Search results for: physical tests
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10006

Search results for: physical tests

3136 Fluid Prescribing Post Laparotomies

Authors: Gusa Hall, Barrie Keeler, Achal Khanna

Abstract:

Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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3135 Exploring the Feasibility of Utilizing Blockchain in Cloud Computing and AI-Enabled BIM for Enhancing Data Exchange in Construction Supply Chain Management

Authors: Tran Duong Nguyen, Marwan Shagar, Qinghao Zeng, Aras Maqsoodi, Pardis Pishdad, Eunhwa Yang

Abstract:

Construction supply chain management (CSCM) involves the collaboration of many disciplines and actors, which generates vast amounts of data. However, inefficient, fragmented, and non-standardized data storage often hinders this data exchange. The industry has adopted building information modeling (BIM) -a digital representation of a facility's physical and functional characteristics to improve collaboration, enhance transmission security, and provide a common data exchange platform. Still, the volume and complexity of data require tailored information categorization, aligning with stakeholders' preferences and demands. To address this, artificial intelligence (AI) can be integrated to handle this data’s magnitude and complexities. This research aims to develop an integrated and efficient approach for data exchange in CSCM by utilizing AI. The paper covers five main objectives: (1) Investigate existing framework and BIM adoption; (2) Identify challenges in data exchange; (3) Propose an integrated framework; (4) Enhance data transmission security; and (5) Develop data exchange in CSCM. The proposed framework demonstrates how integrating BIM and other technologies, such as cloud computing, blockchain, and AI applications, can significantly improve the efficiency and accuracy of data exchange in CSCM.

Keywords: construction supply chain management, BIM, data exchange, artificial intelligence

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3134 Elemental and Magnetic Properties of Bed Sediment of Siang River, a Major River of Brahmaputra Basin

Authors: Abhishek Dixit, Sandip S. Sathe, Chandan Mahanta

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The Siang river originates in Angsi glacier in southern Tibet (there known as the Yarlung Tsangpo). After traveling through Indus-Tsangpo suture zone and deep gorges near Namcha Barwa peak, it takes a south-ward turn and enters India, where it is known as Siang river and becomes a major tributary of the Brahmaputra in Assam plains. In this study, we have analyzed the bed sediment of the Siang river at two locations (one at extreme upstream near the India-China border and one downstream before Siang Brahmaputra confluence). We have also sampled bed sediment at the remote location of Yammeng river, an eastern tributary of Siang. The magnetic hysteresis properties show the combination of paramagnetic and weak ferromagnetic behavior with a multidomain state. Moreover, curie temperature analysis shows titanomagnetite solid solution series, which is causing the weak ferromagnetic signature. Given that the magnetic mineral was in a multidomain state, the presence of Ti, Fe carrying heave mineral, may be inferred. The Chemical index of alteration shows less weathered sediment. However, the Yammeng river sample being close to source shows fresh grains subjected to physical weathering and least chemically alteration. Enriched Ca and K and depleted Na and Mg with respect to upper continental crust concentration also points toward the less intense chemical weathering along with the dominance of calcite weathering.

Keywords: bed sediment, magnetic properties, Siang, weathering

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3133 Increasing Sulfur Handling Cost Efficiency Using the Eco Sulfur Paving Block Method at PT Pertamina EP Field Cepu

Authors: Adha Bayu Wijaya, A. Zainal Abidin, Naufal Baihaqi, Joko Suprayitno, Astika Titistiti, Muslim Adi Wijaya, Endah Tri Lestari, Agung Wibowo

Abstract:

Sulfur is a non-metallic chemical element in the form of a yellow crystalline solid with the chemical formula, and is formed from several types of natural and artificial chemical reactions. Commercial applications of sulfur processed products can be found in various aspects of life, for example in the use of processed sulfur as paving blocks. The Gundih Central Processing Plant (CPP) is capable of producing 14 tons/day of sulfur pellets. This amount comes from the high H2S content of the wells with a total concentration of 20,000 ppm and a volume accumulation of 14 MMSCFD acid gas. H2S is converted to sulfur using the thiobacillus microbe in the Biological Sulfur Recovery Unit (BSRU) with a sulfur product purity level greater than 95%. In 2018 sulfur production at Gundih CPP was recorded at 4044 tons which could potentially trigger serious problems from an environmental aspect. The use of sulfur as material for making paving blocks is an alternative solution in addressing the potential impact on the environment, as regulated by Government Regulation No.22 of Year 2021 concerning the Waste Management of Non-Hazardous and Toxic Substances (B3), and the high cost of handling sulfur by third parties. The design mix of ratio sulfur paving blocks is 22% cements, rock ash 67%, and 11% of sulfur pellets. The sulfur used in making the paving mixture is pure sulfur, namely the side product category without any contaminants, thereby eliminating the potential for environmental pollution when implementing sulfur paving. Strength tests of sulfur paving materials have also been confirmed by external laboratories. The standard used in making sulfur paving blocks refers to the SNI 03-0691-1996 standard. With the results of sulfur paving blocks made according to quality B. Currently, sulfur paving blocks are used in building access to wells locations and in public roads in the Cepu Field area as a contribution from Corporate Social Responsibility (CSR).

Keywords: sulphur, innovation, paving block, CSR, sulphur paving

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3132 In Life: Space as Doppelganger in “The House of Usher”

Authors: Tuğçe Arslan

Abstract:

In the dark and gloomy times of the Middle Ages, high, majestic, and frightening structures were revealed in the architectural field. Thus, gothic architecture began to find a place for itself in different areas and spread its influence. Gothic has found its place in almost every literary genre and manages to show itself as the dominant genre in the works it enters. It has exploited many concepts, such as a chest full of bad feelings, and creates a gloomy, scary, frightening, and pessimistic mood in the story with these concepts. One of the essential concepts it uses while creating these feelings is the concept of “Doppelganger.” With this concept, the authors make sense of the uncanny; at this point, they allow the spaces to act like characters, just like the uncanny feeling Edgar Allan Poe creates in his story “The Fall of the House of the Usher.” In this story by Edgar Allan Poe, attention should be paid to the symbolic link between the two, as “House of Usher” refers to the family and the building. And indeed, it is possible to see this minor rift as representative of a breakdown in family unity, specifically between Madeline and Roderick. Because although the home is not alive, it has some supernatural features that make it look like a living, breathing being. Therefore, the remainder of this paper will argue that apart from the apparent twins, the house should also qualify as a Doppelganger in the story. This study will first explore the physical and mental disorders of the twins and their journey to complement each other; next, in an attempt to demonstrate how the house as a non-living needs to be considered as a Doppelganger of the twins, a close reading on the house depictions will be scrutinized.

Keywords: Edgar Allan Poe, doppelganger, uncanny, gothic, space, home

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3131 Investigation of Pollution and the Physical and Chemical Condition of Polour River, East of Tehran, Iran

Authors: Azita Behbahaninia

Abstract:

This research has been carried out to determine the water quality and physico-chemical properties Polour River, one of the most branch of Haraz River. Polour River was studied for a period of one year Samples were taken from different stations along the main branch of River polour. In water samples determined pH, DO, SO4, Cl, PO4, NO3, EC, BOD, COD, Temprature, color and number of Caliform per liter. ArcGIS was used for the zoning of phosphate concentration in the polour River basin. The results indicated that the river is polluted in polour village station, because of discharge domestic wastewater and also river is polluted in Ziar village station, because of agricultural wastewater and water is contaminated in aquaculture station, because of fish ponds wastewater. Statistical analysis shows that between independent traits and coliform regression relationship is significant at the 1% level. Coefficient explanation index indicated independent traits control 80% coliform and 20 % is for unknown parameters. The causality analysis showed Temperature (0.6) has the most positive and direct effect on coliform and sulfate has direct and negative effect on coliform. The results of causality analysis and the results of the regression analysis are matched and other forms direct and indirect effects were negligible and ignorable. Kruskal-Wallis test showed, there is different between sampling stations and studied characters. Between stations for temperature, DO, COD, EC, sulfate and coliform is at 1 % and for phosphate 5 % level of significance.

Keywords: coliform, GIS, pollution, phosphate, river

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3130 Assessment of Music Performance Anxiety in Portuguese Children and Adolescents

Authors: Pedro Dias, Lurdes Verissimo, Maria Joao Baptista, Ana Pinheiro, Patricia Oliveira-Silva, Sofia Serra, Daniela Coimbra

Abstract:

To achieve a high standard in performance, a musician must be well in all aspects of health (physical, mental and social). Anxiety in performance is related to the high level of coordination and skill needed in performance, as well as to the public evaluation of the performer. It affects some key elements of performance, such as concentration, memory, motor coordination, and relaxation. This work presents two studies focused on the adaptation and evaluation of the psychometric properties of the Music Performance Anxiety Inventory (MPAI-A) in young Portuguese music students. The first study was conducted with a sample of 161 adolescent music students, who responded to the Portuguese version of this instrument, and to the State-Trait Anxiety Inventory for Children (STAIC-c2). Validity and reliability were examined, and this measure revealed robust psychometric properties in this sample. The second study aimed to adapt the MPAI to a younger population (one hundred 8-10 years-old music students). Again, the MPAI and the STAIC c-2 were used in this study. Exploratory factor analysis, correlations, and internal consistency were used to evaluate the final children version of the instrument (MPAI-C), presenting a different factor structure compared to the adolescent version (10 items organized in 2 factors) and high levels of reliability and convergent validity.

Keywords: anxiety, assessment, children and adolescents, music performance

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3129 Towards a Smart Irrigation System Based on Wireless Sensor Networks

Authors: Loubna Hamami, Bouchaib Nassereddine

Abstract:

Due to the evolution of technologies, the need to observe and manage hostile environments, and reduction in size, wireless sensor networks (WSNs) are becoming essential and implicated in the most fields of life. WSNs enable us to change the style of living, working and interacting with the physical environment. The agricultural sector is one of such sectors where WSNs are successfully used to get various benefits. For successful agricultural production, the irrigation system is one of the most important factors, and it plays a tactical role in the process of agriculture domain. However, it is considered as the largest consumer of freshwater. Besides, the scarcity of water, the drought, the waste of the limited available water resources are among the critical issues that touch the almost sectors, notably agricultural services. These facts are leading all governments around the world to rethink about saving water and reducing the volume of water used; this requires the development of irrigation practices in order to have a complete and independent system that is more efficient in the management of irrigation. Consequently, the selection of WSNs in irrigation system has been a benefit for developing the agriculture sector. In this work, we propose a prototype for a complete and intelligent irrigation system based on wireless sensor networks and we present and discuss the design of this prototype. This latter aims at saving water, energy and time. The proposed prototype controls water system for irrigation by monitoring the soil temperature, soil moisture and weather conditions for estimation of water requirements of each plant.

Keywords: precision irrigation, sensor, wireless sensor networks, water resources

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3128 Animal-Assisted Therapy: A Perspective From Singapore

Authors: Julia Wong, Hua Beng Lim, Petrina Goh, Johanna Foo, Caleb Ng, Nurul ‘Aqilah Bte Mohd Taufek

Abstract:

Animal-assisted therapy (AAT) utilizes human-animal interaction to achieve specific therapeutic goals, and its efficacy has been demonstrated across various settings overseas. The use of AAT in Singapore, however, is still limited. Ang Mo Kio-Thye Hua Kwan (AMKH) is one of the first community hospitals in Singapore to use AAT to complement its occupational therapy services with elderly patients. This study explored the perspectives of AMKH’s occupational therapists (OTs) in relation to AAT to understand barriers and enablers in implementing and practising AAT. We also examined how OTs at-large across practice settings perceive AAT. A mixed method design was used. 64 OTs at-large participated in on online survey, and 7 AMKH OTs were interviewed individually via Zoom. Survey results were analysed with descriptive and Mann-Whitney U tests. Interviews were thematically analysed. AMKH OTs perceived various benefits of AAT articulated in overseas studies in domains such as motivation and participation, emotional, social interaction, sensory tactile stimulation, and cognition. Interestingly, this perception was also supported by 67% of OTs who had responded to the survey, even though most of the OTs who had participated in the survey had no experience in AAT. Despite the perceived benefits of AAT, both OTs from AMKH and those at-large articulated concerns on risks pertaining to AAT (e.g., allergies, unexpected animal behaviour, infections, etc). However, AMKH OTs shared several ways to mitigate these risks, demonstrating their ability to develop a safe program. For e.g., volunteers and their dogs must meet specific recruitment criteria, stringent protocols are used to screen and match dogs with patients, and there are strict exclusion criteria for patients participating in AAT. AMKH OTs’ experience suggests that additional skills and knowledge are required to implement AAT, therefore, healthcare institutions should first consider improving their staff training and risk mitigation knowledge before implementing AAT. They can also refer to AMKH’s AAT protocols and those found in overseas studies, but institutions must adapt the protocols to fit their institutional settings and patients’ profiles.

Keywords: animal-assisted therapy, dog-assisted therapy, occupational therapy, complementary therapy

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3127 Effect of Experience on Evacuation of Mice in Emergency Conditions

Authors: Teng Zhang, Shenshi Huang, Gang Xu, Xuelin Zhang, Shouxiang Lu

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With the acceleration of urbanization and the increasing of the population in the city, the evacuation of pedestrians suffering from disaster environments such as fire in a room or other limited space becomes a vital issue in modern society. Mice have been used in experimental crowd evacuation in recent years for its good similarities to human in physical structure and stress reaction. In this study, the effect of experience or memory on the collective behavior of mice was explored. To help mice familiarize themselves with the design of the space and the stimulus caused by smoke, we trained them repeatedly for 2 days so that they can escape from the emergency conditions as soon as possible. The escape pattern, trajectories, walking speed, turning angle and mean individual escape time of mice in each training trail were analyzed. We found that mice can build memory quickly after the first trial on the first day. On the second day, the evacuation of mice was maintained in a stable and efficient state. Meanwhile, the group with size of 30 (G30) had a shorter mean individual escape time compared with G12. Furthermore, we tested the experience of evacuation skill of mice after several days. The results showed that the mice can hold the experience or memory over 3 weeks. We proposed the importance of experience of evacuation skill and the research of training methods in experimental evacuation of mice. The results can deepen our understanding of collective behavior of mice and conduce to the establishment of animal models in the study of pedestrian crowd dynamics in emergency conditions.

Keywords: experience, evacuation, mice, group size, behavior

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3126 Implications of Meteorological Parameters in Decision Making for Public Protective Actions during a Nuclear Emergency

Authors: M. Hussaina, K. Mahboobb, S. Z. Ilyasa, S. Shaheena

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Plume dispersion modeling is a computational procedure to establish a relationship between emissions, meteorology, atmospheric concentrations, deposition and other factors. The emission characteristics (stack height, stack diameter, release velocity, heat contents, chemical and physical properties of the gases/particle released etc.), terrain (surface roughness, local topography, nearby buildings) and meteorology (wind speed, stability, mixing height, etc.) are required for the modeling of the plume dispersion and estimation of ground and air concentration. During the early phase of Fukushima accident, plume dispersion modeling and decisions were taken for the implementation of protective measures. A difference in estimated results and decisions made by different countries for taking protective actions created a concern in local and international community regarding the exact identification of the safe zone. The current study is focused to highlight the importance of accurate and exact weather data availability, scientific approach for decision making for taking urgent protective actions, compatible and harmonized approach for plume dispersion modeling during a nuclear emergency. As a case study, the influence of meteorological data on plume dispersion modeling and decision-making process has been performed.

Keywords: decision making process, radiation doses, nuclear emergency, meteorological implications

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3125 Application of Active Chitosan Coating Incorporated with Spirulina Extract as a Potential Food Packaging Material for Enhancing Quality and Shelf Life of Shrimp

Authors: Rafik Balti, Nourhene Zayoud, Mohamed Ben Mansour, Abdellah Arhaliass, Anthony Masse

Abstract:

Application of edible films and coatings with natural active compounds for enhancing storage stability of food products is a promising active packaging approach. Shrimp are generally known as valuable seafood products around the world because of their delicacy and good nutritional. However, shrimp is highly vulnerable to quality deterioration associated with biochemical, microbiological or physical changes during postmortem storage, which results in the limited shelf life of the product. Chitosan is considered as a functional packaging component for maintaining the quality and increasing the shelf life of perishable foods. The present study was conducted to evaluate edible coating of crab chitosan containing variable levels of ethanolic extract of Spirulina on microbiological (mesophilic aerobic, psychrotrophic, lactic acid bacteria, and enterobacteriacea), chemical (pH, TVB-N, TMA-N, PV, TBARS) and sensory (odor, color, texture, taste, and overall acceptance) properties of shrimp during refrigerated storage. Also, textural and color characteristics of coated shrimp were performed. According to the obtained results, crab chitosan in combination with Spirulina extract was very effective in order to extend the shelf life of shrimp during storage in refrigerated condition.

Keywords: food packaging, chitosan, spirulina extract, white shrimp, shelf life

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3124 Policy and Practice of Later-Life Learning in China: A Critical Document Discourse Analysis

Authors: Xue Wu

Abstract:

Since the 1980s, a series of policies and practices have been implemented in China in response to the unprecedented rate of ageing population. The paper provides a detailed narrative of what later-life learning policy discourses have been advocated and gives a description on relevant practical issues during the past three decades. The research process based on the discourse approach with a systematic review of the government-issued documents. It finds that the main practices taken by central government at various levels were making University of the Aged (UA) available in all urban and rural regions to consolidate the newly student enrollments; focusing social-recreational, leisure and cultural activities on 55-75 age group; and utilizing various methods including voluntary works and tourism to improve older adults’ physical and mental wellness. Although there were greater achievements with 30 years of development, many problems still exist. Finding reveals that the curriculum should be modified to meet the needs of the local development, to promote older adults’ contact and contribution to the community, and to enhance technical competences of those in rural areas involving in agricultural production. Central government should also integrate resources from all sectors of the society for further developing later-life learning in China. The result of this paper highlights the value to promote community-based later-life learning for building a society for active ageing and ageing in place.

Keywords: ageing population, China, later-life learning, policy, University of the Aged

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3123 Using Multiomic Plasma Profiling From Liquid Biopsies to Identify Potential Signatures for Disease Diagnostics in Late-Stage Non-small Cell Lung Cancer (NSCLC) in Trinidad and Tobago

Authors: Nicole Ramlachan, Samuel Mark West

Abstract:

Lung cancer is the leading cause of cancer-associated deaths in North America, with the vast majority being non-small cell lung cancer (NSCLC), with a five-year survival rate of only 24%. Non-invasive discovery of biomarkers associated with early-diagnosis of NSCLC can enable precision oncology efforts using liquid biopsy-based multiomics profiling of plasma. Although tissue biopsies are currently the gold standard for tumor profiling, this method presents many limitations since these are invasive, risky, and sometimes hard to obtain as well as only giving a limited tumor profile. Blood-based tests provides a less-invasive, more robust approach to interrogate both tumor- and non-tumor-derived signals. We intend to examine 30 stage III-IV NSCLC patients pre-surgery and collect plasma samples.Cell-free DNA (cfDNA) will be extracted from plasma, and next-generation sequencing (NGS) performed. Through the analysis of tumor-specific alterations, including single nucleotide variants (SNVs), insertions, deletions, copy number variations (CNVs), and methylation alterations, we intend to identify tumor-derived DNA—ctDNA among the total pool of cfDNA. This would generate data to be used as an accurate form of cancer genotyping for diagnostic purposes. Using liquid biopsies offer opportunities to improve the surveillance of cancer patients during treatment and would supplement current diagnosis and tumor profiling strategies previously not readily available in Trinidad and Tobago. It would be useful and advantageous to use this in diagnosis and tumour profiling as well as to monitor cancer patients, providing early information regarding disease evolution and treatment efficacy, and reorient treatment strategies in, timethereby improving clinical oncology outcomes.

Keywords: genomics, multiomics, clinical genetics, genotyping, oncology, diagnostics

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3122 Adaptor Protein APPL2 Could Be a Therapeutic Target for Improving Hippocampal Neurogenesis and Attenuating Depressant Behaviors and Olfactory Dysfunctions in Chronic Corticosterone-induced Depression

Authors: Jiangang Shen

Abstract:

Olfactory dysfunction is a common symptom companied by anxiety- and depressive-like behaviors in depressive patients. Chronic stress triggers hormone responses and inhibits the proliferation and differentiation of neural stem cells (NSCs) in the hippocampus and subventricular zone (SVZ)-olfactory bulb (OB), contributing to depressive behaviors and olfactory dysfunction. However, the cellular signaling molecules to regulate chronic stress mediated olfactory dysfunction are largely unclear. Adaptor proteins containing the pleckstrin homology domain, phosphotyrosine binding domain, and leucine zipper motif (APPLs) are multifunctional adaptor proteins. Herein, we tested the hypothesis that APPL2 could inhibit hippocampal neurogenesis by affecting glucocorticoid receptor (GR) signaling, subsequently contributing to depressive and anxiety behaviors as well as olfactory dysfunctions. The major discoveries are included: (1) APPL2 Tg mice had enhanced GR phosphorylation under basic conditions but had no different plasma corticosterone (CORT) level and GR phosphorylation under stress stimulation. (2) APPL2 Tg mice had impaired hippocampal neurogenesis and revealed depressive and anxiety behaviors. (3) GR antagonist RU486 reversed the impaired hippocampal neurogenesis in the APPL2 Tg mice. (4) APPL2 Tg mice displayed higher GR activity and less capacity for neurogenesis at the olfactory system with lesser olfactory sensitivity than WT mice. (5) APPL2 negatively regulates olfactory functions by switching fate commitments of NSCs in adult olfactory bulbs via interaction with Notch1 signaling. Furthermore, baicalin, a natural medicinal compound, was found to be a promising agent targeting APPL2/GR signaling and promoting adult neurogenesis in APPL2 Tg mice and chronic corticosterone-induced depression mouse models. Behavioral tests revealed that baicalin had antidepressant and olfactory-improving effects. Taken together, APPL2 is a critical therapeutic target for antidepressant treatment.

Keywords: APPL2, hippocampal neurogenesis, depressive behaviors and olfactory dysfunction, stress

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3121 Applied Free Living Nematode as Bioindicator to Assess Environmental Impact of Dam Construction in Ba Lai Estuary, Vietnam

Authors: Ngo Xuan Quang, Tran Thanh Thai, Ann Vanreusel

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The Ba Lai dam construction was created in 2000 in the Ba Lai estuarine river, Ben Tre province, Vietnam to prevent marine water infiltration, drainage and de-acidification, and to build a reservoir of freshwater for land reclamation in the Ba Lai tributary. However, this dam is considered as an environmental failure for the originally connected estuarine and river ecosystem, especially to bad effect to benthic fauna distribution. This research aims to study applying free living nematode communities’ distribution in disturbance of dam construction as bioindicator to detect environmental impact. Nematode samples were collected together measuring physical–chemical environmental parameters such as chlorophyll, CPE, coliform, nutrient, grain size, salinity, dissolved oxygen, turbidity, conductivity, temperature in three stations within three replicates. Results showed that free living nematode communities at the dam construction was significantly low densities, low diversity (Hurlbert’s index, Hill diversity indices) and very low maturity index in comparison with two remaining stations. Strong correlation of nematode feeding types and communities’ structure was found in relation with sediment grain size and nutrient enrichment such nitrite, nitrate, phosphate and pigment concentration. Moreover, greatly negative link between nematode maturity index with nutrient parameters can serve as warning organic pollution of the Ba Lai river due to dam construction.

Keywords: Ba Lai, dam impact, nematode, environment

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3120 Organizational Commitment in Islamic Boarding School: The Implementation of Organizational Behavior Integrative Model

Authors: Siswoyo Haryono

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Purpose – The fundamental goal of this research is to see if the integrative organizational behavior model can be used effectively in Islamic boarding schools. This paper also seeks to assess the effect of Islamic organizational culture, leadership, and spiritual intelligence on teachers' organizational commitment to Islamic Boarding schools. The goal of the mediation analysis is to see if the Islamic work ethic has a more significant effect on the instructors' organizational commitment than the direct effects of Islamic organizational culture, leadership, and Islamic spiritual intelligence. Design/methodology/approach – A questionnaire survey was used to obtain data from teachers at Islamic Boarding Schools. This study used the AMOS technique for structural equation modeling to evaluate the expected direct effect. To test the hypothesized indirect effect, employed Sobel test. Findings – Islamic organizational culture, Islamic leadership, and Islamic spiritual intelligence significantly affect Islamic work ethic. When it comes to Islamic corporate culture, Islamic leadership, Islamic spiritual intelligence, and Islamic work ethics have a significant impact. The findings of the mediation study reveal that Islamic organizational culture, leadership, and spiritual intelligence influences organizational commitment through Islamic work ethic. The total effect analysis shows that the most effective path to increasing teachers’ organizational commitment is Islamic leadership - Islamic work ethic – organizational commitment. Originality/value – This study evaluates the Integrative Model of Organizational Behavior by Colquitt (2016) applied in Islamic Boarding School. The model consists of contemporary leadership and individual characteristic as the antecedent. The mediating variables of the model consist of individual mechanisms such as trust, justice, and ethic. Individual performance and organizational commitment are the model's outcomes. These variables, on the other hand, do not represent the Islamic viewpoint as a whole. As a result, this study aims to assess the role of Islamic principles in the model. The study employs reliability and validity tests to get reliable and valid measures. The findings revealed that the evaluation model is proven to improve organizational commitment at Islamic Boarding School.

Keywords: Islamic leadership, Islamic spiritual intelligence, Islamic work ethic, organizational commitment, Islamic boarding school

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3119 Cytokine Changes of Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors

Authors: Chao Hsing Yeh, Wei Chun Lin

Abstract:

Background: Current management of aromatase inhibitor-induced arthralgia (AIA) in postmenopausal breast cancer survivors (PBCS) has limited effect. Method: In this prospective randomized clinical trial (RCT), a 4-week APA treatment was used to manage AIA. Twenty PBCS participated. After baseline data was collected, participants were waited for a month before they receive APA at a convenient time once a week for 4 weeks. Blood samples from participants in both groups were collected at baseline and after 4 weeks of treatment. The primary outcomes included: pain intensity, pain interference, stiffness, and physical function. Results: After the 4-week APA treatment, the pro-inflammatory cytokines and chemokines display a trend of mean percentage reduction (i.e., -22% in IL-1α, -4% in IL-1β, -1% in IL-2, -3% in IL-6, -19% in IL-12, -9% in Eotaxin, and -2% in MCP-1). The anti-inflammatory cytokine IL-10 and IL-13 (i.e., 5% in IL-10 and 29% in IL-13) increased from pre- to post-APA treatment. Significant positive correlation of percentage mean change was observed between symptom severity and eotaxin (ρ = 0.56; p < 0.01) & MCP-1 (ρ = 0.65; p < 0.01). Interference and chemokines (eotaxin & MIP-1) also shows positive correlation (ρ = 0.48; p < 0.01 & ρ = 0.39; p < 0.05). Another positive correlation was found between worst pain and chemokines (eotaxin, ρ = 0.48; p < 0.01 & MIP-1, ρ = 0.39; p < 0.05). Additionally, interference also shows positive correlation among IL-1α (ρ = 0.36; p < 0.05) and IL-β (ρ = 0.33; p < 0.05). Conclusion: These findings suggest that APA intervention may inhibit inflammation of AIA patients and chemokine could be one of the key factors of AIA symptom improvement.

Keywords: acupressure, cytokine, pain management, breast cancer survivors

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3118 Investigation of Contact Pressure Distribution at Expanded Polystyrene Geofoam Interfaces Using Tactile Sensors

Authors: Chen Liu, Dawit Negussey

Abstract:

EPS (Expanded Polystyrene) geofoam as light-weight material in geotechnical applications are made of pre-expanded resin beads that form fused cellular micro-structures. The strength and deformation properties of geofoam blocks are determined by unconfined compression of small test samples between rigid loading plates. Applied loads are presumed to be supported uniformly over the entire mating end areas. Predictions of field performance on the basis of such laboratory tests widely over-estimate actual post-construction settlements and exaggerate predictions of long-term creep deformations. This investigation examined the development of contact pressures at a large number of discrete points at low and large strain levels for different densities of geofoam. Development of pressure patterns for fine and coarse interface material textures as well as for molding skin and hot wire cut geofoam surfaces were examined. The lab testing showed that I-Scan tactile sensors are useful for detailed observation of contact pressures at a large number of discrete points simultaneously. At low strain level (1%), the lower density EPS block presents low variations in localized stress distribution compared to higher density EPS. At high strain level (10%), the dense geofoam reached the sensor cut-off limit. The imprint and pressure patterns for different interface textures can be distinguished with tactile sensing. The pressure sensing system can be used in many fields with real-time pressure detection. The research findings provide a better understanding of EPS geofoam behavior for improvement of design methods and performance prediction of critical infrastructures, which will be anticipated to guide future improvements in design and rapid construction of critical transportation infrastructures with geofoam in geotechnical applications.

Keywords: geofoam, pressure distribution, tactile pressure sensors, interface

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3117 Study of Buried Interfaces in Fe/Si Multilayer by Hard X-Ray Emission Spectroscopy

Authors: Hina Verma, Karine Le Guen, Renaud Dalaunay, Iyas Ismail, Vita Ilakovac, Jean Pascal Rueff, Yunlin Jacques Zheng, Philippe Jonnard

Abstract:

To the extent of our knowledge, X-ray emission spectroscopy (XES) has been applied in the soft x-ray region (photon energy ≤ 2 keV) to study the buried layers and interfaces of stacks of nanometer-thin films. Now we extend the methodology to study the buried interfaces in the hard X-ray region (i.e., ≥ five keV). The emission spectra allow us to study the interactions between elements in the buried layers from the analysis of their valence states, thereby providing sensitive information about the physical-chemical environment of the emitting element in multilayers. We exploit the chemical sensitivity of XES to study the interfaces between Fe and Si layers in the Fe/Si multilayer from the Fe Kβ₂,₅ emission spectra (7108 eV). The Fe Kβ₅ emission line results from the electronic transition from occupied 3d to 1s levels (i.e., valence to core transition) and is hence sensitive to the chemical state of emitting Fe atoms. The comparison of emission spectra recorded for Fe/Si multilayer with Fe and FeSi₂ references reveal the formation of FeSi₂ at the Fe-Si interfaces inside the multilayer stack. The interfacial thickness was calculated to be 1.4 ± 0.2 nm by taking into consideration the intensity of Fe atoms emitted from the interface and the Fe layer. The formation of FeSi₂ at the interface was further confirmed by the X-ray diffraction and X-ray photoelectron spectroscopy done on the Fe/Si multilayer. Hence, we can conclude that the XES in the hard X-ray range could be used to study multilayers and their interfaces and obtain information both qualitatively and quantitatively.

Keywords: buried interfaces, hard X-ray emission spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy

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3116 Information and Communication Technology Application in the Face of COVID-19 Pandemic in Effective Service Delivery in Schools

Authors: Odigie Veronica

Abstract:

The paper focused on the application of Information and Communication Technology (ICT) in effective service delivery in view of the ongoing COVID-19 experience. It adopted the exploratory research method with three research objectives captured. Consequently, the objectives were to ascertain the meaning of online education, understand the concept of COVID-19 and to determine the relevance of online education in effective service delivery in institutions of learning. It is evident from the findings that through ICT, online mode of learning can be adopted in schools which helps greatly in promoting continual education. Online mode of education is practiced online; it brings both the teacher and learners from different places together, without any physical boundary/contact (at least 75%); and has helped greatly in human development in countries where it has been practiced. It is also a welcome development owing to its many benefits such as exposure to digital learning, having access to works of great teachers and educationists such as Socrates, Plato, Dewey, R.S. Peters, J. J. Rosseau, Nnamdi Azikwe, Carol Gilligan, J. I. Omoregbe, Jane Roland Martin, Jean Piaget, among others; and the facilitation of uninterrupted learning for class promotion and graduation of students. Developing the learners all round is part of human development which helps in developing a nation. These and many more are some benefits online education offers which make ICT very relevant in our contemporary society

Keywords: online education, COVID-19 pandemic, effective service delivery, human development

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3115 Athlete Burnout and Moral Disengagement in Sports

Authors: Min Pan, An-Hsu Chen

Abstract:

Burnout has been proved to be one of the factors that hinder the development and sport performances of athletes while moral disengagement is the psychological mechanism used by athletes to elevate the guilt caused by conducting the anti-social behaviors to gain competitive advantages and in sports which have both been discussed extensively. The sports devaluation in burnout may undermine the sportsmanship of athletes therefore may serve as one of factors of moral disengagement in sports. Nonetheless, the connection between athlete burnout and moral disengagement in sports is yet established. Hence, the study aims to investigate whether there is the correlation between athlete burnout and moral disengagement in sports. Participants of this study are 120 collegiate athletes who specialize in seven different sports (e.g., fence, boxing, taekwondo, and etc.) with average training hours of 3.7 per day and 4.5 days per week. Athlete Burnout Questionnaire and Moral Disengagement in Sports – Short were administrated as the research instruments. Data collected were analyzed with descriptive statistics, t-test, one-way ANOVA, and step-wise regression. The results show, participants demonstrate mild to moderate burnout and moral disengagement in their perspective sports disciplines. Moreover, athletes specialize in different sports experience distinct burnout situations while there is no significant variation of moral disengagement in different sports. It is also found, moral disengagement in sports has significant and positive correlations with emotional and physical exhaustion as well as sports devaluation in athlete burnout. Furthermore, athlete burnout can positively predict moral disengagement in sports while sports devaluation plays an important role within. It can be concluded that, athlete burnout may contribute to their tendency of moral disengagement in sport. By relieving the burnout level may help improve their moral disengagement inclination in sports. The finding may contribute to the current literature regarding athlete burnout and moral disengagement in sports.

Keywords: athlete burnout, dehumanization, moral disengagement, reduced sense of accomplishment

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3114 Distraction from Pain: An fMRI Study on the Role of Age-Related Changes in Executive Functions

Authors: Katharina M. Rischer, Angelika Dierolf, Ana M. Gonzalez-Roldan, Pedro Montoya, Fernand Anton, Marian van der Meulen

Abstract:

Even though age has been associated with increased and prolonged episodes of pain, little is known about potential age-related changes in the ˈtop-downˈ modulation of pain, such as cognitive distraction from pain. The analgesic effects of distraction result from competition for attentional resources in the prefrontal cortex (PFC), a region that is also involved in executive functions. Given that the PFC shows pronounced age-related atrophy, distraction may be less effective in reducing pain in older compared to younger adults. The aim of this study was to investigate the influence of aging on task-related analgesia and the underpinning neural mechanisms, with a focus on the role of executive functions in distraction from pain. In a first session, 64 participants (32 young adults: 26.69 ± 4.14 years; 32 older adults: 68.28 ± 7.00 years) completed a battery of neuropsychological tests. In a second session, participants underwent a pain distraction paradigm, while fMRI images were acquired. In this paradigm, participants completed a low (0-back) and a high (2-back) load condition of a working memory task while receiving either warm or painful thermal stimuli to their lower arm. To control for age-related differences in sensitivity to pain and perceived task difficulty, stimulus intensity, and task speed were individually calibrated. Results indicate that both age groups showed significantly reduced activity in a network of regions involved in pain processing when completing the high load distraction task; however, young adults showed a larger neural distraction effect in different parts of the insula and the thalamus. Moreover, better executive functions, in particular inhibitory control abilities, were associated with a larger behavioral and neural distraction effect. These findings clearly demonstrate that top-down control of pain is affected in older age, and could explain the higher vulnerability for older adults to develop chronic pain. Moreover, our findings suggest that the assessment of executive functions may be a useful tool for predicting the efficacy of cognitive pain modulation strategies in older adults.

Keywords: executive functions, cognitive pain modulation, fMRI, PFC

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3113 Development of a Robot Assisted Centrifugal Casting Machine for Manufacturing Multi-Layer Journal Bearing and High-Tech Machine Components

Authors: Mohammad Syed Ali Molla, Mohammed Azim, Mohammad Esharuzzaman

Abstract:

Centrifugal-casting machine is used in manufacturing special machine components like multi-layer journal bearing used in all internal combustion engine, steam, gas turbine and air craft turboengine where isotropic properties and high precisions are desired. Moreover, this machine can be used in manufacturing thin wall hightech machine components like cylinder liners and piston rings of IC engine and other machine parts like sleeves, and bushes. Heavy-duty machine component like railway wheel can also be prepared by centrifugal casting. A lot of technological developments are required in casting process for production of good casted machine body and machine parts. Usually defects like blowholes, surface roughness, chilled surface etc. are found in sand casted machine parts. But these can be removed by centrifugal casting machine using rotating metallic die. Moreover, die rotation, its temperature control, and good pouring practice can contribute to the quality of casting because of the fact that the soundness of a casting in large part depends upon how the metal enters into the mold or dies and solidifies. Poor pouring practice leads to variety of casting defects such as temperature loss, low quality casting, excessive turbulence, over pouring etc. Besides these, handling of molten metal is very unsecured and dangerous for the workers. In order to get rid of all these problems, the need of an automatic pouring device arises. In this research work, a robot assisted pouring device and a centrifugal casting machine are designed, developed constructed and tested experimentally which are found to work satisfactorily. The robot assisted pouring device is further modified and developed for using it in actual metal casting process. Lot of settings and tests are required to control the system and ultimately it can be used in automation of centrifugal casting machine to produce high-tech machine parts with desired precision.

Keywords: bearing, centrifugal casting, cylinder liners, robot

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3112 Determination of Elasticity Constants of Isotropic Thin Films Using Impulse Excitation Technique

Authors: M. F. Slim, A. Alhussein, F. Sanchette, M. François

Abstract:

Thin films are widely used in various applications to enhance the surface properties and characteristics of materials. They are used in many domains such as: biomedical, automotive, aeronautics, military, electronics and energy. Depending on the elaboration technique, the elastic behavior of thin films may be different from this of bulk materials. This dependence on the elaboration techniques and their parameters makes the control of the elasticity constants of coated components necessary. Our work is focused on the characterization of the elasticity constants of isotropic thin films by means of Impulse Excitation Techniques. The tests rely on the measurement of the sample resonance frequency before and after deposition. In this work, a finite element model was performed with ABAQUS software. This model was then compared with the analytical approaches used to determine the Young’s and shear moduli. The best model to determine the film Young’s modulus was identified and a relation allowing the determination of the shear modulus of thin films of any thickness was developed. In order to confirm the model experimentally, Tungsten films were deposited on glass substrates by DC magnetron sputtering of a 99.99% purity tungsten target. The choice of tungsten was done because it is well known that its elastic behavior at crystal scale is ideally isotropic. The macroscopic elasticity constants, Young’s and shear moduli and Poisson’s ratio of the deposited film were determined by means of Impulse Excitation Technique. The Young’s modulus obtained from IET was compared with measurements by the nano-indentation technique. We did not observe any significant difference and the value is in accordance with the one reported in the literature. This work presents a new methodology on the determination of the elasticity constants of thin films using Impulse Excitation Technique. A formulation allowing the determination of the shear modulus of a coating, whatever the thickness, was developed and used to determine the macroscopic elasticity constants of tungsten films. The developed model was validated numerically and experimentally.

Keywords: characterization, coating, dynamical resonant method, Poisson's ratio, PVD, shear modulus, Young's modulus

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3111 Physicochemical and Functional significance of Two Lychee (Litchi chinensis Sonn.) Cultivars Gola and Surakhi from Pakistan

Authors: Naila Safdar, Faria Riasat, Azra Yasmin

Abstract:

Lychee is an emerging fruit crop in Pakistan. Two famous cultivars of lychee, Gola and Surakhi, were collected from Khanpur Orchard, Pakistan and their whole fruit (including peel, pulp and seed) was investigated for pomological features and therapeutic activities. Both cultivars differ in shape and size with Gola having large size (3.27cm length, 2.36cm width) and more flesh to seed ratio (8.65g). FTIR spectroscopy and phytochemical tests confirmed presence of different bioactive compounds like phenol, flavonoids, quinones, anthraquinones, tannins, glycosides, and alkaloids, in both lychee fruits. Atomic absorption spectroscopy indicated an increased amount of potassium, magnesium, sodium, iron, and calcium in Gola and Surakhi fruits. Small amount of trace metals, zinc and copper, were also detected in lychee fruit, while heavy metals lead, mercury, and nickel were absent. These two lychee cultivars were also screened for antitumor activity by Potato disc assay with maximum antitumor activity shown by aqueous extract of Surakhi seed (77%) followed by aqueous extract of Gola pulp (74%). Antimicrobial activity of fruit parts was checked by agar well diffusion method against six bacterial strains Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus, Bacillus subtilis, Bacillus sp. MB083, and Bacillus sp. MB141. Highest antimicrobial activity was shown by methanolic extract of Gola pulp (27mm ± 0.70) and seed (19.5mm ± 0.712) against Enterococcus faecalis. DPPH scavenging assay revealed highest antioxidant activity by aqueous extract of Gola peel (98.10%) followed by n-hexane extract of Surakhi peel (97.73%). Results obtained by reducing power assay also corroborated with the results of DPPH scavenging activity.

Keywords: antimicrobial evaluation, antitumor assay, gola, phytoconstituents, reactive oxygen species, Surakhi

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3110 The Status and Role of Women in Indian IT Industry and Relevant Role and Scope of HRM

Authors: Shivani Kolarkar

Abstract:

Splendid growth in Indian IT has generated women employment on a large scale in India and continues to do it. Indian IT industry has achieved this in spite of total masculine dominance in other Indian engineering industries, where the ratio of women employment is almost negligible as compared to men. Indian IT today proudly enjoys a strong pool of technically educated, intellectual, and skillful women employees. IT industry has encouraged technical education for women in India, to a great extent. The software industry has definitely contributed to developing a positive and dignified role and status of women employees in Indian IT industry. It has promoted women’s social and economic role and status. In spite of all, gender discrimination still persists in Indian IT, also, which is low as compared to other industries, but it is a matter of concern. An Indian woman is bound to carry dual roles which are equally over-stressed for IT women employees. Long working hours, night shifts, work pressures and insufficient safety majors and necessary facilities for women contributes to making her physical-mental life, family and married life troublesome. Which forces her either to cluster at low-end jobs in IT/elsewhere or to sacrifice her career. Nature, role and status of HRM needs to be broadened, deepened and shaped into research-oriented multidimensional perspective in the context of really enhancing role and status of Indian IT women with high appreciation of women employees’ dignity and entity.

Keywords: attrition, gender discrimination, HRM, Indian IT, software industry, job satisfaction, safety, technical education, women employment

Procedia PDF Downloads 646
3109 Assessing the Survival Time of Hospitalized Patients in Eastern Ethiopia During 2019–2020 Using the Bayesian Approach: A Retrospective Cohort Study

Authors: Chalachew Gashu, Yoseph Kassa, Habtamu Geremew, Mengestie Mulugeta

Abstract:

Background and Aims: Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition. Methods: A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analyzed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analyzed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods. Results: Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition. Conclusions: This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished.

Keywords: Bayesian analysis, severe acute malnutrition, survival data analysis, survival time

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3108 The Successful in Construction Project via Effectiveness of Project Team

Authors: Zarabizan Zakaria, Hayati Zainal

Abstract:

The construction industry is one of the most important sectors that contribute to the nation’s economy and catalyze towards the growth of other industries. However, some construction projects have not been completed on its stipulated time and duration, scope and budget due to several factors. This problem arises due to the weaknesses of human factors, especially from ineffective leadership quality practiced by project managers and contractors in managing project teams. Therefore, a construction project should impose the element of Project Team. The project team is formed in the implementation of the project which includes the project brief, project scope, customer requirements and provided designs. Many organizations in the construction sector use teams to meet today's global competition and customer expectations, however, team effectiveness evaluation is required. In insuring the construction team is successful and effectiveness, the construction department must encourage, measure, set up, and evaluate or review the effectiveness of project team that was formed. In order to produce a better outcome for a high-end project, an effective and efficient project team is required which also help in increasing overall productivity. The purpose of this study is to determine the role of team effectiveness in the construction project team based on the overall construction project performance. It examines several different factors which related to team effectiveness. It also examines the relationship between team effectiveness factor and project performance aspect. Team Effect Review and Project Performance Review are developed to be used for data collection. Data collected were analyzed using several statistical tests. Results obtained from data analysis are validated using semi-structured interviews. Besides that, a comprehensive survey were developed to assess the way construction project teams in order to maintain its effectiveness throughout the project phase. In order to determine a project successful it has been found that Project Team Leadership is the most important factor. In addition, the definition of team effectiveness in the construction project team is developed based on the perspective of project clients and project team members. The results of this study are expected to provide an idea on the factors that are needed to be focused on improving the team's effectiveness towards project performance aspects. At the same time, the definition of team effectiveness from team members and owner views has been developed in order to provide a better understanding of the word team's effectiveness in construction projects.

Keywords: project team, leadership, construction project, project successful

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3107 Caring for a Spinal Cord Injury Patient with Diabetic Nephropathy Receiving Hospice Palliative Care

Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

Abstract:

Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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