Search results for: diagnostic challenge

Authors: Shaista Suhail

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As cancer populations is increasing sharply, the incidence of oral squamous cell carcinoma (OSCC) has also been expected to increase. Oral carcinogenesis is a highly complex, multistep process which involves accumulation of genetic alterations that lead to the induction of proteins promoting cell growth (encoded by oncogenes), increased enzymatic (telomerase) activity promoting cancer cell proliferation. The global increase in frequency and mortality, as well as the poor prognosis of oral squamous cell carcinoma, has intensified current research efforts in the field of prevention and early detection of this disease. The advances in the understanding of the molecular basis of oral cancer should help in the identification of new markers. The study of the carcinogenic process of the oral cancer, including continued analysis of new genetic alterations, along with their temporal sequencing during initiation, promotion and progression, will allow us to identify new diagnostic and prognostic factors, which will provide a promising basis for the application of more rational and efficient treatments. Telomerase activity has been readily found in most cancer biopsies, in premalignant lesions or germ cells. Activity of telomerase is generally absent in normal tissues. It is known to be induced upon immortalization or malignant transformation of human cells such as in oral cancer cells. Maintenance of telomeres plays an essential role during transformation of precancer to malignant stage. Mammalian telomeres, a specialized nucleoprotein structures are composed of large conctamers of the guanine-rich sequence 5_-TTAGGG-3_. The roles of telomeres in regulating both stability of genome and replicative immortality seem to contribute in essential ways in cancer initiation and progression. It is concluded that activity of telomerase can be used as a biomarker for diagnosis of malignant oral cancer and a target for inactivation in chemotherapy or gene therapy. Its expression will also prove to be an important diagnostic tool as well as a novel target for cancer therapy. The activation of telomerase may be an important step in tumorgenesis which can be controlled by inactivating its activity during chemotherapy. The expression and activity of telomerase are indispensable for cancer development. There are no drugs which can effect extremely to treat oral cancers. There is a general call for new emerging drugs or methods that are highly effective towards cancer treatment, possess low toxicity, and have a minor environment impact. Some novel natural products also offer opportunities for innovation in drug discovery. Natural compounds isolated from medicinal plants, as rich sources of novel anticancer drugs, have been of increasing interest with some enzyme (telomerase) blockage property. The alarming reports of cancer cases increase the awareness amongst the clinicians and researchers pertaining to investigate newer drug with low toxicity.

Keywords: oral carcinoma, telomere, telomerase, blockage

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Authors: Richard Harrison

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Developing competency in mathematics and related critical thinking skills is essential to the education of undergraduate students of Science, Technology, Engineering and Mathematics (STEM). Recently, the HE sector has been impacted by a seemingly widening disconnect between the mathematical competency of incoming first-year STEM students and their entrance qualification tariffs. Despite relatively high grades in A-Level Mathematics, students may initially lack fundamental skills in key areas such as algebraic manipulation and have limited capacity to apply problem solving strategies. Compounded by compensatory measures applied to entrance qualifications during the pandemic, there has been an associated decline in student performance on introductory university mathematics modules. In the UK, a number of online resources have been developed to help scaffold the transition to university mathematics. However, in general, these do not offer a structured learning journey focused on individual developmental needs, nor do they offer an experience coherent with the teaching and learning characteristics of the destination institution. In order to address some of these issues, a bespoke framework has been designed and implemented on our VLE in the Faculty of Engineering & Physical Sciences (FEPS) at the University of Surrey. Called the FEPS Maths Support Framework, it was conceived to scaffold the mathematical development of individuals prior to entering the university and during the early stages of their transition to undergraduate studies. More than 90% of our incoming STEM students voluntarily participate in the process. Students complete a set of initial diagnostic questions in the late summer. Based on their performance and feedback on these questions, they are subsequently guided to self-select specific mathematical topic areas for review using our proprietary resources. This further assists students in preparing for discipline related diagnostic tests. The framework helps to identify students who are mathematically weak and facilitates early intervention to support students according to their specific developmental needs. This paper presents a summary of results from a rich data set captured from the framework over a 3-year period. Quantitative data provides evidence that students have engaged and developed during the process. This is further supported by process evaluation feedback from the students. Ranked performance data associated with seven key mathematical topic areas and eight engineering and science discipline areas reveals interesting patterns which can be used to identify more generic relative capabilities of the discipline area cohorts. In turn, this facilitates evidence based management of the mathematical development of the new cohort, informing any associated adjustments to teaching and learning at a more holistic level. Evidence is presented establishing our framework as an effective early intervention strategy for addressing the sector-wide issue of supporting the mathematical development of STEM students transitioning to HE

Keywords: competency, development, intervention, scaffolding

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Authors: Frederick Huie, Lauren Fusfeld, William Burchenal, Scott Howell, Alyssa McVey, Thomas F. Goss

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Alzheimer’s Disease (AD) is a degenerative brain disease characterized by memory loss and cognitive decline that presents a substantial economic burden for patients and health insurers in the US. This study evaluates the payer budget impact of the DISCERN™ test in the diagnosis and management of patients with symptoms of dementia evaluated for AD. DISCERN™ comprises three assays that assess critical factors related to AD that regulate memory, formation of synaptic connections among neurons, and levels of amyloid plaques and neurofibrillary tangles in the brain and can provide a quicker, more accurate diagnosis than tests in the current diagnostic pathway (CDP). An Excel-based model with a three-year horizon was developed to assess the budget impact of DISCERN™ compared with CDP in a Medicare Advantage plan with 1M beneficiaries. Model parameters were identified through a literature review and were verified through consultation with clinicians experienced in diagnosis and management of AD. The model assesses direct medical costs/savings for patients based on the following categories: •Diagnosis: costs of diagnosis using DISCERN™ and CDP. •False Negative (FN) diagnosis: incremental cost of care avoidable with a correct AD diagnosis and appropriately directed medication. •True Positive (TP) diagnosis: AD medication costs; cost from a later TP diagnosis with the CDP versus DISCERN™ in the year of diagnosis, and savings from the delay in AD progression due to appropriate AD medication in patients who are correctly diagnosed after a FN diagnosis.•False Positive (FP) diagnosis: cost of AD medication for patients who do not have AD. A one-way sensitivity analysis was conducted to assess the effect of varying key clinical and cost parameters ±10%. An additional scenario analysis was developed to evaluate the impact of individual inputs. In the base scenario, DISCERN™ is estimated to decrease costs by $4.75M over three years, equating to approximately $63.11 saved per test per year for a cohort followed over three years. While the diagnosis cost is higher with DISCERN™ than with CDP modalities, this cost is offset by the higher overall costs associated with CDP due to the longer time needed to receive a TP diagnosis and the larger number of patients who receive a FN diagnosis and progress more rapidly than if they had received appropriate AD medication. The sensitivity analysis shows that the three parameters with the greatest impact on savings are: reduced sensitivity of DISCERN™, improved sensitivity of the CDP, and a reduction in the percentage of disease progression that is avoided with appropriate AD medication. A scenario analysis in which DISCERN™ reduces the utilization for patients of computed tomography from 21% in the base case to 16%, magnetic resonance imaging from 37% to 27% and cerebrospinal fluid biomarker testing, positive emission tomography, electroencephalograms, and polysomnography testing from 4%, 5%, 10%, and 8%, respectively, in the base case to 0%, results in an overall three-year net savings of $14.5M. DISCERN™ improves the rate of accurate, definitive diagnosis of AD earlier in the disease and may generate savings for Medicare Advantage plans.

Keywords: Alzheimer’s disease, budget, dementia, diagnosis.

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Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

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Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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Authors: Yifang Gong

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Pulse diagnosis is one of the most important diagnosis methods in traditional Chinese medicine. It is also the trickiest method to learn. It is known as that it can only to be sensed not explained. This becomes a serious threat to the survival of this diagnostic method. However, there are a large amount of experiences accumulated during the several thousand years of practice of Chinese doctors. A pulse pattern called 'Slippery pulse' is one of the indications of pregnancy. A simple fluid dynamic model is proposed to simulate the effects of the existence of a placenta. The placenta is modeled as an extra plenum in an extremely simplified fluid network model. It is found that because of the existence of the extra plenum, indeed the pulse pattern shows a secondary peak in one pulse period. As for the author’s knowledge, this work is the first time to show the link between Pulse diagnoses and basic physical principle. Key parameters which might affect the pattern are also investigated.

Keywords: Chinese medicine, flow network, pregnancy, pulse

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Authors: Simon B. N. Thompson

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Retinoblastoma is a rare type of childhood genetic cancer that affects children worldwide. The diagnosis is often missed due to lack of education and difficulty in presentation of the tumor. Frequently, the tumor on the retina is noticed by photography when the red-eye flash, commonly seen in normal eyes, is not produced. Instead, a yellow or white colored patch is seen or the child has a noticeable strabismus. Early detection can be life-saving though often results in removal of the affected eye. Remaining functioning in the healthy eye when the child is young has resulted in super-vision and high or above-average intelligence. Technological advancement of cameras has helped in early detection. Brain imaging has also made possible early detection of neurological diseases and, together with the monitoring of cortisol levels and yawning frequency, promises to be the next new early diagnostic tool for the detection of neurological diseases where cortisol insufficiency is particularly salient, such as multiple sclerosis and Cushing’s disease.

Keywords: cortisol, neurological disease, retinoblastoma, Thompson cortisol hypothesis, yawning

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Authors: M. Brandt, A. Peniak, J. Makarovič, P. Rafajdus

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This paper deals with a novel approach of power transformers diagnostics. This approach identifies the exact location and the range of a fault in the transformer and helps to reduce operation costs related to handling of the faulty transformer, its disassembly and repair. The advantage of the approach is a possibility to simulate healthy transformer and also all faults, which can occur in transformer during its operation without its disassembling, which is very expensive in practice. The approach is based on creating frequency dependent impedance of the transformer by sweep frequency response analysis measurements and by 3D FE parametrical modeling of the fault in the transformer. The parameters of the 3D FE model are the position and the range of the axial short circuit. Then, by comparing the frequency dependent impedances of the parametrical models with the measured ones, the location and the range of the fault is identified. The approach was tested on a real transformer and showed high coincidence between the real fault and the simulated one.

Keywords: transformer, parametrical model of transformer, fault, sweep frequency response analysis, finite element method

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Authors: Denise Levy, Gian M. A. A. Sordi

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This web based project focuses on continuing corporate education and improving workers' skills in Brazilian radioactive facilities throughout the country. The potential of Information and Communication Technologies (ICTs) shall contribute to improve the global communication in this very large country, where it is a strong challenge to ensure high quality professional information to as many people as possible. The main objective of this system is to provide Brazilian radioactive facilities a complete web-based repository - in Portuguese - for research, consultation and information, offering conditions for learning and improving professional and personal skills. UNIPRORAD is a web based system to offer unified programs and inter-related information about radiological protection programs. The content includes the best practices for radioactive facilities in order to meet both national standards and international recommendations published by different organizations over the past decades: International Commission on Radiological Protection (ICRP), International Atomic Energy Agency (IAEA) and National Nuclear Energy Commission (CNEN). The website counts on concepts, definitions and theory about optimization and ionizing radiation monitoring procedures. Moreover, the content presents further discussions related to some national and international recommendations, such as potential exposure, which is currently one of the most important research fields in radiological protection. Only two publications of ICRP develop expressively the issue and there is still a lack of knowledge of fail probabilities, for there are still uncertainties to find effective paths to quantify probabilistically the occurrence of potential exposures and the probabilities to reach a certain level of dose. To respond to this challenge, this project discusses and introduces potential exposures in a more quantitative way than national and international recommendations. Articulating ICRP and AIEA valid recommendations and official reports, in addition to scientific papers published in major international congresses, the website discusses and suggests a number of effective actions towards safety which can be incorporated into labor practice. The WEB platform was created according to corporate public needs, taking into account the development of a robust but flexible system, which can be easily adapted to future demands. ICTs provide a vast array of new communication capabilities and allow to spread information to as many people as possible at low costs and high quality communication. This initiative shall provide opportunities for employees to increase professional skills, stimulating development in this large country where it is an enormous challenge to ensure effective and updated information to geographically distant facilities, minimizing costs and optimizing results.

Keywords: distance learning, information and communication technology, nuclear science, radioactive facilities

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Authors: Arthi Ganapathy, Arithra Banerjee, Saroj Kaler

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Abdominal aorta is the sole purveyor of all organs in the abdomen. Anomalies of its main trunk or its branches are to be meticulously observed as it effects the perfusion of an organ. Varying patterns of the testicular artery is one of them. The origin and course of testicular arteries have to be identified carefully during various surgical procedures like renal transplant, intra abdominal surgeries and even in orthopedic surgery like spine surgery. With the advent of new intra-abdominal therapeutic and diagnostic techniques, the anatomy of testicular arteries has assumed much more significance. Though the variations of the testicular vein are well documented, the variations of the testicular artery are not so frequent in incidence. We report a case of the bilateral aberrant origin of the testicular artery from polar renal arteries. We also discuss its developmental basis. Such anomalies if left unnoticed will lead to serious intraoperative complications during procedures on retroperitoneal organs. Any damage to testicular arteries will compromise the function of the gonads.

Keywords: cadaver, gonadal, renal, surgery

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Authors: Koteswara Rao Pagolu, Raghava Rao Tamanam

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The present study was aimed to find out the prevalence of DD's in Visakhapatnam, one of the north coastal districts of Andhra Pradesh, India during a span of five years. A cross-sectional investigation was held at District early intervention center (DEIC), Visakhapatnam from 2016 to 2020. To identify the pattern and trend of different DD's including seasonal variations, a retrospective analysis of the health center's inpatient database for the past 5 years was done. Male and female children aged 2 months-18 years are included in the study with the prior permission of the concerned medical officer. The screening tool developed by the Ministry of health and family welfare, India, was used for the study. Among 26,423 cases, children with birth defects are 962, 2229 with deficiencies, 7516 with diseases, and 15716 with disabilities were admitted during the study period. From birth defects, congenital deafness occurred in large numbers with 22.66%, and neural tube defect observed in a small number of cases with 0.83% during the period. From the side of deficiencies, severe acute malnutrition has mostly occurred (66.80 %) and a small number of children were affected with goiter (1.70%). Among the diseases, dental carriers (67.97%) are mostly found and these cases were at peak during the years 2016 and 2019. From disabilities, children with vision impairment (20.55%) have mostly approached the center. Over the past 5 years, the admission rate of down's syndrome and congenital deafness cases showed a rising trend up to 2019 and then declined. Hearing impairment, motor delay, and learning disorder showed a steep rise and gradual decline trend, whereas severe anemia, vitamin-D deficiency, otitis media, reactive airway disease, and attention deficit hyperactivity disorder showed a declining trend. However, congenital heart diseases, dental caries, and vision impairment admission rates showed a zigzag pattern over the past 5 years. This center had inadequate diagnostic facilities related to genetic disease management. For advanced confirmation, the cases are referred to a district government hospital or private diagnostic laboratories in the city for genetic tests. Information regarding the overall burden and pattern of admissions in the health center is obtained by the review of DEIC records. Through this study, it is observed that the incidence of birth defects, as well as genetic disease burden, is high in the Visakhapatnam district. Hence there is a need for strengthening of management services for these diseases in this region.

Keywords: child health screening, developmental delays, district early intervention center, genetic disease management, infrastructural facility, Visakhapatnam district

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Authors: Raj Chandran, Saul Datwyler, Jaime Marino, Daniel West, Karla Grasso, Adam Buss, Hina Syed, Zina Al Sahouri, Jennifer Yen, Krista Caudle, Beth McQuiston

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The Alinity i TBI test is Therapeutic Goods Administration (TGA) registered and is a panel of in vitro diagnostic chemiluminescent microparticle immunoassays for the measurement of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) in plasma and serum. The Alinity i TBI performance was evaluated in a multi-center pivotal study to demonstrate the capability to assist in determining the need for a CT scan of the head in adult subjects (age 18+) presenting with suspected mild TBI (traumatic brain injury) with a Glasgow Coma Scale score of 13 to 15. TBI has been recognized as an important cause of death and disability and is a growing public health problem. An estimated 69 million people globally experience a TBI annually1. Blood-based biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have shown utility to predict acute traumatic intracranial injury on head CT scans after TBI. A pivotal study using prospectively collected archived (frozen) plasma specimens was conducted to establish the clinical performance of the TBI test on the Alinity i system. The specimens were originally collected in a prospective, multi-center clinical study. Testing of the specimens was performed at three clinical sites in the United States. Performance characteristics such as detection limits, imprecision, linearity, measuring interval, expected values, and interferences were established following Clinical and Laboratory Standards Institute (CLSI) guidance. Of the 1899 mild TBI subjects, 120 had positive head CT scan results; 116 of the 120 specimens had a positive TBI interpretation (Sensitivity 96.7%; 95% CI: 91.7%, 98.7%). Of the 1779 subjects with negative CT scan results, 713 had a negative TBI interpretation (Specificity 40.1%; 95% CI: 37.8, 42.4). The negative predictive value (NPV) of the test was 99.4% (713/717, 95% CI: 98.6%, 99.8%). The analytical measuring interval (AMI) extends from the limit of quantitation (LoQ) to the upper LoQ and is determined by the range that demonstrates acceptable performance for linearity, imprecision, and bias. The AMI is 6.1 to 42,000 pg/mL for GFAP and 26.3 to 25,000 pg/mL for UCH-L1. Overall, within-laboratory imprecision (20 day) ranged from 3.7 to 5.9% CV for GFAP and 3.0 to 6.0% CV for UCH-L1, when including lot and instrument variances. The Alinity i TBI clinical performance results demonstrated high sensitivity and high NPV, supporting the utility to assist in determining the need for a head CT scan in subjects presenting to the emergency department with suspected mild TBI. The GFAP and UCH-L1 assays show robust analytical performance across a broad concentration range of GFAP and UCH-L1 and may serve as a valuable tool to help evaluate TBI patients across the spectrum of mild to severe injury.

Keywords: biomarker, diagnostic, neurology, TBI

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Authors: Sherine Farrag

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Currently-used MRI scanners in Cairo City possess static magnetic field (SMF) that varies from 0.25 up to 3T. More than half of them possess SMF of 1.5T. The SMF of the magnet determine the diagnostic power of a scanner, but not worker's exposure profile. This research paper presents an approach for numerical computation of induced electric fields and SAR values by estimation of fringe static magnetic fields. Iso-gauss line of MR was mapped and a polynomial function of the 7th degree was generated and tested. Induced current field due to worker motion in the SMF and SAR values for organs and tissues have been calculated. Results illustrate that the computation tool used permits quick accurate MRI iso-gauss mapping and calculation of SAR values which can then be used for assessment of occupational exposure profile of MRI operators.

Keywords: MRI occupational exposure, MRI safety, induced current density, specific absorption rate, static magnetic fields

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Authors: Sahar Fahmy Mehanna

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Wild fisheries and aquaculture offer excellent opportunities to decrease hunger and improve nutrition, relieve poverty, create economic growth and guarantee healthier use of natural resources. Employment in fisheries and aquaculture has grown continuously quicker than in the agriculture sector, providing up to 55 million jobs worldwide. Fisheries and aquaculture supplied Egypt with 2.1 million tons of fish in 2021, mostly used as food for people. Fish production in Egypt has grown dramatically in the last three decades, where fish production increased from about 346 thousand tons in 1990 to up to 2.1 million tons in 2021. In contrast to natural resources, which increased by only 30% in the period from 1990 to 2021, aquaculture production increased by 2502% during the same period. The majority of wild fisheries production in Egypt arises from coastal areas, where pollution is one of the main challenges severely affected both the productivity and quality of fish stocks. Our marine resources are at the risk of irreversible loss to habitats, ecological functions, and biodiversity because of overfishing, pollution, destructive fishing methods, climatic changes, unsustainable coastal area development and the competing demands from different industrial uses and human activities. Illegal, Unreported and Unregulated (IUU) Fishing continues to be a big challenge to achieve sustainable fisheries. Furthermore, poor governance, management and practices are a further challenge. Reducing overfishing, stimulating responsible and sustainable fisheries management, applying aquaculture new and friendly practices and conserving the marine environment health are among the government’s best opportunities to provide highly nutritious food to the increasing population in Egypt. The present presentation will discuss the fishery regulations in the Egyptian marine fisheries that taken to maintain, protect and promote the different Egyptian marine environments and to what extent these regulations were effective.

Keywords: egypt, marine fisheries, fishery regulations, fisheries management, Marine ecosystem conservation

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Authors: Xiao Wen Xu

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There exists a challenge of accommodating/integrating people at risk and those from various backgrounds in urban areas. The success of interdependence as a tool for survival largely rests on the mutually beneficial relationships amongst individuals within a given society. One approach to meeting this challenge has been written by Ivan Illich in his book, Tools for Conviviality, where he defines 'conviviality' as interactions that help individuals. With the goal of helping the community and applying conviviality as a principle to actors in both natural and social realms of Moss Park in Toronto, the proposal involves redesigning the park and buildings as a series of different health care, extended learning, employment support, armoury, and recreation facilities that integrate the exterior landscape as treatment, teaching, military, and recreation areas; in other words, the proposal links services with access to park space. While buildings are traditionally known to physically provide shelter, parks embody shelter and act as service, as people often find comfort and relief from being in nature, and Moss Park, in particular, is home to many people at risk. This landscape is not only an important space for the homeless community but also the rest of the neighborhood. The thesis proposes that the federal government rebuilds the current armoury, as it is an obsolete building while acknowledging the extensive future developments proposed by developers and its impact on public space. The neighbourhood is an underserved area, and the new design develops not just a new armoury, but also a complex of interrelated services, which are completely integrated into the park. The armoury is redesigned as an integral component of the community that not only serves as training facilities for reservists but also serves as an emergency shelter in sub-zero temperatures for the homeless community. This paper proposes a new design for Moss Park through examining how 'park buildings', interconnected buildings and parks, can foster empowering relationships that create a supportive public realm.

Keywords: conviviality, natural, social, Ivan Illich

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Authors: Domenico Palladino, Nicolandrea Calabrese, Francesca Caffari, Giulia Centi, Francesca Margiotta, Giovanni Murano, Laura Ronchetti, Paolo Signoretti, Lisa Volpe, Silvia Di Turi

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The aim to achieve a fully decarbonized building stock by 2050 stands as one of the most challenging issues within the spectrum of energy and climate objectives. Numerous strategies are imperative, particularly emphasizing the reduction and optimization of energy demand. Ensuring the high energy performance of buildings emerges as a top priority, with measures aimed at cutting energy consumptions. Concurrently, it is imperative to decrease greenhouse gas emissions by using renewable energy sources for the on-site energy production, thereby striving for an energy balance leading towards zero-emission buildings. Italy's predominant building stock comprises ancient buildings, many of which hold historical significance and are subject to stringent preservation and conservation regulations. Attaining high levels of energy efficiency and reducing CO2 emissions in such buildings poses a considerable challenge, given their unique characteristics and the imperative to adhere to principles of conservation and restoration. Additionally, conducting a meticulous analysis of these buildings' current state is crucial for accurately quantifying their energy performance and predicting the potential impacts of proposed renovation strategies on energy consumption reduction. Within this framework, the paper presents a pilot case in Rome, outlining a methodological approach for the renovation of historic buildings towards achieving Zero Emission Building (ZEB) objective. The building has a mixed function with offices, a conference hall, and an exposition area. The building envelope is made of historical and precious materials used as cladding which must be preserved. A thorough understanding of the building's current condition serves as a prerequisite for analyzing its energy performance. This involves conducting comprehensive archival research, undertaking on-site diagnostic examinations to characterize the building envelope and its systems, and evaluating actual energy usage data derived from energy bills. Energy simulations and audit are the first step in the analysis with the assessment of the energy performance of the actual current state. Subsequently, different renovation scenarios are proposed, encompassing advanced building techniques, to pinpoint the key actions necessary for improving mechanical systems, automation and control systems, and the integration of renewable energy production. These scenarios entail different levels of renovation, ranging from meeting minimum energy performance goals to achieving the highest possible energy efficiency level. The proposed interventions are meticulously analyzed and compared to ascertain the feasibility of attaining the Zero Emission Building objective. In conclusion, the paper provides valuable insights that can be extrapolated to inform a broader approach towards energy-efficient refurbishment of historical buildings that may have limited potential for renovation in their building envelopes. By adopting a methodical and nuanced approach, it is possible to reconcile the imperative of preserving cultural heritage with the pressing need to transition towards a sustainable, low-carbon future.

Keywords: energy conservation and transition, energy efficiency in historical buildings, buildings energy performance, energy retrofitting, zero emission buildings, energy simulation

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Authors: D. P. Houhoula, J. Papaparaskevas, S. Konteles, A. Dargenta, A. Farka, C. Spyrou, M. Ziaka, S. Koussisis, E. Charvalos

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Objectives: Nanotechnology is providing revolutionary opportunities for the rapid and simple diagnosis of many infectious diseases. Staphylococcus aureus, Listeria monocytogenes and Salmonella enteritis are important human pathogens. Diagnostic assays for bacterial culture and identification are time consuming and laborious. There is an urgent need to develop rapid, sensitive, and inexpensive diagnostic tests. In this study, a gold nanoprobe strategy developed and relies on the colorimetric differentiation of specific DNA sequences based approach on differential aggregation profiles in the presence or absence of specific target hybridization. Method: Gold nanoparticles (AuNPs) were purchased from Nanopartz. They were conjugated with thiolated oligonucleotides specific for the femA gene for the identification of members of Staphylococcus aureus, the mecA gene for the differentiation of Staphylococcus aureus and MRSA Staphylococcus aureus, hly gene encoding the pore-forming cytolysin listeriolysin for the identification of Listeria monocytogenes and the invA sequence for the identification of Salmonella enteritis. DNA isolation from Staphylococcus aureus Listeria monocytogenes and Salmonella enteritis cultures was performed using the commercial kit Nucleospin Tissue (Macherey Nagel). Specifically 20μl of DNA was diluted in 10mMPBS (pH5). After the denaturation of 10min, 20μl of AuNPs was added followed by the annealing step at 58oC. The presence of a complementary target prevents aggregation with the addition of acid and the solution remains pink, whereas in the opposite event it turns to purple. The color could be detected visually and it was confirmed with an absorption spectrum. Results: Specifically, 0.123 μg/μl DNA of St. aureus, L.monocytogenes and Salmonella enteritis was serially diluted from 1:10 to 1:100. Blanks containing PBS buffer instead of DNA were used. The application of the proposed method on isolated bacteria produced positive results with all the species of St. aureus and L. monocytogenes and Salmonella enteritis using the femA, mecA, hly and invA genes respectively. The minimum detection limit of the assay was defined at 0.2 ng/μL of DNA. Below of 0.2 ng/μL of bacterial DNA the solution turned purple after addition of HCl, defining the minimum detection limit of the assay. None of the blank samples was positive. The specificity was 100%. The application of the proposed method produced exactly the same results every time (n = 4) the evaluation was repeated (100% repeatability) using the femA, hly and invA genes. Using the gene mecA for the differentiation of Staphylococcus aureus and MRSA Staphylococcus aureus the method had a repeatability 50%. Conclusion: The proposed method could be used as a highly specific and sensitive screening tool for the detection and differentiation of Staphylococcus aureus Listeria monocytogenes and Salmonella enteritis. The use AuNPs for the colorimetric detection of DNA targets represents an inexpensive and easy-to-perform alternative to common molecular assays. The technology described here, may develop into a platform that could accommodate detection of many bacterial species.

Keywords: gold nanoparticles, pathogens, nanotechnology, bacteria

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Authors: Marta Błażkiewicz, Adam Konefał

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Currently, boron-neutron therapy is carried out mainly with the use of a neutron beam generated in research nuclear reactors. This fact limits the possibility of realization of a BNCT in centers distant from the above-mentioned reactors. Moreover, the number of active nuclear reactors in operation in the world is decreasing due to the limited lifetime of their operation and the lack of new installations. Therefore, the possibilities of carrying out boron-neutron therapy based on the neutron beam from the experimental reactor are shrinking. However, the use of nuclear power reactors for BNCT purposes is impossible due to the infrastructure not intended for radiotherapy. Therefore, a serious challenge is to find ways to perform boron-neutron therapy based on neutrons generated outside the research nuclear reactor. This work meets this challenge. Its goal is to develop a BNCT technique based on commonly available neutron sources such as Cf-252 and PuBe, which will enable the above-mentioned therapy in medical centers unrelated to nuclear research reactors. Advances in the field of neutron source fabrication make it possible to achieve strong neutron fluxes. The current stage of research focuses on the development of virtual models of the above-mentioned sources using the Monte Carlo simulation method. In this study, the GEANT4 tool was used, including the model for simulating neutron-matter interactions - High Precision Neutron. Models of neutron sources were developed on the basis of experimental verification based on the activation detectors method with the use of indium foil and the cadmium differentiation method allowing to separate the indium activation contribution from thermal and resonance neutrons. Due to the large number of factors affecting the result of the verification experiment, the 10% discrepancy between the simulation and experiment results was accepted.

Keywords: BNCT, virtual models, neutron sources, monte carlo, GEANT4, neutron activation detectors, gamma spectroscopy

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Authors: Chigozie Azunna, Botes Lucius

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Child homelessness remains a significant challenge in South Africa in the upcoming decade. Despite children making up a substantial portion of South Africa's population, the issue of child homelessness continues to pose a socio-economic crisis with diverse impacts. Achieving the UN 2050 Agenda for Sustainable Development Goals (SDGs), especially in terms of equality and non-discrimination, requires an effective approach to curb child homelessness. Addressing this issue will positively influence the economic trajectory of South Africa's evolving demographic landscape. This research uses content analysis through an extensive review of current literature on child homelessness in South Africa. Findings indicate alignment between national policies and international agendas in tackling child homelessness in South Africa. However, the following statistics depict the ongoing challenge: In metropolitan areas, homelessness stands at 74.1%, whereas non-metro regions account for 25.9%. The City of Tshwane has the highest number of homeless individuals at 18.1%, followed by the City of Johannesburg at 15.6%, while Nelson Mandela Bay Metropolitan has the lowest at 2.7%. Despite existing national policy frameworks, child homelessness persists. The lack of accurate data, compounded by issues such as economic challenges, the lingering impacts of the COVID-19 pandemic, poverty, the HIV/AIDS epidemic, and gaps in policy implementation, has exacerbated the problem. The consequences are dire, affecting children’s physical and emotional health, education, and future opportunities. The study recommends reinforcing actionable policies to address child homelessness effectively. Bridging the urban-rural divide and establishing intra-community networks are crucial for tackling this issue comprehensively. This includes addressing multifaceted challenges such as access to education, disease susceptibility, and the overall vulnerability of homeless children.

Keywords: South Africa, child, homeless, SDGs, COVID, urban, rural

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Authors: Gholba Niranjan Dilip, Anil Kumar

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Conduct of accurate reliable mapping of oil palm plantations and census of individual palm trees is a huge challenge. This study addresses this challenge and developed an optimized solution implemented deep learning techniques on remote sensing data. The oil palm is a very important tropical crop. To improve its productivity and land management, it is imperative to have accurate census over large areas. Since, manual census is costly and prone to approximations, a methodology for automated census using panchromatic images from Cartosat-2, SkySat and World View-3 satellites is demonstrated. It is selected two different study sites in Indonesia. The customized set of training data and ground-truth data are created for this study from Cartosat-2 images. The pre-trained model of Single Shot MultiBox Detector (SSD) Lite MobileNet V2 Convolutional Neural Network (CNN) from the TensorFlow Object Detection API is subjected to transfer learning on this customized dataset. The SSD model is able to generate the bounding boxes for each oil palm and also do the counting of palms with good accuracy on the panchromatic images. The detection yielded an F-Score of 83.16 % on seven different images. The detections are buffered and dissolved to generate polygons demarcating the boundaries of the oil palm plantations. This provided the area under the plantations and also gave maps of their location, thereby completing the automated census, with a fairly high accuracy (≈100%). The trained CNN was found competent enough to detect oil palm crowns from images obtained from multiple satellite sensors and of varying temporal vintage. It helped to estimate the increase in oil palm plantations from 2014 to 2021 in the study area. The study proved that high-resolution panchromatic satellite image can successfully be used to undertake census of oil palm plantations using CNNs.

Keywords: object detection, oil palm tree census, panchromatic images, single shot multibox detector

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Authors: Desiree Vandenberghe, Johan Albrecht

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Non-communicable diseases (NCDs) are responsible for the vast majority of deaths in the European Union (EU) and represent a large share of total health care spending. A future increase in this health and financial burden is likely to be driven by population ageing, lifestyle changes and technological advances in medicine. Without adequate prevention measures, this burden can severely threaten population health and economic development. To tackle this challenge, a correct assessment of the current burden of NCDs is required, as well as a projection of potential increases of this burden. The contribution of this paper is to offer perspective on the evolution of the NCD burden towards the future and to give an indication of the potential of prevention policy. A Non-Homogenous, Semi-Markov model for the EU was constructed, which allowed for a projection of the cost burden for the four main NCDs (cancer, cardiovascular disease, chronic respiratory disease and diabetes mellitus) towards 2030 and 2050. This simulation is done based on multiple baseline scenarios that vary in demand and supply factors such as health status, population structure, and technological advances. Finally, in order to assess the potential of preventive measures to curb the cost explosion of NCDs, a simulation is executed which includes increased efforts for preventive health care measures. According to the Markov model, by 2030 and 2050, total costs (direct and indirect costs) in the EU could increase by 30.1% and 44.1% respectively, compared to 2015 levels. An ambitious prevention policy framework for NCDs will be required if the EU wants to meet this challenge of rising costs. To conclude, significant cost increases due to Non-Communicable Diseases are likely to occur due to demographic and lifestyle changes. Nevertheless, an ambitious prevention program throughout the EU can aid in making this cost burden manageable for future generations.

Keywords: non-communicable diseases, preventive health care, health policy, Markov model, scenario analysis

Procedia PDF Downloads 139

Authors: Elena Barbaro, Elena Gregoris, Rossano Piazza, Boris Mifka, Tatjana Ivošević, Ivo Orlić, Ana Alebić-Juretić, Andrea Gambaro, Daniele Contini

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The aim of the POSEIDON project is to quantify the relative contribution of maritime traffic and harbor activities to atmospheric pollutants concentration in four port-cities of the Adriatic Sea. This study focuses on the harbors of Venice and Rijeka. In order to investigate the main pollution sources, emission inventories were used as input for receptor models: PMF (positive matrix factorization) and PCA (principal components analysis); moreover source identification was also conducted using PAHs diagnostic ratios. The ship traffic impact was quantified: i) on gaseous and particulate PAHs, collected using a new method which consisted in a double simultaneous sampling, in different wind sectors; ii) applying PMF to data of metals, PAHs and ions in PM10; iii) using the vanadium concentration according to the Agrawal methodology.

Keywords: ship traffic, PMF, harbor, POSEIDON

Procedia PDF Downloads 601

Authors: Fengqing Li, Petra Schneider

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Failure of tailings management facilities (TMF) of radioactive residues is an enormous challenge worldwide and can result in major catastrophes. Particularly in transboundary regions, such failure is most likely to lead to international conflict. This risk occurs in Kyrgyzstan and Uzbekistan, where the current major challenge is the quantification of impacts due to pollution from uranium legacy sites and especially the impact on river basins after natural hazards (i.e., landslides). By means of GoldSim, a probabilistic simulation model, the amount of tailing material that flows into the river networks of Mailuu Suu in Kyrgyzstan after pond failure was simulated for three scenarios, namely 10%, 20%, and 30% of material inputs. Based on Muskingum-Cunge flood routing procedure, the peak value of uranium flood wave along the river network was simulated. Among the 23 TMF, 19 ponds are close to the river networks. The spatiotemporal distributions of uranium along the river networks were then simulated for all the 19 ponds under three scenarios. Taking the TP7 which is 30 km far from the Kyrgyzstan-Uzbekistan border as one example, the uranium concentration decreased continuously along the longitudinal gradient of the river network, the concentration of uranium was observed at the border after 45 min of the pond failure and the highest value was detected after 69 min. The highest concentration of uranium at the border were 16.5, 33, and 47.5 mg/L under scenarios of 10%, 20%, and 30% of material inputs, respectively. In comparison to the guideline value of uranium in drinking water (i.e., 30 µg/L) provided by the World Health Organization, the observed concentrations of uranium at the border were 550‒1583 times higher. In order to mitigate the transboundary impact of a radioactive pollutant release, an integrated framework consisting of three major strategies were proposed. Among, the short-term strategy can be used in case of emergency event, the medium-term strategy allows both countries handling the TMF efficiently based on the benefit-sharing concept, and the long-term strategy intends to rehabilitate the site through the relocation of all TMF.

Keywords: Central Asia, contaminant transport modelling, radioactive residue, transboundary conflict

Procedia PDF Downloads 118

Authors: Yog Raj Sood, Rajnish Shrivastava, Anchal Wadhwa

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Power transformer is one of the electrical equipment that has a central and critical role in the power system. In order to avoid power transformer failure, information system that provides the transformer condition is needed. This paper presents an information system to know the exact situations prevailing within the transformer by declaring its health index. Health index of a transformer is decided by considering several diagnostic tools. The current work deals with UV-Vis, IFT, FP, BDV and Water Content. UV/VIS results have been pre-accessed using separate FL controller for concluding with the Furan contents. It is broadly accepted that the life of a power transformer is the life of the oil/ paper insulating system. The method relies on the use of furan analysis (insulation paper), and other oil analysis results as a means to declare health index. Fuzzy logic system is used to develop the information system. The testing is done on 5 samples of oil of transformers of rating 132/66 KV to obtain the results and results are analyzed using fuzzy logic model.

Keywords: interfacial tension analyzer (ift), flash point (fp), furfuraldehyde (fal), health index

Procedia PDF Downloads 634

Authors: Adebola Adedugbe

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The challenge of post-harvest losses poses serious threats for food security in Nigeria and the north-eastern part with the country losing about $9billion annually due to postharvest losses in the sector. Post-harvest loss (PHL) is the quantitative and qualitative loss of food in various post-harvest operations. In Nigeria, post-harvest losses (PHL) have been a major challenge to food security and improved farmer’s income. In 2022, the Nigerian government had said over 30 percent of food produced by Nigerian farmers perish during post-harvest. For many in northeast Nigeria, agriculture is the predominant source of livelihood and income. The persistent communal conflicts, flood, decade-old attacks by boko haram and insurgency in this region have disrupted farming activities drastically, with farmlands becoming insecure and inaccessible as communities are forced to abandon ancestral homes, The impact of climate change is also affecting agricultural and fishing activities, leading to shortage of food supplies, acute hunger and loss of livelihood. This has continued to impact negatively on the region and country’s food production and availability making it loose billions of US dollars annually in income in this sector. The root cause of postharvest losses among others in crops, livestock and fisheries are lack of modern post-harvest equipment, chemical and lack of technologies used for combating losses. The 2019 Global Hunger Index showed Nigeria’s case was progressing from a ‘serious to alarming level’. As part of measures to address the problem of post-harvest losses experienced by farmers, the federal government of Nigeria concessioned 17 silos with 6000 metric tonne storage space to private sector to enable farmers to have access to storage facilities. This paper discusses the causes, effects and solutions in handling post-harvest losses and optimize returns on food security in northeast Nigeria.

Keywords: farmers, food security, northeast Nigeria, postharvest loss

Procedia PDF Downloads 72

Authors: T. R. Sreeram, S. Natarajan, C. Jena

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Civil engineering construction is a network of tasks involving varying degree of complexity and streamlining, and standardization is the only way to establish a systemic approach to design. While there are off the shelf tools such as AutoCAD that play a role in the realization of design, the repeatable process in which these tools are deployed often is ignored. The present paper addresses this challenge through a sustainable design process and effective standardizations at all stages in the design workflow. The same is demonstrated through a case study in the context of construction, and further improvement points are highlighted.

Keywords: syste, lean, value stream, process improvement

Procedia PDF Downloads 123

Authors: Simone Galati, Adriano Troia

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Ultrasound (US) is widely used in medical field for a variety diagnostic techniques but, in recent years, it has also been creating great interest for therapeutic aims. Regarding drug delivery, the use of US as an activation source provides better spatial delivery confinement and limits the undesired side effects. However, at present there is no complete characterization at a fundamental level of the different signals produced by sono-activated nanocarriers. Therefore, the aim of this study is to obtain a metrological characterization of the cavitation phenomena induced by US through three parallel investigation approaches. US was focused into a channel of a customized phantom in which a solution with oxygen-loaded nanodroplets (OLNDs) was led to flow and the cavitation activity was monitored. Both quantitative and qualitative real-time analysis were performed giving information about the dynamics of bubble formation, oscillation and final implosion with respect to the working acoustic pressure and the type of nanodroplets, compared with pure water. From this analysis a possible interpretation of the observed results is proposed.

Keywords: cavitation, drug delivery, nanodroplets, ultra-sound

Procedia PDF Downloads 110

Authors: Mohammad Yousefikia, Sara Moridpour, Ehsan Mazloumi

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Perceiving track geometry deterioration decisively influences the optimization of track maintenance operations. The effective management of this deterioration and increasingly utilized system with limited financial resources is a significant challenge. This paper provides a review of degradation models relevant for railroad tracks. Furthermore, due to the lack of long term information on the condition development of tram infrastructures, presents the methodology which will be used to derive degradation models from the data of Melbourne tram network.

Keywords: deterioration modeling, asset management, railway, tram

Procedia PDF Downloads 379

Authors: E.K.K. Agyeman, P. Mousseau, A. Sarda, D. Edelin

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The uniform and controlled cooling of hot metals by the circulation of water in canals remains a challenge due to the phase change of the water and the high heat fluxes associated with the phase change. This is because, during the cooling process, the phases are not uniformly distributed along the canals with the liquid phase dominating at the entrances of the canals and the gaseous phase dominating towards the exits. The difference in thermal properties between both phases leads to a heterogeneous temperature distribution in the part being cooled. Slowing down the cooling process is also a challenge due to the high heat fluxes associated with the phase change of water. This study investigates the use of multiple water jets for the controlled and homogenous cooling of hot metal parts and the effect of gravity on the effectiveness of the cooling process with a potential application in the cooling of composite forming moulds. A hole is bored at the centre of a steel block along its length. The jets are generated from the holes of a perforated steel pipe which is placed along the centre of the hole bored in the steel block. The evolution of the temperature with respect to time on the external surface of the steel block is measured simultaneously by thermocouples and an infrared camera. Different jet positions are tested in order to identify the jet placement configuration that ensures the most homogenous cooling of the block while the cooling speed is controlled by an intermittent impingement of the jets. In order to study the effect of gravity on the cooling process, a scenario where the jets are oriented in the opposite direction to that of gravity is compared to one where the jets are aligned in the same direction as gravity. It’s observed that orienting the jets in the direction of gravity reduces the effectiveness of the cooling process on the face of the block facing the impinging jets. This is due to the formation of a deeper pool of water due to the effect gravity and of the curved surface of the canal. This deeper pool of water influences the boiling regime characterized by a slower bubble evacuation when compared to the scenario where the jets are opposed to gravity.

Keywords: cooling speed, gravity, homogenous cooling, jet impingement

Procedia PDF Downloads 121

Authors: Orkide Donma, Mustafa M. Donma

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Obesity is a low-grade inflammatory disease and may lead to health problems such as hypertension, dyslipidemia, diabetes. It is also associated with important risk factors for cardiovascular diseases. This requires the detailed evaluation of obesity, particularly in children. The aim of this study is to enlighten the potential associations between lipid ratios and obesity indices and to introduce those with discriminating features among children with obesity and metabolic syndrome (MetS). A total of 408 children (aged between six and eighteen years) participated in the scope of the study. Informed consent forms were taken from the participants and their parents. Ethical Committee approval was obtained. Anthropometric measurements such as weight, height as well as waist, hip, head, neck circumferences and body fat mass were taken. Systolic and diastolic blood pressure values were recorded. Body mass index (BMI), diagnostic obesity notation model assessment index-II (D2 index), waist-to-hip, head-to-neck ratios were calculated. Total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDLChol), low-density lipoprotein cholesterol (LDLChol) analyses were performed in blood samples drawn from 110 children with normal body weight, 164 morbid obese (MO) children and 134 children with MetS. Age- and sex-adjusted BMI percentiles tabulated by World Health Organization were used to classify groups; normal body weight, MO and MetS. 15^th-to-85^th percentiles were used to define normal body weight children. Children, whose values were above the 99th percentile, were described as MO. MetS criteria were defined. Data were evaluated statistically by SPSS Version 20. The degree of statistical significance was accepted as p≤0.05. Mean±standard deviation values of BMI for normal body weight children, MO children and those with MetS were 15.7±1.1, 27.1±3.8 and 29.1±5.3 kg/m², respectively. Corresponding values for the D2 index were calculated as 3.4±0.9, 14.3±4.9 and 16.4±6.7. Both BMI and D2 index were capable of discriminating the groups from one another (p≤0.01). As far as other obesity indices were considered, waist-to hip and head-to-neck ratios did not exhibit any statistically significant difference between MO and MetS groups (p≥0.05). Diagnostic obesity notation model assessment index-II was correlated with the triglycerides-to-HDL-C ratio in normal body weight and MO (r=0.413, p≤0.01 and r=0.261, (p≤0.05, respectively). Total cholesterol-to-HDL-C and LDL-C-to-HDL-C showed statistically significant differences between normal body weight and MO as well as MO and MetS (p≤0.05). The only group in which these two ratios were significantly correlated with waist-to-hip ratio was MetS group (r=0.332 and r=0.334, p≤0.01, respectively). Lack of correlation between the D2 index and the triglycerides-to-HDL-C ratio was another important finding in MetS group. In this study, parameters and ratios, whose associations were defined previously with increased cardiovascular risk or cardiac death have been evaluated along with obesity indices in children with morbid obesity and MetS. Their profiles during childhood have been investigated. Aside from the nature of the correlation between the D2 index and triglycerides-to-HDL-C ratio, total cholesterol-to-HDL-C as well as LDL-C-to- HDL-C ratios along with their correlations with waist-to-hip ratio showed that the combination of obesity-related parameters predicts better than one parameter and appears to be helpful for discriminating MO children from MetS group.

Keywords: children, lipid ratios, metabolic syndrome, obesity indices

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Authors: Vishwas Chakranarayan, Mariyam Al Salman

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Despite the global environmental threats, previous approaches used to overcome these problems have failed to prevent environmental degradation. Scholars believe that entrepreneurs can help conserve habitats, combat climate change, increase freshwater availability, sustain biodiversity, and reduce environmental degradation and deforestation. The pandemic is creating a different ecosystem for fostering the eco-entrepreneurship opportunities. However, attending a course physically is a challenge for many willing learners. Therefore, it is an opportune time to contemplate on developing a social entrepreneurship curriculum which can be offered online.

Keywords: ecopreneurship, environmental problems, environmental degradation, entrepreneurship education

Procedia PDF Downloads 167