 A Time since of Injection Model for Hepatitis C Amongst People Who Inject Drugs

Authors: Nader Al-Rashidi, David Greenhalgh

Abstract:

Mathematical modelling techniques are now being used by health organizations worldwide to help understand the likely impact that intervention strategies treatment options and combinations of these have on the prevalence and incidence of hepatitis C virus (HCV) in the people who inject drugs (PWID) population. In this poster, we develop a deterministic, compartmental mathematical model to approximate the spread of the HCV in a PWID population that has been divided into two groups by time since onset of injection. The model assumes that after injection needles adopt the most infectious state of their previous state or that of the PWID who last injected with them. Using analytical techniques, we find that the model behaviour is determined by the basic reproductive number R₀, where R₀ = 1 is a critical threshold separating two different outcomes. The disease-free equilibrium is globally stable if R₀ ≤ 1 and unstable if R₀ > 1. Additionally, we make some simulations where have confirmed that the model tends to this endemic equilibrium value with realistic parameter values giving an HCV prevalence.

Keywords: hepatitis C, people who inject drugs, HCV, PWID

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4690 Gas While Drilling (GWD) Classification in Betara Complex; An Effective Approachment to Optimize Future Candidate of Gumai Reservoir

Authors: I. Gusti Agung Aditya Surya Wibawa, Andri Syafriya, Beiruny Syam

Abstract:

Gumai Formation which acts as regional seal for Talang Akar Formation becomes one of the most prolific reservoir in South Sumatra Basin and the primary exploration target in this area. Marine conditions were eventually established during the continuation of transgression sequence leads an open marine facies deposition in Early Miocene. Marine clastic deposits where calcareous shales, claystone and siltstones interbedded with fine-grained calcareous and glauconitic sandstones are the domination of lithology which targeted as the hydrocarbon reservoir. All this time, the main objective of PetroChina’s exploration and production in Betara area is only from Lower Talang Akar Formation. Successful testing in some exploration wells which flowed gas & condensate from Gumai Formation, opened the opportunity to optimize new reservoir objective in Betara area. Limitation of conventional wireline logs data in Gumai interval is generating technical challenge in term of geological approach. A utilization of Gas While Drilling indicator initiated with the objective to determine the next Gumai reservoir candidate which capable to increase Jabung hydrocarbon discoveries. This paper describes how Gas While Drilling indicator is processed to generate potential and non-potential zone by cut-off analysis. Validation which performed by correlation and comparison with well logs, Drill Stem Test (DST), and Reservoir Performance Monitor (RPM) data succeed to observe Gumai reservoir in Betara Complex. After we integrated all of data, we are able to generate a Betara Complex potential map and overlaid with reservoir characterization distribution as a part of risk assessment in term of potential zone presence. Mud log utilization and geophysical data information successfully covered the geological challenges in this study.

Keywords: Gumai, gas while drilling, classification, reservoir, potential

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4689 Optimizing Sustainable Graphene Production: Extraction of Graphite from Spent Primary and Secondary Batteries for Advanced Material Synthesis

Authors: Pratima Kumari, Sukha Ranjan Samadder

Abstract:

This research aims to contribute to the sustainable production of graphene materials by exploring the extraction of graphite from spent primary and secondary batteries. The increasing demand for graphene materials, a versatile and high-performance material, necessitates environmentally friendly methods for its synthesis. The process involves a well-planned methodology, beginning with the gathering and categorization of batteries, followed by the disassembly and careful removal of graphite from anode structures. The use of environmentally friendly solvents and mechanical techniques ensures an efficient and eco-friendly extraction of graphite. Advanced approaches such as the modified Hummers' method and chemical reduction process are utilized for the synthesis of graphene materials, with a focus on optimizing parameters. Various analytical techniques such as Fourier-transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, thermogravimetric analysis, and Raman spectroscopy were employed to validate the quality and structure of the produced graphene materials. The major findings of this study reveal the successful implementation of the methodology, leading to the production of high-quality graphene materials suitable for advanced material applications. Thorough characterization using various advanced techniques validates the structural integrity and purity of the graphene. The economic viability of the process is demonstrated through a comprehensive economic analysis, highlighting the potential for large-scale production. This research contributes to the field of sustainable production of graphene materials by offering a systematic methodology that efficiently transforms spent batteries into valuable graphene resources. Furthermore, the findings not only showcase the potential for upcycling electronic waste but also address the pressing need for environmentally conscious processes in advanced material synthesis.

Keywords: spent primary batteries, spent secondary batteries, graphite extraction, advanced material synthesis, circular economy approach

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4688 E4D-MP: Time-Lapse Multiphysics Simulation and Joint Inversion Toolset for Large-Scale Subsurface Imaging

Authors: Zhuanfang Fred Zhang, Tim C. Johnson, Yilin Fang, Chris E. Strickland

Abstract:

A variety of geophysical techniques are available to image the opaque subsurface with little or no contact with the soil. It is common to conduct time-lapse surveys of different types for a given site for improved results of subsurface imaging. Regardless of the chosen survey methods, it is often a challenge to process the massive amount of survey data. The currently available software applications are generally based on the one-dimensional assumption for a desktop personal computer. Hence, they are usually incapable of imaging the three-dimensional (3D) processes/variables in the subsurface of reasonable spatial scales; the maximum amount of data that can be inverted simultaneously is often very small due to the capability limitation of personal computers. Presently, high-performance or integrating software that enables real-time integration of multi-process geophysical methods is needed. E4D-MP enables the integration and inversion of time-lapsed large-scale data surveys from geophysical methods. Using the supercomputing capability and parallel computation algorithm, E4D-MP is capable of processing data across vast spatiotemporal scales and in near real time. The main code and the modules of E4D-MP for inverting individual or combined data sets of time-lapse 3D electrical resistivity, spectral induced polarization, and gravity surveys have been developed and demonstrated for sub-surface imaging. E4D-MP provides capability of imaging the processes (e.g., liquid or gas flow, solute transport, cavity development) and subsurface properties (e.g., rock/soil density, conductivity) critical for successful control of environmental engineering related efforts such as environmental remediation, carbon sequestration, geothermal exploration, and mine land reclamation, among others.

Keywords: gravity survey, high-performance computing, sub-surface monitoring, electrical resistivity tomography

Procedia PDF Downloads 146
4687 The Development of Psychosis in Offenders and Its Relationship to Crime

Authors: Belinda Crissman

Abstract:

Serious mental disorder is greatly overrepresented in prisoners compared to the general community, with consequences for prison management, recidivism and the prisoners themselves. Incarcerated individuals with psychotic disorders experience insufficient detection and treatment and higher rates of suicide in custody. However direct evidence to explain the overrepresentation of individuals with psychosis in prisons is sparse. The current study aimed to use a life course criminology perspective to answer two key questions: 1) What is the temporal relationship between psychosis and offending (does first mental health contact precede first recorded offence, or does the offending precede the mental health diagnosis)? 2) Are there key temporal points or system contacts prior to incarceration that could be identified as opportunities for early intervention? Data from the innovative Queensland Linkage project was used to link individuals with their corrections, health and relevant social service systems to answer these questions.

Keywords: mental disorder, crime, life course criminology, prevention

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4686 Effects of Butea superba Roxb. on Skeletal Muscle Functions and Parvalbumin Levels of Orchidectomized Rat

Authors: Surapong Vongvatcharanon, Fardeela Binalee, Wandee Udomuksorn, Ekkasit Kumarnsit, Uraporn Vongvatcharanon

Abstract:

Hypogonadism is characterized by a decline in sex hormone levels, especially testosterone. It has been shown to be an important contributor to the decrease in muscle mass, muscle strength and performance, a condition known as sarcopenia. Preparations from Butea superba Roxb. (red Kwao Krua) have been reported to have androgenic properties. The active compounds are proposed to be flavonoids and flavonoid glycosides. Treatment with B. superba has been shown to improve erectile dysfunction in males. Parvalbumin (PV) is a relaxing factor and identified in fast twitch fibers. Alterations of the PV levels affects skeletal muscle functions. This study aimed to investigate the effects of orhchidectomy, testosterone replacement and different doses of Butea superba Roxb. on the structure, performance, levels of parvalbumin, parvalbumin and androgen receptor immunoreactivities in the extensor digitorum longus (EDL) and gastrocnemius muscles of orchidectomized rats. Twelve-week old male Wistar rats were randomly divided into 6 groups; sham-operated (SHAM), orchidectomized (BS-0), orchidectomized group that was treated with testosterone replacement of 6 µg/kg (TP) or an orchidectomized group that was treated with various doses of an extract from Butea superba Roxb.; 5 mg/kg (BS-5), 50 mg/kg (BS-50) and 500 mg/kg (BS-500) all for 90 days. The testosterone level, epididymis, seminal vesicle, prostate gland, vas deference weight, muscle fiber size, strength and endurance in both the EDL and gastrocnemius muscle were decreased in the BS-0 group but increased in the testosterone replacement group. Treatment with the B. superba Roxb. extract replacement group improved muscle fiber size, strength and endurance, but not total testosterone levels, or the epididymis, seminal vesicle, prostate gland, vas deference weight. Furthermore, the parvalbumin level, parvalbumin and androgen receptor immunoreactivities were reduced in the BS-0 group but increased in the testosterone replacement group and the B. superba Roxb. extract groups for both the EDL and gastrocnemius muscle. This study indicated that the reduction of testosterone level led to a decrease of the androgen receptor density resulting in a decline in the muscle mass and parvalbumin levels. The decrease of parvalbumin levels affected muscle performance. Testosterone replacement increased the androgen receptor density and led to an increase of muscle mass and parvalbumin levels. The increase in the parvalbumin levels may result in an improvement of muscle performance. This may explain one mechanism of testosterone on muscle mass and strength in the testosterone dependent sarcopenia. The B. superba Roxb. extract groups also had improved muscle mass, strength and endurance, parvalbumin level, parvalbumin and androgen immunoreactivities compared to the BS-O group . Butea superba Roxb. Extracts contains a flavonoid (3, 7, 3'-Trihydroxy-4'-methoxyflavone), flavonoiglycoside (3, 3'-dihydroxy-4'-methoxyflavone-7-O-β-D-glucopyranoside) and isoflavanolignans (butesuperins A and butesuperins B) all known to inhibit the cAMP phosphodiesterase enzyme. Therefore, cAMP signaling may have adaptive effects on skeletal muscle by increasing muscle mass, strength and endurance.

Keywords: Butea superba, parvalbumin, skeletal muscle, orchidectomy

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4685 Localized Treatment of Cutaneous Candidiasis through Cubosomes in vitro Evaluation

Authors: Aakanchha Jain, D. V. Kohli

Abstract:

Cubosomes are nanoparticles but instead of the solid particles, cubosomes are self-assembled liquid crystalline particles of certain surfactant with proper ratio of water with a microstructure that provides unique properties of practical interest. Cubosomes encapsulating Fluconazole were prepared by emulsification method and characterized for particle size, entrapment efficiency. The cubosomes prepared were 257.2±2.94 nm in size with drug entrapment efficiency of 66.2±2.69%. The optimized formulation characterized for shape and surface morphology by TEM and SEM analysis. SEM photograph showed the smooth surface of optimized cubosomes and TEM photograph revealed square somewhat circular intact shapes of cubosomes. MIC was determined by XTT based method and antifungal activity was determined in vitro. The cumulative percentage of Fnz from cubosomes permeated via dialysis membrane (MWCO 12-14 KD) showed a percent cumulative drug release of 76.86% while Fnz solution showed release up to 91.04% in 24 hours in PBS (pH 6.5)(p < 0.005).

Keywords: Candids albicans, cubosomes, fluconazole, topical delivery

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4684 Diallyl Trisulfide Protects the Rat Liver from CCl4-Induced Injury and Fibrogenesis by Attenuating Oxidative Stress

Authors: Xiao-Jing Zhu, Liang Zhou, Shi-Zhong Zheng

Abstract:

Various studies have shown that diallyl trisulfide (DATS) can protect the liver injury, and DATS has a strong antioxidant property. The aim of this study is to evaluate the in vivo role of DATS in protecting the liver against injury and fibrogenesis and further explores the underlying mechanisms. Our results demonstrated that DATS protected the liver from CCl4-caused injury by suppressing the elevation of ALT and AST activities, and by improving the histological architecture of the liver. Treatment with DATS or colchicine improved the liver fibrosis by sirius red staining and immunofluorescence. In addition, immunohistochemistry, western blot, and RT-PCR analyses indicated that DATS inhibited HSC activation. Furthermore, DATS attenuated oxidative stress by increasing glutathione and reducing lipid peroxides and malondialdehyde. These findings suggest that the protective effect of DATS on CCl4-caused liver injury and liver fibrogenesis was, at least partially, attributed to its antioxidant activity.

Keywords: liver fibrogenesis, liver injury, oxidative stress, DATS

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4683 The Role of Intraluminal Endoscopy in the Diagnosis and Treatment of Fluid Collections in Patients With Acute Pancreatitis

Authors: A. Askerov, Y. Teterin, P. Yartcev, S. Novikov

Abstract:

Introduction: Acute pancreatitis (AP) is a socially significant problem for public health and continues to be one of the most common causes of hospitalization of patients with pathology of the gastrointestinal tract. It is characterized by high mortality rates, which reaches 62-65% in infected pancreatic necrosis. Aims & Methods: The study group included 63 patients who underwent transluminal drainage (TLD) fluid collection (FC). All patients were performed transabdominal ultrasound, computer tomography of the abdominal cavity and retroperitoneal organs and endoscopic ultrasound (EUS) of the pancreatobiliary zone. The EUS was used as a final diagnostic method to determine the characteristics of FC. The indications for TLD were: the distance between the wall of the hollow organ and the FC was not more than 1 cm, the absence of large vessels on the puncture trajectory (more than 3 mm), and the size of the formation was more than 5 cm. When a homogeneous cavity with clear, even contours was detected, a plastic stent with rounded ends (“double pig tail”) was installed. The indication for the installation of a fully covered self-expanding stent was the detection of nonhomogeneous anechoic FC with hyperechoic inclusions and cloudy purulent contents. In patients with necrotic forms after drainage of the purulent cavity, a cystonasal drainage with a diameter of 7Fr was installed in its lumen under X-ray control to sanitize the cavity with a 0.05% aqueous solution of chlorhexidine. Endoscopic necrectomy was performed every 24-48 hours. The plastic stent was removed in 6 month, the fully covered self-expanding stent - in 1 month after the patient was discharged from the hospital. Results: Endoscopic TLD was performed in 63 patients. The FC corresponding to interstitial edematous pancreatitis was detected in 39 (62%) patients who underwent TLD with the installation of a plastic stent with rounded ends. In 24 (38%) patients with necrotic forms of FC, a fully covered self-expanding stent was placed. Communication with the ductal system of the pancreas was found in 5 (7.9%) patients. They underwent pancreaticoduodenal stenting. A complicated postoperative period was noted in 4 (6.3%) cases and was manifested by bleeding from the zone of pancreatogenic destruction. In 2 (3.1%) cases, this required angiography and endovascular embolization a. gastroduodenalis, in 1 (1.6%) case, endoscopic hemostasis was performed by filling the cavity with 4 ml of Hemoblock hemostatic solution. The combination of both methods was used in 1 (1.6%) patient. There was no evidence of recurrent bleeding in these patients. Lethal outcome occurred in 4 patients (6.3%). In 3 (4.7%) patients, the cause of death was multiple organ failure, in 1 (1.6%) - severe nosocomial pneumonia that developed on the 32nd day after drainage. Conclusions: 1. EUS is not only the most important method for diagnosing FC in AP, but also allows you to determine further tactics for their intraluminal drainage.2. Endoscopic intraluminal drainage of fluid zones in 45.8% of cases is the final minimally invasive method of surgical treatment of large-focal pancreatic necrosis. Disclosure: Nothing to disclose.

Keywords: acute pancreatitis, fluid collection, endoscopy surgery, necrectomy, transluminal drainage

Procedia PDF Downloads 94
4682 Numerical Modelling of Shear Zone and Its Implications on Slope Instability at Letšeng Diamond Open Pit Mine, Lesotho

Authors: M. Ntšolo, D. Kalumba, N. Lefu, G. Letlatsa

Abstract:

Rock mass damage due to shear tectonic activity has been investigated largely in geoscience where fluid transport is of major interest. However, little has been studied on the effect of shear zones on rock mass behavior and its impact on stability of rock slopes. At Letšeng Diamonds open pit mine in Lesotho, the shear zone composed of sheared kimberlite material, calcite and altered basalt is forming part of the haul ramp into the main pit cut 3. The alarming rate at which the shear zone is deteriorating has triggered concerns about both local and global stability of pit the walls. This study presents the numerical modelling of the open pit slope affected by shear zone at Letšeng Diamond Mine (LDM). Analysis of the slope involved development of the slope model by using a two-dimensional finite element code RS2. Interfaces between shear zone and host rock were represented by special joint elements incorporated in the finite element code. The analysis of structural geological mapping data provided a good platform to understand the joint network. Major joints including shear zone were incorporated into the model for simulation. This approach proved successful by demonstrating that continuum modelling can be used to evaluate evolution of stresses, strain, plastic yielding and failure mechanisms that are consistent with field observations. Structural control due to geological shear zone structure proved to be important in its location, size and orientation. Furthermore, the model analyzed slope deformation and sliding possibility along shear zone interfaces. This type of approach can predict shear zone deformation and failure mechanism, hence mitigation strategies can be deployed for safety of human lives and property within mine pits.

Keywords: numerical modeling, open pit mine, shear zone, slope stability

Procedia PDF Downloads 289
4681 Therapeutic Potential of GSTM2-2 C-Terminal Domain and Its Mutants, F157A and Y160A on the Treatment of Cardiac Arrhythmias: Effect on Ca2+ Transients in Neonatal Ventricular Cardiomyocytes

Authors: R. P. Hewawasam, A. F. Dulhunty

Abstract:

The ryanodine receptor (RyR) is an intracellular ion channel that releases Ca2+ from the sarcoplasmic reticulum and is essential for the excitation-contraction coupling and contraction in striated muscle. Human muscle specific glutathione transferase M2-2 (GSTM2-2) is a highly specific inhibitor of cardiac ryanodine receptor (RyR2) activity. Single channel-lipid bilayer studies and Ca2+ release assays performed using the C-terminal half of the GSTM2-2 and its mutants F157A and Y160A confirmed the ability of the C terminal domain of GSTM2-2 to specifically inhibit the cardiac ryanodine receptor activity. Objective of the present study is to determine the effect of C terminal domain of GSTM2-2 (GSTM2-2C) and the mutants, F157A and Y160A on the Ca2+ transients of neonatal ventricular cardiomyocytes. Primary cardiomyocytes were cultured from neonatal rats. They were treated with GSTM2-2C and the two mutants F157A and Y160A at 15µM and incubated for 2 hours. Then the cells were led with Fluo-4AM, fluorescent Ca2+ indicator, and the field stimulated (1 Hz, 3V and 2ms) cells were excited using the 488 nm argon laser. Contractility of the cells were measured and the Ca2+ transients in the stained cells were imaged using Leica SP5 confocal microscope. Peak amplitude of the Ca2+ transient, rise time and decay time from the peak were measured for each transient. In contrast to GSTM2C which significantly reduced the % shortening (42.8%) in the field stimulated cells, F157A and Y160A failed to reduce the % shortening.Analysis revealed that the average amplitude of the Ca2+ transient was significantly reduced (P<0.001) in cells treated with the wild type GSTM2-2C compared to that of untreated cells. Cells treated with the mutants F157A and Y160A didn’t change the Ca2+ transient significantly compared to the control. A significant increase in the rise time (P< 0.001) and a significant reduction in the decay time (P< 0.001) were observed in cardiomyocytes treated with GSTM2-2C compared to the control but not with F157A and Y160A. These results are consistent with the observation that GSTM2-2C reduced the Ca2+ release from the cardiac SR significantly whereas the mutants, F157A and Y160A didn’t show any effect compared to the control. GSTM2-2C has an isoform-specific effect on the cardiac ryanodine receptor activity and also it inhibits RyR2 channel activity only during diastole. Selective inhibition of RyR2 by GSTM2-2C has significant clinical potential in the treatment of cardiac arrhythmias and heart failure. Since GSTM2-2C-terminal construct has no GST enzyme activity, its introduction to the cardiomyocyte would not exert any unwanted side effects that may alter its enzymatic action. The present study further confirms that GSTM2-2C is capable of decreasing the Ca2+ release from the cardiac SR during diastole. These results raise the future possibility of using GSTM2-2C as a template for therapeutics that can depress RyR2 function when the channel is hyperactive in cardiac arrhythmias and heart failure.

Keywords: arrhythmia, cardiac muscle, cardiac ryanodine receptor, GSTM2-2

Procedia PDF Downloads 274
4680 From Tionghoa to Tjina: Historical Tracing on the Identity Politics in Demonization of Ethnic Chinese in Indonesia

Authors: Michael J. Kristiono

Abstract:

This paper attempts to investigate the reasons behind the negative sentiments directed towards Chinese Indonesians from International Relations (IR) perspective. By tracing back the treatment of the New Order government towards ethnic Chinese, it was found that such demonization initially happened due to two politically motivated reasons. Firstly, as part of de-Soekarnoization done by the New Order, the Chinese were outcast because Chinese identity does not conform to the 'Indonesian identity', which was in essence, the Javanese identity. Secondly, the condition reflected the change in Indonesian foreign policy which drifted apart from People’s Republic of China (PRC) as the latter was suspected to be involved in September 30 Movement. Then, this paper argues that due to those reasons, coupled by blatant maltreatment from the New Order Government, Chinese Indonesians were constructed as the Others, that is, as non-Indonesians. Such construct has been deeply embedded such that reconciliation attempts done by the Reformation Era government were not sufficient enough to stop ethnic discrimination towards Chinese Indonesians from happening even until the present.

Keywords: Chinese Indonesians, ethnic discrimination, identity, New Order

Procedia PDF Downloads 324