Search results for: university students' health

Authors: Xin Chen, Xiao Yang, Rongrong Han, Lu Chen, Lingling Gao

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Background: Leisure time physical activity (LTPA) benefits both pregnant women and their fetuses. The guidelines recommended that pregnant women should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week. The aim of this study was to investigate the rate of LTPA participation among Chinese pregnant women and to identify its predictors based on the health belief model. Methods: A cross-sectional study was conducted from June 2019 to September 2019 in Changchun, China. A total of 225 pregnant women aged 18 years or older with no severe physical or mental disease were recruited in the obstetric clinic. Self-administered questionnaires were used to collect data. LTPA was assessed by a pregnant physical activity questionnaire (PPAQ). A revised pregnancy physical activity health belief scale and social-demographic and perinatal characteristics factors were collected and used to predict LTPA participation. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: The participants had a high level of perceived susceptibility, perceived severity, perceived benefits, and action clues, with mean item scores above 3.5. The predictors of LTPA in Chinese pregnant women were pre-pregnancy exercise habits [OR 3.236 (95% CI:1.632, 6.416)], perceived susceptibility score [OR 2.083 (95% CI:1.002, 4.331)], and perceived barriers score [OR 3.113 (95%CI:1.462, 6.626)]. Conclusions: The results of this study will lead to better identification of pregnant women who may not participate in LTPA. Healthcare professionals should be cognizant of issues that may affect LTPA participation among pregnant women, including pre-pregnancy exercise habits, perceived susceptibility, and perceived barriers.

Keywords: pregnancy, health belief model., leisure time physical activity, factors

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Authors: Abdel Rahman Altakhaineh, Mohamma Alaghawat, Hiba Alhendi

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This paper reports an investigation of the comprehension of English compound nouns by sixty Arabic-speaking English Foreign Language (EFL) learners majoring in English at the University of Jordan, Amman. The investigation focused on the problems that these learners may encounter in understanding certain types of compounds and their ability to use their L1 compound noun knowledge to produce the meaning of L2 compound nouns. Participants whose English proficiency level was advanced underwent a test to identify the meaning ofan underlined compound without using a dictionary. Theresponses to the three different types of compounds were analyzed usingTwo-Way repeated measures ANOVA, and the results showed that there were different endocentric and exocentric compound responses within subordinative compounds, with a statistically significant difference between the two in favor of endocentric compounds. We argue that the endocentric, especially subordinative endocentric compounds,weremore easily understood due to its representative nature, i.e., because the head represents the meaning of the whole compound. The study concludes with pedagogical implications for teaching compound nouns.

Keywords: morphology, compounding, SLA, arabic-speaking EFL learners

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Authors: Pelin Kinay, Andy P. Morse, Elmer V. Villanueva, Karyn Morrissey, Philip L Staddon, Shanzheng Zhang, Jingjing Liu

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The present study aims to evaluate the climate change and health related knowledge, attitudes and practices (KAP) of the elderly population (60 years plus) in Hefei and Suzhou cities of China (n=300). This cross-sectional study includes 150 participants in each city. Data regarding demographic characteristics, KAP, and climate change perceptions were collected using a semi-structured questionnaire. When asked about the potential impacts of climate change over 79% of participants stated that climate change affected their lifestyle. Participants were most concerned about storms (51.7%), food shortage (33.3%) and drought (26%). The main health risks cited included water contamination (32%), air pollution related diseases (38.3%) and lung disease (43%). Finally, a majority (68.3%) did not report receiving government assistance on climate change issues. Logistic regression models were used to analyse the data in order to understand the links between socio-demographical factors and KAP of the participants. These findings provide insights for potential adaptation strategies targeting the elderly. It is recommended that government should take responsibility in creating awareness strategies to improve the coping capacity of elderly in China to climate change and its health impacts and develop climate change adaptation strategies.

Keywords: China, climate change, elderly, KAP

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Authors: Pooja Rawat, Rakhi Tyagi

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Globally, almost 3 billion people rely on biomass (wood, charcoal, dung and crop residues) and coal as their primary source of domestic energy. Cooking and heating with solid fuels on open fire give rise to major pollutants. Women are primarily affected by these pollutants as they spend most of their time in the house. The WHO World Health Report 2002 estimates that indoor air pollution (IAP) is responsible for 2.7% of the loss of disability adjusted life years (DALYs) worldwide and 3.7% in high mortality developing countries. Indoor air pollution has the potential to not only impact health, but also impact the general economic well-being of the household. Exposure to high level of household pollution lead to acute and chronic respiratory conditions (e.g.: pneumonia, chronic obstructive pulmonary disease, lung cancer and cataract). There has been many strategies for reducing IAP like subsidize cleaner fuel technologies, for example use of kerosene rather than traditional biomass fuels. Another example is development, promotion of 'improved cooking stoves'. India, likely ranks second- distributing over 12 million improved stoves in the first seven years of a national program to develop. IAP should be reduced by understanding the welfare effects of reducing IAP within households and to understanding the most cost effective way to reduce it.

Keywords: open fire, indoor pollution, lung diseases, indoor air pollution

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Authors: Güler Duru Aşiret

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Introduction: Poor sleep quality is a common problem among the older people living in nursing homes. Our study aimed at assessing the effect of individual reminiscence therapy on the sleep quality of the elderly living in nursing homes. Methods: The study had 22 people in the intervention group and 24 people in the control group. The intervention group had reminiscence therapy once a week for 12 weeks in the form of individual sessions of 25-30 minutes. In our study, we first determined the dates suitable for the intervention group and researcher and planned the date and time of individual reminiscence therapies, which would take 12 weeks. While preparing this schedule, we considered subjects’ time schedules for their regular visits to health facilities and the arrival of their visitors. At this stage, the researcher informed the participants that their regular attendance in sessions would affect the intervention outcome. One topic was discussed every week. Weekly topics included: introduction in the first week; childhood and family life, school days, starting work and work life (a day at home for housewives), a fun day out of home, marriage (friendship for the singles), plants and animals they loved, babies and children, food and cooking, holidays and travelling, special days and celebrations, assessment and closure, in the following weeks respectively. The control group had no intervention. Study data was collected by using an introductory information form and the Pittsburgh Sleep Quality Index (PSQI). Results: In our study, participants’ average age was 76.02 ± 7.31. 58.7% of them were male and 84.8% were single. All of them had at least one chronic disease. 76.1% did not need help for performing their daily life activities. The length of stay in the institution was 6.32 ± 3.85 years. According to the participants’ descriptive characteristics, there was no difference between groups. While there was no statistically significant difference between the pretest PSQI median scores (p > 0.05) of both groups, PSQI median score had a statistically significant decrease after 12 weeks of reminiscence therapy (p < 0.05). There was no statistically significant change in the median scores of the subcomponents of sleep latency, sleep duration, sleep efficiency, sleep disturbance and use of sleep medication before and after reminiscence therapy. After the 12-weeks reminiscence therapy, there was a statistically significant change in the median scores for the PSQI subcomponents of subjective sleep quality (p<0.05). Conclusion: Our study found that reminiscence therapy increased the sleep quality of the elderly living in nursing homes. Acknowledgment: This study (project no 2017-037) was supported by the Scientific Research Projects Coordination Unit of Aksaray University. We thank the elderly subjects for their kind participation.

Keywords: nursing, older people, reminiscence therapy, sleep

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Authors: Daniel Motlhanka, Neo Kerebotswe

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The strong and long history of use of medicinal plants in Botswana to address existing and emerging health threats provides undebatable evidence for their potential as innovative therapeutic tools. The prevalence of emerging health threats, such as COVID-19 and hard-to-treat non-communicable diseases, warrants the scientific community to revisit and exploit ethnopharmacology for its potential as a source of therapeutic tools. Many studies conducted on bioactivity-guided bioassays of ethnobotanical resources have proved a number of health beneficial properties of these plants, such as free radical scavenging, anti-inflammatory, antimicrobial and, most importantly, the capability of medicinal plants to alleviate oxidative stress. In this work, a number of medicinal plants used in Botswana traditional medicine were investigated for both their free radical scavenging capability and total phenolic contents using the Free Radical Scavenging Power (FRSP) and Folin Ciocalteau (FC) method. At 100 micrograms/ml all the studied plants expressed above 90% Scavenging power and expressed total phenolic contents between 5000- 8890 mg/L.GAE. These plants are promising tools for engineering active therapeutic tools against life-threatening diseases of oxidative stress origin.

Keywords: oxidative stress, non-communicable diseases, total phenolics, ethnobotanicals

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Authors: Abdeljalil Metioui

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The purpose of this article is to present the results of two-stage qualitative research. The first involved the identification of the alternative conceptions of 80 elementary pre-service teachers from Quebec in Canada about the operation of simple electrical circuits. To do this, they completed a two-choice questionnaire (true or false) with justification. Data analysis identifies many conceptual difficulties. For example, for their majority, whatever the electrical device that composes an electrical circuit, the current source (power supply), and the generated electrical power is constant. The second step was to develop a double multiple-choice questionnaire based on the identified designs. It allows teachers to quickly diagnose their students' conceptions and take them into account in their teaching.

Keywords: development, electrical circuits, two-tier diagnostic test, secondary and high school

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Authors: Hafiz A. Sakandar, M. Afzaal, U. Khan, M. N. Akhtar

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Food is the primary concern of living organisms, provision of diet for maintenance of good physical and mental health is a basic right of an individual and the outcome of factors related to diet on health has been matter of apprehension since ancient times. Healthy and fresh food always demanded by the consumers. Modern research has find out many alternatives of traditional packaging. Now the consumer knows that good packaging system is that which protects the food from the contaminants and increases shelf life of food product. While in Pakistan about 40% of fruits and vegetables lost due to spoilage caused by poor handling, transportation, and poor packaging interaction with other environmental conditions. So it is crucial for developing countries like Pakistan to pay attention to these exacerbating situations for economy losses by considering food packaging an ultimate solution to the problem.

Keywords: packaging, food safety, antimicrobial, food losses

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Authors: R. M. Korzerzer, J. O. Hambolu, S. O. Salami, S. B. Oladele

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Twelve apparently healthy grasscutters between the ages of three and seven months were used for this study. The animals were purchased from local breeders in Oturkpo, Benue state, Nigeria and transported to the research laboratory in the Department of Veterinary Anatomy, Ahmadu Bello University, Zaria by means of constructed cages. The animals were divided into three groups according to their ages and acclimatised. Sacrifice was done using chloroform gaseous inhalation anaesthesia. An incision was made at the neck region and the thymus located and identified by its prominent bilateral nature. Extirpated thymuses from each animal were immediately weighed and fixed in Bouin’s fluid for 48 hours. The tissues were then prepared using standard methods. Haematoxilin and eosin was used for routine histology and Rhodamine B aniline methylene blue was for studying the architecture of the elastic and reticular fibres of the thymus. Grossly, the thymus appeared as a bilateral organ on either side of the thoracic midline. The organ size decreased consistently as the animals advanced in age. Mean ± SEM values for thymic weights were 1.23 ± 0.048 g, 0.53 ± 0.019 g and 0.30 ± 0.042 g at three, five and seven months of age respectively.

Keywords: gross, histological, thymus, grasscutter

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Authors: Godaye Gobena Gomiole

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The purpose of this study is to determine how principals at Tarcha Town Primary Schools in Ethiopia perceive their instructional leadership responsibilities in curriculum execution. The research was guided by a phenomenological study design. The data was collected through semi-structured interviews. Purposive sampling was used to include twelve principals. The study's conclusions showed that principals fall short of their duties in overseeing instruction. Setting clear objectives for the school and coordinating the curriculum receive less attention from principals. Additionally, they focus less on keeping track of students' progress. It is, therefore, advised that principals take instructional leadership and management training.

Keywords: curriculum execution, instructional leadership, practice, primary school

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Authors: Awais Ahmad, Mudssar Ali

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Berseem is the major fodder crop grown in Pakistan and is highly preferred by cattle farmers due to its multicut nature and nutritious value. The quality seed production in berseem is largely dependent upon the activities of insect pollinators, particularly bees. In order to determine the effectiveness of native bee species in quality seed production of berseem, an experiment was conducted in the research field of MNS-University of Agriculture, Multan, Pakistan. The pollinator community of berseem was composed of four bees, three syrphid fly, and two butterfly species. Pesudapis sp. was the most abundant insect visitor, followed by Apis mellifera and A. dorsata. The visitation rate of A. mellifera was found highest, followed by Pesudapis sp. and A. dorsata. Moreover, single-visit efficacy in terms of seed per head and 1000 seed weight proved A. mellifera and Pesudapis sp as the most effective pollinators. Conserving these bee species may lead to sustainable berseem seed production in Pakistan.

Keywords: honey bees, syrphid fly, visitation rate, single visit

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Authors: Svetlana L. Mishlanova, Evgeniia V. Ermakova, Mariia E. Timirkina

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The paper is concerned with the study of metaphor production in essays written by Russian and English native speakers in the framework of cognitive metaphor theory. It considers metaphorical competence as individual’s ability to recognize, understand and use metaphors in speech. The work analyzes the influence of visual metaphor on production and density of conventional and novel verbal metaphors. The main methods of research include experiment connected with image interpretation, metaphor identification procedure (MIPVU) and visual conventional metaphors identification procedure proposed by VisMet group. The research findings will be used in the project aimed at comparing metaphorical competence of native and non-native English speakers.

Keywords: metaphor, metaphorical competence, conventional, novel

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Authors: Jennifer Walinga, Samantha Heron

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The goal of the study was to inform the design of effective leadership and mentorship development programming for sport science leaders within the network of Canadian sport institutes and centers. The LEAD (Learn, Engage, Accelerate, Develop) program was implemented to equip sport science leaders with the leadership knowledge, skills, and practice to foster a high - performance culture, enhance the daily training environment, and contribute to optimal performance in sport. After two years of delivery, this analysis of LEAD’s effect on individual and organizational health and performance factors informs the quality of future deliveries and identifies best practice for leadership development across the Canadian sport system and beyond. A larger goal for this project was to inform the public sector more broadly and position sport as a source of best practice for human and social health, development, and performance. The objectives of this study were to review and refine the LEAD program in collaboration with Canadian Sport Institute and Centre leaders, 40-50 participants from three cohorts, and the LEAD program advisory committee, and to trace the effects of the LEAD leadership development program on key leadership mentorship and organizational health indicators across the Canadian sport institutes and centers so as to capture best practice. The study followed a participatory action research framework (PAR) using semi structured interviews with sport scientist participants, program and institute leaders inquiring into impact on specific individual and organizational health and performance factors. Findings included a strong increase in self-reported leadership knowledge, skill, language and confidence, enhancement of human and organizational health factors, and the opportunity to explore more deeply issues of diversity and inclusion, psychological safety, team dynamics, and performance management. The study was significant in building sport leadership and mentorship development strategies for managing change efforts, addressing inequalities, and building personal and operational resilience amidst challenges of uncertainty, pressure, and constraint in real time.

Keywords: sport leadership, sport science leader, leadership development, professional development, sport education, mentorship

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Authors: Sudha Subramani, Hua Wang

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Domestic Violence (DV) against women is now recognized to be a serious and widespread problem worldwide. There is a growing concern that violence against women has a global public health impact, as well as a violation of human rights. From the existing statistical surveys, it is revealed that there exists a strong relationship between DV and health issues of women like bruising, lacerations, depression, anxiety, flashbacks, sleep disturbances, hyper-arousal, emotional distress, sexually transmitted diseases and so on. This social problem is still considered as behind the closed doors issue and stigmatized topic. Women conceal their sufferings from family and friends, as they experience a lack of trust in others, feelings of shame and embarrassment among the society. Hence, women survivors of DV experience some barriers in seeking the support of specialized services such as health care access, crisis support, and legal guidance. Fortunately, with the popularity of social media like Facebook and Twitter, people share their opinions and emotional feelings to seek the social and emotional support, for sympathetic encouragement, to show compassion and empathy among the public. Considering the DV, social media plays a predominant role in creating the awareness and promoting the support services to the public, as we live in the golden era of social media. The various professional people like the public health researchers, clinicians, psychologists, social workers, national family health organizations, lawyers, and victims or their family and friends share the unprecedentedly valuable information (personal opinions and experiences) in a single platform to improve the social welfare of the community. Though each tweet or post contains a less informational value, the consolidation of millions of messages can generate actionable knowledge and provide valuable insights about the public opinion in general. Hence, this paper reports on an exploratory analysis of the effectiveness of social media for unobtrusive assessment of attitudes and awareness towards DV. In this paper, mixed methods such as qualitative analysis and text mining approaches are used to understand the social media disclosures of DV through the lenses of opinion sharing, anonymity, and support seeking. The results of this study could be helpful to avoid the cost of wide scale surveys, while still maintaining appropriate research conditions is to leverage the abundance of data publicly available on the web. Also, this analysis with data enrichment and consolidation would be useful in assisting advocacy and national family health organizations to provide information about resources and support, raise awareness and counter common stigmatizing attitudes about DV.

Keywords: domestic violence, social media, social stigma and support, women health

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Authors: Sidramappa Gaddnakeri, Lokanath Malligawad

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Any kind of research on production technology of individual crop / commodity /breed has not brought sustainability or stability in crop production. The sustainability of the system over years depends on the maintenance of the soil health. Organic production system includes use of organic manures, biofertilizers, green manuring for nutrient supply and biopesticides for plant protection helps to sustain the productivity even under adverse climatic condition. The study was initiated to evaluate the performance of different cropping systems under organic, inorganic and integrated production systems at The Institute of Organic Farming, University of Agricultural Sciences, Dharwad (Karnataka-India) under ICAR Network Project on Organic Farming. The trial was conducted for four years (2013-14 to 2016-17) on fixed site. Five cropping systems viz., sequence cropping of cowpea – safflower, greengram– rabi sorghum, maize-bengalgram, sole cropping of pigeonpea and intercropping of groundnut + cotton were evaluated under six nutrient management practices. The nutrient management practices are NM1 (100% Organic farming (Organic manures equivalent to 100% N (Cereals/cotton) or 100% P2O5 (Legumes), NM2 (75% Organic farming (Organic manures equivalent to 75% N (Cereals/cotton) or 100% P2O5 (Legumes) + Cow urine and Vermi-wash application), NM3 (Integrated farming (50% Organic + 50% Inorganic nutrients, NM4 (Integrated farming (75% Organic + 25% Inorganic nutrients, NM5 (100% Inorganic farming (Recommended dose of inorganic fertilizers)) and NM6 (Recommended dose of inorganic fertilizers + Recommended rate of farm yard manure (FYM). Among the cropping systems evaluated for different production systems indicated that the Groundnut + Hybrid cotton (2:1) intercropping system found more remunerative as compared to Sole pigeonpea cropping system, Greengram-Sorghum sequence cropping system, Maize-Chickpea sequence cropping system and Cowpea-Safflower sequence cropping system irrespective of the production systems. Production practices involving application of recommended rates of fertilizers + recommended rates of organic manures (Farmyard manure) produced higher net monetary returns and higher B:C ratio as compared to integrated production system involving application of 50 % organics + 50 % inorganic and application of 75 % organics + 25 % inorganic and organic production system only Both the two organic production systems viz., 100 % Organic production system (Organic manures equivalent to 100 % N (Cereals/cotton) or 100 % P2O5 (Legumes) and 75 % Organic production system (Organic manures equivalent to 75 % N (Cereals) or 100 % P2O5 (Legumes) + Cow urine and Vermi-wash application) are found to be on par. Further, integrated production system involving application of organic manures and inorganic fertilizers found more beneficial over organic production systems.

Keywords: cropping systems, production systems, cowpea, safflower, greengram, pigeonpea, groundnut, cotton

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Authors: Zeinab Aliyas, Diba Mahboubi

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Leisure walking is known as one of the most common types of physical activity that perform in purpose of recreation or health, which in turn may affect resident’s health. In the recent years, promoting leisure walking activity in neighborhood areas become as one of the important issues regarding promoting mental and physical health, however; the level of physical inactivity is rising in many societies including Iran. As it was proven that the tendency to walk out of choice is not encouraging among Iranian people. Hence; understanding the main concern of residents regarding walking activity in their neighborhoods can help in increasing the tendency to do leisure activity among residents. Built environment, social and individual factors are known as the main factors that affect decision to walk, in this regard, the study aimed to investigate the influence of personal and social factors that prevent residents to walk for recreation or exercise in their neighborhoods. Hence the fear of crime and personal barriers were examined in the current research as social and personal factors respectively. To collect the required data, 500 questionnaires by using systematic sampling were distributed from March to May 2016 in four residential neighborhoods of Bandar Abbas in Iran out which 411 questionnaire turned out to be qualified to be used in the study. The Smart-PLS was used to analyze the data. The findings of the study revealed that personal and fear of crime both have significant influence on the level of recreation and exercise walking in the neighborhood areas. The study found that fear of crime has the higher influence on exercise and recreational walking behavior in comparison to individual factors. It was revealed that social factors such as fear of crime in the neighborhoods might be more important than the personal reason for walking optionally in the surrounding environment. The finding of this study can help urban and health researcher to know the significant influence of fear of crime and individual attitudes on the level of leisure walking activity, in addition, the findings of the study suggest that urban planners and designers, as well as public health promoters, need to highly consider the contribution of neighborhoods' social environment variables as well as individual variables to promote walking behavior changes among adult population.

Keywords: exercise walking, fear of crime, neighborhood, personal barriers, recreation walking

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Authors: Nadjet Mekaouche, Hanane Zitouni, Fatma Boudia, Habiba Fetati, A. Saleh, A. Lardjam, H. Geniaux, A. Coubret, H. Toumi

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Medicines have undeniably played a major role in prolonging shelf life and improving quality. The absolute efficacy of the drug remains a lever for innovation, its benefit/risk balance is not always assured and it does not always have the expected effects. Prior to marketing, knowledge about adverse drug reactions is incomplete. Once on the market, phase IV drug studies begin. For years, the drug was prescribed with less care to a large number of very heterogeneous patients and often in combination with other drugs. It is at this point that previously unknown adverse effects may appear, hence the need for the implementation of a pharmacovigilance system. Pharmacovigilance represents all methods for detecting, evaluating, informing and preventing the risks of adverse drug reactions. The most severe adverse events occur frequently in hospital and that a significant proportion of adverse events result in hospitalizations. In addition, the consequences of hospital adverse events in terms of length of stay, mortality and costs are considerable. It, therefore, appears necessary to develop ‘hospital pharmacovigilance’ aimed at reducing the incidence of adverse reactions in hospitals. The most widely used monitoring method in pharmacovigilance is spontaneous notification. However, underreporting of adverse drug reactions is common in many countries and is a major obstacle to pharmacovigilance assessment. It is in this context that this study aims to describe the experience of the pharmacovigilance service at the University Hospital of Oran (EHUO). This is a retrospective study extending from 2011 to 2017, carried out on archived records of declarations collected at the level of the EHUO Pharmacovigilance Department. Reporting was collected by two methods: ‘spontaneous notification’ and ‘active pharmacovigilance’ targeting certain clinical services. We counted 217 statements. It involved 56% female patients and 46% male patients. Age ranged from 5 to 78 years with an average of 46 years. The most common adverse reaction was drug toxidermy. For the drugs in question, they were essentially according to the ATC classification of anti-infectives followed by anticancer drugs. As regards the evolution of declarations by year, a low rate of notification was noted in 2011. That is why we decided to set up an active approach at the level of some services where a resident of reference attended the staffs every week. This has resulted in an increase in the number of reports. The declarations came essentially from the services where the active approach was installed. This highlights the need for ongoing communication between all relevant health actors to stimulate reporting and secure drug treatments.

Keywords: adverse drug reactions, hospital, pharmacovigilance, spontaneous notification

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Authors: Selina Schwaabe

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Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government's goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. The analysis focuses on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. In addition, the paper examines seven selected countries in depth, selected for the substantial variance in their pharmacy system: Germany, Austria, Portugal, Denmark, Sweden, Finland and Poland. Overall, the results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of this analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies.

Keywords: community pharmacy, market conditions, pharmacy, pharmacy market, pharmacy lobby, prescription, e-prescription, ownership structures

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Authors: Sıdıka Kaya, Gülay Sain Güven, Seda Karsavuran, Onur Toka

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This study is part of an ongoing research project supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under Project Number 114K404, and participation to this conference was supported by Hacettepe University Scientific Research Coordination Unit under Project Number 10243. Evaluation of hospital readmissions is gaining importance in terms of quality and cost, and is becoming the target of national policies. In Turkey, the topic of hospital readmission is relatively new on agenda and very few studies have been conducted on this topic. The aim of this study was to determine 30-day readmission rates and risk factors for readmission. Whether readmission was planned, related to the prior admission and avoidable or not was also assessed. The study was designed as a ‘prospective cohort study.’ 472 patients hospitalized in internal medicine departments of a university hospital in Turkey between February 1, 2015 and April 30, 2015 were followed up. Analyses were conducted using IBM SPSS Statistics version 22.0 and SPSS Modeler 16.0. Average age of the patients was 56 and 56% of the patients were female. Among these patients 95 were readmitted. Overall readmission rate was calculated as 20% (95/472). However, only 31 readmissions were unplanned. Unplanned readmission rate was 6.5% (31/472). Out of 31 unplanned readmission, 24 was related to the prior admission. Only 6 related readmission was avoidable. To determine risk factors for readmission we constructed Chi-square automatic interaction detector (CHAID) decision tree algorithm. CHAID decision trees are nonparametric procedures that make no assumptions of the underlying data. This algorithm determines how independent variables best combine to predict a binary outcome based on ‘if-then’ logic by portioning each independent variable into mutually exclusive subsets based on homogeneity of the data. Independent variables we included in the analysis were: clinic of the department, occupied beds/total number of beds in the clinic at the time of discharge, age, gender, marital status, educational level, distance to residence (km), number of people living with the patient, any person to help his/her care at home after discharge (yes/no), regular source (physician) of care (yes/no), day of discharge, length of stay, ICU utilization (yes/no), total comorbidity score, means for each 3 dimensions of Readiness for Hospital Discharge Scale (patient’s personal status, patient’s knowledge, and patient’s coping ability) and number of daycare admissions within 30 days of discharge. In the analysis, we included all 95 readmitted patients (46.12%), but only 111 (53.88%) non-readmitted patients, although we had 377 non-readmitted patients, to balance data. The risk factors for readmission were found as total comorbidity score, gender, patient’s coping ability, and patient’s knowledge. The strongest identifying factor for readmission was comorbidity score. If patients’ comorbidity score was higher than 1, the risk for readmission increased. The results of this study needs to be validated by other data–sets with more patients. However, we believe that this study will guide further studies of readmission and CHAID is a useful tool for identifying risk factors for readmission.

Keywords: decision tree, hospital, internal medicine, readmission

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Authors: Recep Kesli, Cengiz Demir, Onur Turkyilmaz, Hayriye Tokay

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Objective: Gram-negative rods are a large group of bacteria, and include many families, genera, and species. Most clinical isolates belong to the family Enterobacteriaceae. Resistance due to the production of extended-spectrum β-lactamases (ESBLs) is a difficulty in the handling of Enterobacteriaceae infections, but other mechanisms of resistance are also emerging, leading to multidrug resistance and threatening to create panresistant species. We aimed in this study to evaluate resistance rates of Gram-negative rods bacteria isolated from clinical specimens in Microbiology Laboratory, Afyon Kocatepe University, ANS Research and Practice Hospital, between October 2012 and September 2015. Methods: The Gram-negative rods strains were identified by conventional methods and VITEK 2 automated identification system (bio-Mérieux, Marcy l’etoile, France). Antibiotic resistance tests were performed by both the Kirby-Bauer disk-diffusion and automated Antimicrobial Susceptibility Testing (AST, bio-Mérieux, Marcy l’etoile, France) methods. Disk diffusion results were evaluated according to the standards of Clinical and Laboratory Standards Institute (CLSI). Results: Of the totally isolated 1.701 Enterobacteriaceae strains 1434 (84,3%) were Klebsiella pneumoniae, 171 (10%) were Enterobacter spp., 96 (5.6%) were Proteus spp., and 639 Nonfermenting gram negatives, 477 (74.6%) were identified as Pseudomonas aeruginosa, 135 (21.1%) were Acinetobacter baumannii and 27 (4.3%) were Stenotrophomonas maltophilia. The ESBL positivity rate of the totally studied Enterobacteriaceae group were 30.4%. Antibiotic resistance rates for Klebsiella pneumoniae were as follows: amikacin 30.4%, gentamicin 40.1%, ampicillin-sulbactam 64.5%, cefepime 56.7%, cefoxitin 35.3%, ceftazidime 66.8%, ciprofloxacin 65.2%, ertapenem 22.8%, imipenem 20.5%, meropenem 20.5 %, and trimethoprim-sulfamethoxazole 50.1%, and for 114 Enterobacter spp were detected as; amikacin 26.3%, gentamicin 31.5%, cefepime 26.3%, ceftazidime 61.4%, ciprofloxacin 8.7%, ertapenem 8.7%, imipenem 12.2%, meropenem 12.2%, and trimethoprim-sulfamethoxazole 19.2 %. Resistance rates for Proteus spp. were: 24,3% meropenem, 26.2% imipenem, 20.2% amikacin 10.5% cefepim, 33.3% ciprofloxacin and levofloxacine, 31.6% ceftazidime, 20% ceftriaxone, 15.2% gentamicin, 26.6% amoxicillin-clavulanate, and 26.2% trimethoprim-sulfamethoxale. Resistance rates of P. aeruginosa was found as follows: Amikacin 32%, gentamicin 42 %, imipenem 43%, merpenem 43%, ciprofloxacin 50%, levofloxacin 52%, cefepim 38%, ceftazidim 63%, piperacillin/tacobactam 85%, for Acinetobacter baumannii; Amikacin 53.3%, gentamicin 56.6 %, imipenem 83%, merpenem 86%, ciprofloxacin 100%, ceftazidim 100%, piperacillin/tacobactam 85 %, colisitn 0 %, and for S. malthophilia; levofloxacin 66.6 % and trimethoprim/sulfamethoxozole 0 %. Conclusions: This study showed that resistance in Gram-negative rods was a serious clinical problem in our hospital and suggested the need to perform typification of the isolated bacteria with susceptibility testing regularly in the routine laboratory procedures. This application guided to empirical antibiotic treatment choices truly, as a consequence of the reality that each hospital shows different resistance profiles.

Keywords: antibiotic resistance, gram negative rods, ESBL, VITEK 2

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Authors: M. Mortas, H. Asar, P. Dursun Cebi

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The visionary works of architectural representation in the 21st century's present situation, are practiced through the methodologies which try to expose the intellectual and theoretical essences of futurologist positions that are revealed with this era's interactions. Expansions of conceptual and contextual inputs related to one architectural design representation, depend on its deepness of critical attitudes, its interactions with the concepts such as experience, meaning, affection, psychology, perception and aura, as well as its communication with spatial, cultural and environmental factors. The purpose of this research study is to be able to offer methodological application areas for the design dimensions of experiential practices into architectural design studios, by focusing on the architectural representative narrations of 'transformation,' 'metamorphosis,' 'morphogenesis,' 'in-betweenness', 'superposition' and 'intertwine’ in which they affect and are affected by the today’s spatiotemporal hybridizations of architecture. The narrative representations and the visual theory paradigms of the designers are chosen under the main title of 'transformation' for the investigation of these visionary and critical representations' dismantlings and decodings. Case studies of this research area are chosen from Neil Spiller, Bryan Cantley, Perry Kulper and Dan Slavinsky’s transformative, morphogenetic representations. The theoretical dismantlings and decodings which are obtained from these artists’ contemporary architectural representations are tried to utilize and practice in the structural design studios as alternative methodologies when to approach architectural design processes, for enriching, differentiating, diversifying and 'transforming' the applications of so far used design process precedents. The research aims to indicate architectural students about how they can reproduce, rethink and reimagine their own representative lexicons and so languages of their architectural imaginations, regarding the newly perceived tectonics of prosthetic, biotechnology, synchronicity, nanotechnology or machinery into various experiential design workshops. The methodology of this work can be thought as revealing the technical and theoretical tools, lexicons and meanings of contemporary-visionary architectural representations of our decade, with the essential contents and components of hermeneutics, etymology, existentialism, post-humanism, phenomenology and avant-gardism disciplines to re-give meanings the architectural visual theorists’ transformative representations of our decade. The value of this study may be to emerge the superposed and overlapped atmospheres of futurologist architectural representations for the students who need to rethink on the transcultural, deterritorialized and post-humanist critical theories to create and use the representative visual lexicons of themselves for their architectural soft machines and beings by criticizing the now, to be imaginative for the future of architecture.

Keywords: architectural design studio, visionary lexicon, narrative architecture, transformative representation

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Authors: Emmylou Rahtz, Sarah Goldingay, Sara Warber, Ann Arbor, Paul Dieppe

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Introduction: Lourdes is a Catholic, Marian healing venue in South West France. Many miraculous cures have been attributed to visits there. In addition, many visitors seem to experience improvements in health and wellbeing, in the absence of a cure of disease. We wanted to investigate that phenomenon. Methods: We spent 10 days in Lourdes in 2017, carrying out ethnographic research, talking to many visitors, and carrying out formal, recorded interviews with several pilgrims, doctors, nurses, helpers, and priests. Results: Profound experiences and improvements in health and wellbeing were commonly reported. A number of ‘noetic’ experiences were also described. The paper will illustrate these phenomena. In addition, many participants in the research talked about why being in Lourdes was so beneficial to them. The community spirit, ethos of prayer, flow, synchronicity, and ability to find new meaning for life’s ills were cited as likely reasons. Conclusions: We believe that the ‘real miracle’ of Lourdes is the fact that of the many hundreds of thousands of people who go there each year, many find great benefit in health and wellbeing. It is likely that this is due to the ethos of the place, the community spirit, non-judgmental approach and loving acceptance of all aspects of humanity. Acknowledgments: We thank the BIAL foundation for generous funding of this research, and Dr. Alessandro de Franciscis and his team for facilitating our work, as well as all those who participated.

Keywords: healing, miracles, noetic experiences, wellbeing

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Authors: Haoyu Zhao, Qianshu Ma, Min Xie, Yunqi Huang, Yunjia Liu, Huan Song, Hongsheng Gui, Mingli Li, Qiang Wang

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Rationale: Bipolar disorder (BD) and major depressive disorder (MDD), as severe chronic illnesses that restrict patients’ psychosocial functioning and reduce their quality of life, are both categorized into mood disorders. Emerging evidence has suggested that the reliability of self-rated health (SRH) was wellvalidated and that the risk of various health outcomes, including mortality and health care costs, could be predicted by SRH. Compared with other lengthy multi-item patient-reported outcomes (PRO) measures, SRH was proven to have a comparable predictive ability to predict mortality and healthcare utilization. However, to our knowledge, no study has been conducted to assess the association between SRH and hospitalization among people with mental disorders. Therefore, our study aims to determine the association between SRH and subsequent all-cause hospitalizations in patients with BD and MDD. Methods: We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. Results: A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02% were female, and 3,029 (10.11%), 15,972 (53.30%), 8,313 (27.74%), and 2,652 (8.85%) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19% had a hospitalization event within 2 years compared with 22.65% for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95% CI 1.21-1.42), 1.82 (95% CI 1.68-1.98), and 2.45 (95% CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. Conclusion: SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study facilitates rapid interpretation of SRH values and underscores the need for proactive SRH screening in this population, which might inform resource allocation and enhance high-risk population detection.

Keywords: severe mental illnesses, hospitalization, risk prediction, patient-reported outcomes

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Authors: Sunayana Basu Mallik, Shishira Prakash

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The inclusion of Rights of Author (Moral and Personal Rights) resonate the century long battle of rights of authors, composers, performers across developed and developing countries (whether following civil law or common law systems). But, the juxtaposition of author’s special, moral, personal rights within the legislative framework of Copyright statutes (Indian Copyright Act, 1957, applicable statutes) underscores the foundational role of the right which goes to the root of the constitutional structure of India and philosophies of political and literary leaders like Mahatma Gandhi and Gurudeb Rabindranath Tagore. In the pre-independence era when the concept of moral rights was unknown to both England and India’s statutory laws, the strategic deployment method of Gandhi, his ideologies and thoughts scripted the concept of moral rights for authors/composers. The preservation of Rabindric Style (Characteristic Tagore’s vocal renditions) by Vishwabharati University (successor in interest for Tagore’s literary and musical compositions) prior to the Copyright Amendment of 1999 recognizing Author’s Special Rights in line with 6bis of Berne Convention invigorates the fact that the right existed intrinsically prior to the legislative amendment. The paper would in addition to the academic probe carry out an empirical enquiry of the institution’s (Navjivan Trust and Vishwa Bharati University’s) reasoning on the same. The judicial discourse and transforming constitutional ideals between 1950s till date in India alludes Moral Rights to be an essential legal right which have been reasoned by Indian Courts based on the underlying philosophies in culture, customs, religion wherein composers and literary figures have played key roles in enlightening and encouraging the members of society through their literary, musical and artistic work during pre-independence renaissance of India. The discourses have been influenced by the philosophies reflected in the preamble of the Indian constitution, ‘socialist, secular, democratic republic’ and laws of other civil law countries. Lastly, the paper would analyze the adjudication process and witness involvement in ascertaining violations of moral rights and further summarize the indigenous and country specific economic thoughts that often chisel decisions on moral rights of authors, composers, performers which sometimes intersect with author’s right of privacy and against defamation. The exclusivity contracts or other arrangements between authors, composers and publishing companies not only have an erosive effect on each thread of moral rights but irreparably dents factors that promote creativity. The paper would also be review these arrangements in view of the principles of unjust enrichment, unfair trade practices, anti-competitive behavior and breach of Section 27 (Restrain of Trade) of Indian Contract Act, 1857. The paper will thus lay down the three pillars on which author’s rights in India should namely rest, (a) political and judicial discourse evolving principles supporting moral rights of authors; (b) amendment and insertion of Section 57 of the Copyright Act, 1957; (c) overall constitutional framework supporting author’s rights.

Keywords: copyright, moral rights, performer’s rights, personal rights

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Authors: Mario Chiasson, Monique Boudreau

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Problem statement: Innovation in education has become a central topic of discussion at various levels, including schools and scholarly literature, driven by the global technological advancements of Industry 4.0. This study aims to contribute to the ongoing dialogue by examining the role of innovation in transforming school culture through the reimagination of traditional structures. The study argues that such a transformation necessitates an understanding and experience of systems leadership. This paper presents the case of the Francophone South School District, where a transformative initiative created an innovative learning environment by engaging students, teachers, and community members collaboratively through eco-communities. Traditional barriers and structures in education were dismantled to facilitate this process. The research component of this paper focuses on the Intr’Appreneur project, a unique initiative launched by the district team in the New Brunswick, Canada to support a system-wide transformation towards progressive and innovative organizational models. Methods This study is part of a larger research project that focuses on the transformation of educational systems in six pilot schools involved in the Intr’Appreneur project. Due to COVID-19 restrictions, the project was downscaled to three schools, and virtual qualitative interviews were conducted with volunteer teachers and administrators. Data was collected from students, teachers, and principals regarding their perceptions of the new learning environment and experiences. The analysis process involved developing categories, establishing codes for emerging themes, and validating the findings. The study emphasizes the importance of system leadership in achieving successful transformation. Results: The findings demonstrate that school principals played a vital role in enabling system-wide change by fostering a dynamic, collaborative, and inclusive culture, coordinating and mobilizing community members, and serving as educational role models who facilitated active and personalized pedagogy among the teaching staff. These qualities align with the characteristics of Leadership 4.0 and are crucial for successful school system transformations. Conclusion: This paper emphasizes the importance of systems leadership in driving educational transformations that extend beyond pedagogical and technological advancements. The research underscores the potential impact of such a leadership approach on teaching, learning, and leading processes in Education 4.0.

Keywords: leadership, system transformation, innovation, innovative learning environment, Education 4.0, system leadership

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Authors: Kalpana Rajouriya, Ajay Taneja

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The objective of the present study is to investigate the regional and lobar deposition of size-segregated PM in respiratory tract of human body. PM in different fractions is monitored using the Grimm portable environmental dust monitor during winter season in Firozabad; a Glass city of India. PM10 concentration (200.817g/m³) was 4.46 and 2.0 times higher than the limits prescribed by WHO (45g/m⁻³) and NAAQS (100g/m⁻³) government agencies. PM2.5 concentration (83.538 g/m3) was 5.56 and 1.39 times higher from WHO (15g/m-3) and NAAQS (60g/m⁻³) limits. Results inferred that PM10 and PM2.5 was highest deposited in head region (0.3477-0.5622 & 0.366-0.4704) followed by pulmonary region, especially in the 9-21year old persons. The variation in deposition percentage in our study is mainly due to the airway geometry, PM size, and its deposition mechanisms. The coarse fraction, due to its large size, cannot follow the airway path and mostly gets deposited by inertial impaction in the head region and its bifurcations. The present study results inferred that Coarse and fine PM deposition was highly visualized in 9 (8.45610⁻⁴ g, 2.91110⁻⁴g) year and 3 (1.49610⁻⁴ g, 8.59310⁻⁵g) month age category. So, the 9year children and 3month infants category have high level of health risk.

Keywords: particulate matter, MPPD model, regional deposition, lobar deposition, health risk

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Authors: Can Mungan, Gokhan Kilic

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Structural engineers and tunnel owners have good reason to attach importance to the assessment and inspection of tunnels. Regular inspection is necessary to maintain and monitor the health of the structure not only at the present time but throughout its life cycle. Detection of flaws within the structure, such as corrosion and the formation of cracks within the internal elements of the structure, can go a long way to ensuring that the structure maintains its integrity over the course of its life. Other issues that may be detected earlier through regular assessment include tunnel surface delamination and the corrosion of the rebar. One advantage of new technology such as the ground penetrating radar (GPR) is the early detection of imperfections. This study will aim to discuss and present the effectiveness of GPR as a tool for assessing the structural integrity of the heavily used tunnel. GPR is used with various antennae in frequency and application method (2 GHz and 500 MHz GPR antennae). The paper will attempt to produce a greater understanding of structural defects and identify the correct tool for such purposes. Conquest View with 3D scanning capabilities was involved throughout the analysis, reporting, and interpretation of the results. This study will illustrate GPR mapping and its effectiveness in providing information of value when it comes to rebar position (lower and upper reinforcement). It will also show how such techniques can detect structural features that would otherwise remain unseen, as well as moisture ingress.

Keywords: tunnel, GPR, health monitoring, moisture ingress, rebar position

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Authors: Golson Mohamed, Yasmine Gamasy, Khaled EL-Khatib, Anas Al-Natour, Shady Fadel, Haytham Rashwan, Haytham Badawy, Nadia Farghaly

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Introduction: Wilm's tumor is the most common malignant renal tumor in children. Much progress has been made in the management of patients with this malignancy over the last 3 decades. Today treatments are based on several trials and studies conducted by the International Society of Pediatric Oncology (SIOP) in Europe and National Wilm's Tumor Study Group (NWTS) in the USA. It is necessary for us to understand why do we follow either of the protocols, NWTS which follows the upfront surgery principle or the SIOP which follows the upfront chemotherapy principle in all stages of the disease. Objective: The aim of is to assess outcome in patients treated with preoperative chemotherapy and patients treated with upfront surgery to compare their effect on overall survival. Study design: to decide which protocol to follow, study was carried out on records for patients aged 1 day to 18 years old suffering from Wilm's tumor who were admitted to Alexandria University Hospital, pediatric oncology, pediatric urology and pediatric surgery departments, with a retrospective survey records from 2010 to 2015, Design and editing of the transfer sheet with a (PRISMA flow study) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (11) Qualitative data were described using number and percent. Quantitative data were described using Range (minimum and maximum), mean, standard deviation and median. Comparison between different groups regarding categorical variables was tested using Chi-square test. When more than 20% of the cells have expected count less than 5, correction for chi-square was conducted using Fisher’s Exact test or Monte Carlo correction. The distributions of quantitative variables were tested for normality using Kolmogorov-Smirnov test, Shapiro-Wilk test, and D'Agstino test, if it reveals normal data distribution, parametric tests were applied. If the data were abnormally distributed, non-parametric tests were used. For normally distributed data, a comparison between two independent populations was done using independent t-test. For abnormally distributed data, comparison between two independent populations was done using Mann-Whitney test. Significance of the obtained results was judged at the 5% level. Results: A significantly statistical difference was observed for survival between the two studied groups favoring the upfront chemotherapy(86.4%)as compared to the upfront surgery group (59.3%) where P=0.009. As regard complication, 20 cases (74.1%) out of 27 were complicated in the group of patients treated with upfront surgery. Meanwhile, 30 cases (68.2%) out of 44 had complications in patients treated with upfront chemotherapy. Also, the incidence of intraoperative complication (rupture) was less in upfront chemotherapy group as compared to upfront surgery group. Conclusion: Upfront chemotherapy has superiority over upfront surgery.As the patient who started with upfront chemotherapy shown, higher survival rate, less percent in complication, less percent needed for radiotherapy, and less rate in recurrence.

Keywords: Wilm's tumor, renal tumor, chemotherapy, surgery

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Authors: Chih-Hsing Lin, Wen-Ching Chen, Chih-Ting Kuo, Gang-Neng Sung, Chih-Chyau Yang, Chien-Ming Wu, Chun-Ming Huang

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This paper proposes a cellular-based structure health monitoring device (HMD) for temporary bridge monitoring without the requirement of power line and internet service. The proposed HMD includes sensor node, power module, cellular gateway, and rechargeable batteries. The purpose of HMD focuses on short-term collection of civil infrastructure information. It achieves the features of low cost by using three 1-axis accelerometers with data synchronization problem being solved. Furthermore, instead of using data acquisition system (DAQ) sensed data is transmitted to Host through cellular gateway. Compared with 3-axis accelerometer, our proposed 1-axis accelerometers based device achieves 50.5% cost saving with high sensitivity 2000mv/g. In addition to fit different monitoring environments, the proposed system can be easily replaced and/or extended with different PCB boards, such as communication interfaces and sensors, to adapt to various applications. Therefore, with using the proposed device, the real-time diagnosis system for civil infrastructure damage monitoring can be conducted effectively.

Keywords: cellular-based structural health monitoring, cost-effective 1-axis accelerometers, short-term monitoring, structural engineering

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Authors: Mine Cekin

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Self-regulated learning (SRL), which can be defined as learning that takes place when an individual is an active controller over his cognition, behavior, and motivation in the learning process, seems to be an essential educational goal. However, it is asserted that students need an assistance to become self-regulated learners. Therefore, teachers appear to play an important role in the introduction of SRL. Even though the importance of SRL has been shown by many researchers, the issue of how teachers can introduce it in a classroom environment needs to be investigated thoroughly. When it comes to mathematics learning particularly, it seems really difficult to associate this area with self-regulated learning because of the fact that it is mainly seen as a domain that is overwhelmingly memorizing written notations. As a result, self-regulated learning in mathematics education and what roles teachers have seem to deserve a significant attention. In this study, the significance of SRL and the roles of teachers in promoting SRL in the field of mathematics education particularly with the help of current literature have been highlighted. Some of the roles of teachers are becoming self-regulated learners themselves, facilitating motivation and collaboration with their colleagues in their schools.

Keywords: mathematics education, motivation, self-regulated learning, teacher self-regulation

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