Search results for: IATF 16949:2016

Authors: Anamika A. Sharma, Arezou Ahmadi R. A., Narendra B. Parihar, Manjusha Sajith

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Introduction: Hemodialysis is the most effective therapeutic technique for patient with ESRD second to renal transplantation. However it is a lifelong therapy which requires frequent hospital, or dialysis centers visits mainly twice and thrice weekly, thus considerably changes the normal way of patient’s living. So this study aimed to Assess Health-Related Quality of life in End-Stage Renal Disease (ESRD) Undergoing Twice and Thrice weekly Hemodialysis. Method: A prospective observational, cross-sectional study was carried out from September 2016 to April 2017 in end-stage renal disease patients undergoing hemodialysis. Socio-demographic and clinical details of patients were obtained from the medical records. WHOQOL-BREF questionnaire was used to Access Health-Related Quality Of Life. Quality of Life scores of Twice weekly and Thrice weekly hemodialysis was analyzed by Kruskal Wallis Test. Results: Majority of respondents were male (72.55%), married (89.31%), employed (58.02%), belong to middle class (71.00%) and resides in rural area (58.78%). The mean ages in the patient undergoing twice weekly and thrice weekly hemodialysis were 51.89 ± 15.64 years and 51.33 ± 15.70 years respectively. Average Quality of Life scores observed in twice weekly and thrice weekly hemodialysis was 52.07 ± 13.30 (p=0.0037) and 52.87 ± 13.47 (p=0.0004) respectively. The hemoglobin of thrice weekly dialysis patients (10.28 gm/dL) was high as compared to twice weekly dialysis (9.23 gm/dL). Patients undergoing thrice weekly dialysis had improved serum urea, serum creatinine values (95.85 mg/dL, 8.32 mg/dL) as compared to twice weekly hemodialysis ( 104.94 mg/dL, 8.68 mg/dL). Conclusion: Our study concluded that there was no significant difference between overall Health-Related Quality Of Life in twice weekly and thrice weekly hemodialysis. Frequent hemodialysis was associated with improved control of hypertension, serum urea, serum creatinine levels.

Keywords: end stage renal disease, health related quality of life, twice weekly hemodialysis, thrice weekly hemodialysis

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Authors: Pranab Kumar Das

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Vulnerability assessment of buildings with irregularity in the vertical direction has been carried out in this study. The constructions of vertically irregular buildings are increasing in the context of fast urbanization in the developing countries including India. During two reconnaissance based survey performed after Nepal earthquake 2015 and Imphal (India) earthquake 2016, it has been observed that so many structures are damaged due to the vertically irregular configuration. These irregular buildings are necessary to perform safely during seismic excitation. Therefore, it is very urgent demand to point out the actual vulnerability of the irregular structure. So that remedial measures can be taken for protecting those structures during natural hazard as like earthquake. This assessment will be very helpful for India and as well as for the other developing countries. A sufficient number of research has been contributed to the vulnerability of plan asymmetric buildings. In the field of vertically irregular buildings, the effort has not been forwarded much to find out their vulnerability during an earthquake. Irregularity in vertical direction may be caused due to irregular distribution of mass, stiffness and geometrically irregular configuration. Detailed analysis of such structures, particularly non-linear/ push over analysis for performance based design seems to be challenging one. The present paper considered a number of models of irregular structures. Building models made of both reinforced concrete and brick masonry are considered for the sake of generality. The analyses are performed with both help of finite element method and computational method.The study, as a whole, may help to arrive at a reasonably good estimate, insight for fundamental and other natural periods of such vertically irregular structures. The ductility demand, storey drift, and seismic response study help to identify the location of critical stress concentration. Summarily, this paper is a humble step for understanding the vulnerability and framing up the guidelines for vertically irregular structures.

Keywords: ductility, stress concentration, vertically irregular structure, vulnerability

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

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The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, type 2 diabetes mellitus, uncontrolled glycemia

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Authors: Azusa Katsumata

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Where there is collaboration between universities and companies in the educational context, companies seek ‘knowledge’ from universities and provide a ‘place of practice’ to them. Several universities have introduced activities aimed at the mutual enlightenment of a diversity of people in career education. However, several programs emphasize on delivering results, and on practicing the prepared materials as planned. Few programs focus on unexpected failures and setbacks. This way of learning is important in career education so that classmates can help each other, overcome difficulties, draw out each other’s strengths, and learn from them. Seijo University in Tokyo offered Tokyo Tourism, a Project-Based Learning course, as a first-year career education course until 2016. In cooperation with a travel agency, students participate in planning actual tourism products for foreigners visiting Japan, undertake tours serving as guides. This paper aims to study the 'learning platform' created by a series of processes such as the fieldwork, planning tours, the presentation, selling the tourism products, and guiding the tourists. We conducted a questionnaire to measure the development of work-related skills in class. From the results of the questionnaire, we can see, in the example of this class, that students demonstrated an increased desire to be pro-active and an improved motivation to learn. Students have not, however, acquired policy or business skills. This is appropriate for first-year careers education, but we need to consider how this can be incorporated into future courses. In the questionnaire filled out by the students after the class, the following results were found. Planning and implementing travel products while learning from each other, and helping the teams has led to improvements in the student workforce. This course is a collaborative project between Japanese universities and the 2020 Tokyo Olympics and Paralympic Games committee.

Keywords: university career education, platform of learning, project-based learning, collaboration between university and company

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Mark Herman Sumagang Potoy

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State of the City Address (SOCA) is a speech, modelled after the State of the Nation Address, given not as mandated by law but usually a matter of practice or tradition delivered before the chief executive’s constituents. Through this, the general public is made to know the performance of the local government unit and its agenda for the coming year. Therefore, it is imperative for SOCAs to clearly convey its message and carry out the myriad function of enlightening its readers which could be achieved through the proper use of reference. Anaphora and cataphora are the two major types of reference; the former refer back to something that has already been mentioned while the latter points forward to something which is yet to be said. This paper seeks to identify the types of reference employed on the SOCAs from 2014 to 2016 of Hon. Rosalina Garcia Jalosjos, Mayor of Dapitan City and look into how the references contribute to the clarity of the message of the text. The qualitative method of research is used in this study through an in-depth analysis of the corpus. As soon as the copies of the SOCAs are secured from the Office of the City Mayor, they are then analyzed using documentary technique categorizing the types of reference as to anaphora and cataphora, counting each of these types and describing the implications of the dominant types used in the addresses. After a thorough analysis, it is found out that the two reference types namely, anaphora and cataphora are both employed on the three SOCAs, the former being used more frequently than the latter accounting to 80% and 20% of actual usage, respectively. Moreover, the use of anaphors and cataphora on the three addresses helps in conveying the message clearly because they primarily become aids to avoid the repetition of the same element in the text especially when there wasn’t a need to emphasize a point. Finally, it is recommended that writers of State of the City Addresses should have a vast knowledge on how reference should be used and the functions they take in the text since this is a vital tool to clearly transmit a message. Moreover, English teachers should explicitly teach the proper usage of anaphora and cataphora, as instruments to develop cohesion in written discourse, to enable students to write not only with sense but also with fluidity in tying utterances together.

Keywords: anaphora, cataphora, reference, State of the City Address

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Authors: Racha El Kadiri, Mohamed Sultan, Henrique Momm, Zachary Blair, Rachel Schultz, Tamer Al-Bayoumi

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The Mediterranean Basin is a very diverse region of nationalities and climate zones, with a strong dependence on agricultural activities. Predicting long term (with a lead of 1 to 12 months) rainfall, and future droughts could contribute in a sustainable management of water resources and economical activities. In this study, an integrated approach was adopted to construct predictive tools with lead times of 0 to 12 months to forecast rainfall amounts over nine subzones of the Mediterranean Basin region. The following steps were conducted: (1) acquire, assess and intercorrelate temporal remote sensing-based rainfall products (e.g. The CPC Merged Analysis of Precipitation [CMAP]) throughout the investigation period (1979 to 2016), (2) acquire and assess monthly values for all of the climatic indices influencing the regional and global climatic patterns (e.g., Northern Atlantic Oscillation [NOI], Southern Oscillation Index [SOI], and Tropical North Atlantic Index [TNA]); (3) delineate homogenous climatic regions and select nine pilot study zones, (4) apply data mining methods (e.g. neural networks, principal component analyses) to extract relationships between the observed rainfall and the controlling factors (i.e. climatic indices with multiple lead-time periods) and (5) use the constructed predictive tools to forecast monthly rainfall and dry and wet periods. Preliminary results indicate that rainfall and dry/wet periods were successfully predicted with lead zones of 0 to 12 months using the adopted methodology, and that the approach is more accurately applicable in the southern Mediterranean region.

Keywords: rainfall, neural networks, climatic indices, Mediterranean

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Authors: Yong Hwang, Kang Yeol Suh, Yundeok Jang, Tae Hoon Kim

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Introduction: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Acute kidney injury is a potential complication of severe rhabdomyolysis and the prognosis is substantially worse if renal failure develops. We try to identify the factors that were predictive of AKI in severe trauma patients with rhabdomyolysis. Methods: This retrospective study was conducted at the emergency department of a level Ⅰ trauma center. Patients enrolled that initial creatine phosphokinase (CPK) levels were higher than 1000 IU with acute multiple trauma, and more than 18 years older from Oct. 2012 to June 2016. We collected demographic data (age, gender, length of hospital day, and patients’ outcome), laboratory data (ABGA, lactate, hemoglobin. hematocrit, platelet, LDH, myoglobin, liver enzyme, and BUN/Cr), and clinical data (Injury Mechanism, RTS, ISS, AIS, and TRISS). The data were compared and analyzed between AKI and Non-AKI group. Statistical analyses were performed using IMB SPSS 20.0 statistics for Window. Results: Three hundred sixty-four patients were enrolled that AKI group were ninety-six and non-AKI group were two hundred sixty-eight. The base excess (HCO3), AST/ALT, LDH, and myoglobin in AKI group were significantly higher than non-AKI group from laboratory data (p ≤ 0.05). The injury severity score (ISS), revised Trauma Score (RTS), Abbreviated Injury Scale 3 and 4 (AIS 3 and 4) were showed significant results in clinical data. The patterns of CPK level were increased from first and second day, but slightly decreased from third day in both group. Seven patients had received hemodialysis treatment despite the bleeding risk and were survived in AKI group. Conclusion: We recommend that HCO3, CPK, LDH, and myoglobin should be checked and be concerned about ISS, RTS, AIS with injury mechanism at the early stage of treatment in the emergency department.

Keywords: acute kidney injury, emergencies, multiple trauma, rhabdomyolysis

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Authors: Corlia van der Walt, Michele K. Havenga

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The study considers corporate governance regulation and practice in South African higher education institutions and makes recommendations for the improvement of current governance practices in this sector. The development of corporate governance principles and practices in South Africa, culminating in the King IV Report on Corporate Governance which was launched in November 2016, is discussed. King IV enjoys international recognition as a progressive corporate governance instrument. It was necessitated by the fundamental changes in business and society nationally and globally, as well as by the significant changes to South African company law introduced by new legislation. Corporate governance and the corporate form are narrowly associated, but there is general recognition that the principles of ethical and effective leadership are not restricted to corporations. Thus King IV was drafted with the express aim that it should apply to all organisations, regardless of their form of incorporation, and the report includes specific sector supplements in support of this aspiration. The South African higher education sector has of late been under intense scrutiny, and a few universities have been placed under administration because of poor governance practices. Universities have also been severely impacted by the consequences of what is generally known as ‘#FeesmustFall’, a student led protest movement initially aimed against the increase of fees at public universities, but which rapidly expanded to also include other concerns. It was clearly necessary to revisit corporate governance policy and practice in the sector. The review of the current higher education governance regime in light of the King IV recommendations, lessons from company law regarding the entrenchment and enforcement of corporate governance principles, and a comparison of higher education governance practices in selected other jurisdictions led to recommendations for the improvement of governance practices in South African higher education. It is further suggested that a sector supplement for higher education institutions may provide additional clarity. Some of the recommendations may be of comparative value for international higher education governance.

Keywords: committees, corporate governance, ethical leadership, higher education institutions, integrated reporting, King IV, sector supplements, sustainability

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Authors: Endah Tri Lestari, Mustafa Mahmud Amin, Elmeida Effendy

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Background: Vitamin D levels with schizophrenia is lower than the control due to lifestyle and physical health factors such as smoking, increases of body mass index, inactivity, and social withdrawal including decreases of sunlight exposure. Asia has the lowest average of vitamin D serum levels and Europe with lighter colored skin has higher serum levels of vitamin D. Indonesia is a tropical region in the area of the equator, and has only two seasons: the rainy season and summer. The Indonesian people are known as a nation that has a diversity of ethnic groups that exist in many areas. Each tribe has differences in living habits. Ethnic diversity, culture, religion, customs, geographical location, this is reflected in our daily lives that will affect the levels of vitamin D in patients with schizophrenic. Individuals with darker skin tend to be deficient in vitamin D and increases the chance of schizophrenia than the general population. Aims: To determine the difference of vitamin D serum by ethnicity between Bataknese and Malayan schizophrenic patient. Methods: This study was an analytical study to recruited 60 subjects of schizophrenic male patient (30 Bataknese and 30 Malayan), aged between 15 to 55 years old, period at May - November 2016, the acute phase with no agitation. Statistical analysis was using T- independent test. Blood sample for vitamin D serum was using ELFA method. Results: The vitamin D serum levels were lower in Bataknese ethnic group schizophrenic patients in highland than Malayan ethnic group in lowland, reaching statistically (22.9±3.33 ng/ml) vs (27.9±4.19 ng/ml) p < 0,001. Conclusion: There are significant differences of vitamin D serum Status by Ethnicity between Bataknese in the Highland and Malayan in the Lowland on Schizophrenic Patient in North Sumatera.

Keywords: schizophrenia, serum vitamin D, ethnicity

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Authors: Chun-Min Lin, Yuh-Jen Wu, Ching-Ting Chung

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The formulation of tourism policies requires objective academic research and evidence as support, especially research from local academia. Taiwan is a small island, and its economic growth relies heavily on tourism revenue. Taiwanese government has been devoting to the promotion of the tourism industry over the past few decades. Scientific research outcomes by Taiwanese scholars may and will help lay the foundations for drafting future tourism policy by the government. In this study, a total of 120 full journal articles published between 2008 and 2016 from the Journal of Tourism and Leisure Studies (JTSL) were examined to explore the scientific research trend of tourism study in Taiwan. JTSL is one of the most important Taiwanese journals in the tourism discipline which focuses on tourism-related issues and uses traditional Chinese as the study language. The method of co-word analysis from bibliometrics approaches was employed for semantic analysis in this study. When analyzing Chinese words and phrases, word segmentation analysis is a crucial step. It must be carried out initially and precisely in order to obtain meaningful word or word chunks for further frequency calculation. A word segmentation system basing on N-gram algorithm was developed in this study to conduct semantic analysis, and 100 groups of meaningful phrases with the highest recurrent rates were located. Subsequently, co-word analysis was employed for semantic classification. The results showed that the themes of tourism research in Taiwan in recent years cover the scope of tourism education, environmental protection, hotel management, information technology, and senior tourism. The results can give insight on the related issues and serve as a reference for tourism-related policy making and follow-up research.

Keywords: bibliometrics, co-word analysis, word segmentation, tourism research, policy

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Authors: Danute Jablonskyte-Rasce, Laura Masilionyte

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The field experiments of different farming systems were conducted at Joniškėlis Experimental Station of the Lithuanian Research Centre for Agriculture and Forestry in 2006–2016. The soil of the experimental site was Endocalcari-Endohypogleyic Cambisol (CMg-n-w-can). The research was designed to identify the effects of dry matter and nitrogen accumulated in the above-ground biomass of various catch crops grown after winter wheat on soil mineral nitrogen variation during the autumn and spring period in the presence of intensive leaching complex. Research was done in the soil differing in humus status in the organic and sustainable cropping systems by growing various plant mixtures as catch crops: narrow-leafed lupine (Lupinus angustifolius L.) and oil radish (Raphanus sativus var. Oleifera L.), white mustard (Sinapis alba L.) and buckwheat (Fagopyrum exculentum Moench.) and white mustard as a sole crop. All crop and soil management practices have shown optimal efficiency in late autumn – stubble breaking, catch crops and straw used during the post-harvest period of the main crops, reduced Nmin migration into deeper (40–80 cm) soil layer. The greatest Nmin reduction in the 0–40 cm soil layer during the period from late autumn to early spring was identified in the sustainable cropping system having applied N30 for the promotion of straw mineralization and with no catch crops cultivation. The sustainable cropping system, having applied N30 for straw mineralization and growing white mustard in combination with buckwheat as catch crops, Nmin difference in the spring compared with its status in the autumn in the soil low and moderate in humus was lower by 70.1% and 34.2%, respectively.

Keywords: soil nitrogen, catch crops, ecological and sustainable farming systems, Cambisol

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Authors: Chaebong Kim, Yongmin Cho, Minkyung Han, Mooyoung Kim, KooSang Kim

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Background: Air pollution from global warming has a considerable influence on respiratory disease and atopic dermatitis (AD). Present studies base on a hypothesis about correlation between air pollutant and AD, and the results are analyzed from various points of view. Objectives: This study aimed to integrate the relevant researches for air pollutant and AD, and to perform the systematic literature review and meta-analysis to provide the basis of air pollutant control. Methods: Research materials were collected from original articles published in English academic journals including medicine, nursing and health science from August 1 to 31, 2016. We collected the materials from Pubmed, Medline, Embase, Cochrane Central database with Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) based on the Cochrane Systematic Review Manual, and performed the evaluation and analysis for selected materials. We got the research results for risk of bias using Rev-Man ver. 5.2, and meta analyses using STATA. Results: The prevalence of infantile atopic dermatitis were 1.05 times higher than other groups who were exposed to air pollution, and exposure to NO2 (1.08, 95% CI: 1.02 – 1.14), O3 (1.09, 95% CI: 1.04 – 1.15), SO2 (1.07, 95% CI: 1.02 – 1.12) in subgroup air pollutant was considerably associated with infantile atopic dermatitis. The prevalence of infantile atopic dermatitis was 1.03 times higher than other groups who were exposed to PM2.5, but the results were not statistically similar. Conclusion: Health effect from environmental pollution risen people’s interest in environmental diseases. Air pollutant was associated with AD in this study, but selected literature was based on non-RCT (Randomized Controlled Trial) study. Therefore, there was a limit in study method including control, matching, and correction of confounding variables. For clear conclusion, it is necessary to develop the appropriate tool for object of study and clear standard to measure of air pollutant.

Keywords: air pollution, atopic dermatitis, children, meta-analysis

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Authors: Kyung-Sook Bang

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Background: The health status of school-age children has a great influence on their growth and life-long health. The purposes of this study were to identify physical and mental health status of late school-age children in Seoul, South Korea and to investigate the related factors for their health. Methods: After gaining the approval from Institutional Review Board (IRB), a cross-sectional study was conducted with elementary students in grade 4 or 5. Questionnaires were distributed to eight elementary schools located different regions of Seoul in November, 2016, and 302 participants were finally included. From all participants, informed consents from the parents, and assents from children were received. Children's socioeconomic status, family functioning, peer relations, physical health symptoms, and depression were measured with self-reported questionnaires. Data were analyzed with descriptive statistics, t-test, Pearson’s correlations, and multiple regression. Results: Children's physical health symptoms and depression were not significantly different, and only their peer relations were significantly different according to their socioeconomic status (t=-3.93, p<.001). Depression showed significant positive correlation with physical health symptoms (r=.720, p<.001) and negative correlations with family functioning (r=-.428, p<.001) and peer relations (r=-.775, p<.001). The multiple regression model, which explained 73.5% of variance, showed peer relations (r2 =.604), physical health symptoms (r2 change=.125), and family functioning (r2 change=.005) as significant predictors for depression. Only the peer relations was significant predictor for their physical health symptoms and explained 50.6% of it. Conclusions: The peer relations was the most important factor in their physical and mental health at this age, and it can be affected by their socioeconomic status. Nursing interventions for promoting social relations and family functioning are required to improve children’s physical and mental health, especially for vulnerable population.

Keywords: child, depression, health, peer relation

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Authors: Saja Al Zoubi, Humam Wardeh

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This study aims to shed light on the work conditions of female refugees and the most important constraints and challenges preventing them from accessing good earning work. The study was conducted in the Syrian refugee camps in Bekaa province, Lebanon, with a field survey carried out between 2016-2017 through face-to-face interviews of 69 female refugee workers, in addition to 4 focus groups. The results show that 97% of the Syrian female refugees are agricultural workers, they form more than 53% of the agricultural labor work among the refugees. Women predominantly perform all agricultural activities (Planting, weeding, fertilization, irrigation, compacting, cutting, sorting, packaging), except the carriage of heavy objects and sometimes irrigation are exclusive for men. The female child labor is 66% of the child labor. To maintain the livelihoods of their families, women accept to be paid for 4-8 $/day with gender gap around 6 $/day. Women’s acceptance of these low wages is one of the main reasons for landowners’ preference of hiring women under bad work conditions. The less educated and skilled (40% of the women are illiterate, and 2% have some skills) women are more likely to be limited to farm work. In addition, there are other reasons as traditions, labor market demand and other challenges related to security and legal issues. This study finds that enhancing the women capacities (for both refugees and host community) through vocational training and cooperative micro enterprises matched with income generating activities and opening new market channels for local manufactured products can play important role to improve the work skills and conditions, and that can improve the livelihood of their families. The study also recommends to adopt a strategy by all humanitarian agencies to make the aid on educating children condition.

Keywords: agricultural work conditions, gender wage gap, women refugees, work constraints

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Authors: Michael Salib, Samer Ezeldin, Ahmed Waly

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There are numerous challenges and problems facing the construction industry in several countries in the Middle East, as a result of numerous economic and political effects. As an example in Egypt, several construction companies have shut down and left the market since 2016. The closure of these companies occurred, as they did not respond with the suitable techniques and strategies that will enable them to survive during this economic turmoil period. A research is conducted in order to identify adequate strategies to be implemented by the Egyptian contractors that could allow them survive and keep competing during such economic hardship period. Two different techniques were used in order to identify these startegies. First, a deep research were conducted on the companies located in countries that suffered similar economic harship to identify the strategies they used in order to survive. Second, interviews were conducted with experts in the construction field in order to list the effective strategies they used that allowed them to survive. Moreover, at the end of each interview, the experts were asked to rate the applicability of the previously identified strategies used in the foreign countries, then the efficiency of each strategy if used in Egypt. A framework model is developed in order to assist the construction companies in choosing the suitable techniques to their company size, through identifying the top ranked strategies and techniques that should be adopted by the company based on the parameters given to the model. In order to verify this framework, the financial statements of two leading companies in the Egyptian construction market were studied. The first Contractor has applied nearly all the top ranked strategies identified in this paper, while the other contractor has applied only few of the identified top ranked strategies. Finally, another expert interviews were conducted in order to validate the framework. These experts were asked to test the model and rate through a questionnaire its applicability and effectiveness.

Keywords: construction management, economic hardship, recession, survive

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Authors: Dilini Bodhinayaka, Aunsha Sajeewanie Rubasinghe

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The library of the University of Kelaniya plays a significant role in supporting the academic work of the university. As at July, 2016 the library of the University of Kelaniya comprised of 250301 printed books, 2157 CD-ROMs, 1203 theses and 800 non-book materials. Furthermore, the library is subscribed to about 60 local journals, access to over 12,500 full text academic journals and around 100,000 e-books. The library provides the services and resources that support in teaching, doing research and learning. On the other hand, undergraduate students have adopted and continued to use the online information retrieval for their academic and research work. This study aims to compare the usage of internet and the usage of library among undergraduates in the faculties of Humanities, Social Sciences, Science and Commerce & Management in the University of Kelaniya. Also, the research attempts to determine the factors of enthusiasm or the disinterest in the students in using library and Internet. All the undergraduate students in the University (8440 students at the time of the study) were taken as the population of the study and the sample of 15% was selected out of the population using stratified sampling method. A total of 1266 questionnaires were distributed among undergraduates of the above mentioned faculties. The qualitative data were analyzed using Descriptive Statistical Method. Findings, of the study indicated that undergraduate students of the faculties of Humanities, Social Sciences, Science and Commerce & Management use both the library and the internet to fulfill their information needs. But, the students in the faculty of Science and Commerce & Management use the internet sources more than the library. The undergraduates in the faculties of Humanities and Social Sciences frequently use the university library than the internet. Although, majority agreed that the internet is the most preferred source of information they have no an adequate awareness about the available internet resources in the E-library of the University of Kelaniya.

Keywords: university libraries, University of Kelaniya, online resources, undergraduates in Sri Lanka

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Authors: Denise Levy, Helen J. Khoury

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Nuclear technology is a controversial issue among a great share of the Brazilian population. Misinformation and common wrong beliefs confuse public’s perceptions and the scientific community is expected to offer a wider perspective on the benefits and risks resulting from ionizing radiation in everyday life. Attentive to the need of new approaches between science and society, the Nuclear Energy Museum, in northeast Brazil, is an initiative created to communicate the growing impact of the beneficial applications of nuclear technology in medicine, industry, agriculture and electric power generation. Providing accessible scientific information, the museum offers a rich learning environment, making use of different educational strategies, such as films, interactive panels and multimedia learning tools, which not only increase the enjoyment of visitors, but also maximize their learning potential. Developed according to modern active learning instructional strategies, multimedia materials are designed to present the increasingly role of nuclear science in modern life, transforming science education into a meaningful learning experience. In year 2016, nine different interactive computer-based activities were developed, presenting curiosities about ionizing radiation in different landmarks around the world, such as radiocarbon dating works in Egypt, nuclear power generation in France and X-radiography of famous paintings in Italy. Feedback surveys have reported a high level of visitors’ satisfaction, proving the high quality experience in learning nuclear science at the museum. The Nuclear Energy Museum is the first and, up to the present time, the only permanent museum in Brazil devoted entirely to nuclear science.

Keywords: nuclear technology, multimedia learning tools, science museum, society and education

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Authors: Sina Mahdavi

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Background and Objective: Multiple sclerosis (MS) is an inflammatory autoimmune disease of the CNS that affects the myelination process in the central nervous system (CNS). Complex interactions of various "environmental or infectious" factors may act as triggers in autoimmunity and disease progression. The association between viral infections, especially human endogenous retrovirus (HERV) and MS is one potential cause that is not well understood. This study aims to summarize the available data on HERV infection in MS disease progression. Materials and Methods: For this study, the keywords "Multiple sclerosis", "Human endogenous retrovirus", and "central nervous system" in the databases PubMed, Google Scholar, Sid, and MagIran between 2016 and 2022 were searched and 14 articles chosen, studied, and analyzed. Results: In the leptomeningeal cells of MS patients, a retrovirus-like element associated with reverse transcriptase (RT) activity called multiple sclerosis-associated retroviruses (MSRV) has been identified. HERVs are expressed in the human CNS despite mechanisms to suppress their expression. External factors, especially viral infections such as influenza virus, Epstein-Barr virus, and herpes simplex virus type 1, can activate HERV gene expression. The MSRV coat protein is activated by activating TLR4 at the brain surface, particularly in oligodendroglial progenitor cells and macrophages, leading to immune cascades followed by the downregulation of myelin protein expression. The HERV-K18 envelope gene (env) acts as a superantigen and induces inflammatory responses in patients with MS. Conclusion: There is a high expression of endogenous retroviruses during the course of MS, which indicates the relationship between HERV and MS, that this virus can play a role in the development of MS by creating an inflammatory state. Therefore, measures to modulate the expression of endogenous retroviruses may be effective in reducing inflammatory processes in demyelinated areas of MS patients.

Keywords: multiple sclerosis, human endogenous retrovirus, central nervous system, MSRV

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Authors: K. Drabczyk, Z. Starowicz, S. Maleczek, P. Zieba

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The army, police and fire brigade commonly use dedicated equipment based on special textile materials. The properties of these textiles should ensure human life and health protection. Equally important is the ability to use electronic equipment and this requires access to the source of electricity. Photovoltaic cells integrated with such textiles can be solution for this problem in the most of outdoor circumstances. One idea may be to laminate the cells to textile without changing their properties. The main goal of this work was analyzed lamination quality of special designed semi-flexible solar module with special textile materials as a backsheet. In the first step of investigation, the quality of lamination was determined using device equipped with dynamometer. In this work, the crystalline silicon solar cells 50 x 50 mm and thin chemical tempered glass - 62 x 62 mm and 0.8 mm thick - were used. The obtained results showed the correlation between breaking force and type of textile weave and fiber. The breaking force was in the ranges: 4.5-5.5 N, 15-20 N and 30-33 N depending on the type of wave and fiber type. To verify these observations the microscopic and FTIR analysis of fibers was performed. The studies showed the special textile can be used as a backsheet of semi-flexible solar modules. This work presents a new composition of solar module with special textile layer which, to our best knowledge, has not been published so far. Moreover, the work presents original investigations on adhesion of EVA (ethylene-vinyl acetate) polymer to textile with respect to fiber structure of laminated substrate. This work is realized for the GEKON project (No. GEKON2/O4/268473/23/2016) sponsored by The National Centre for Research and Development and The National Fund for Environmental Protection and Water Management.

Keywords: flexible solar modules, lamination process, solar cells, textile for photovoltaics

Procedia PDF Downloads 342

Authors: Mariam Ismail, Kazeem Rufai, Jeremiah Balogun

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A study was conducted to apply fuzzy logic to the development of a monitoring model for child pornography based on associated risk factors, which can be used by forensic experts or integrated into forensic systems for the early detection of child pornographic activities. A number of methods were adopted in the study, which includes an extensive review of related works was done in order to identify the factors that are associated with child pornography following which they were validated by an expert sex psychologist and guidance counselor, and relevant data was collected. Fuzzy membership functions were used to fuzzify the associated variables identified alongside the risk of the occurrence of child pornography based on the inference rules that were provided by the experts consulted, and the fuzzy logic expert system was simulated using the Fuzzy Logic Toolbox available in the MATLAB Software Release 2016. The results of the study showed that there were 4 categories of risk factors required for assessing the risk of a suspect committing child pornography offenses. The results of the study showed that 2 and 3 triangular membership functions were used to formulate the risk factors based on the 2 and 3 number of labels assigned, respectively. The results of the study showed that 5 fuzzy logic models were formulated such that the first 4 was used to assess the impact of each category on child pornography while the last one takes the 4 outputs from the 4 fuzzy logic models as inputs required for assessing the risk of child pornography. The following conclusion was made; there were factors that were related to personal traits, social traits, history of child pornography crimes, and self-regulatory deficiency traits by the suspects required for the assessment of the risk of child pornography crimes committed by a suspect. Using the values of the identified risk factors selected for this study, the risk of child pornography can be easily assessed from their values in order to determine the likelihood of a suspect perpetuating the crime.

Keywords: fuzzy, membership functions, pornography, risk factors

Procedia PDF Downloads 107

Authors: Y. P. Wang, J. K. Chen, C. H. Lee, G. H. Huang, M. C. Wang, S. W. Chen, Y. T. Kuan, H. C. Lin, C. Y. Huang, W. H. Liang, W. C. Lin, H. C. Yu

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The hi-tech industries in the Science Park at southern Taiwan were heavily damaged by a strong earthquake early 2016. The financial loss in this event was attributed primarily to the automated stocker system handling fully processed products, and recovery of the automated stocker system from the aftermath proved to contribute major lead time. Therefore, development of effective means for protection of stockers against earthquakes has become the highest priority for risk minimization and business continuity. This study proposes to mitigate the seismic response of the stockers by introducing viscous fluid dampers in between the ceiling and the top of the stockers. The stocker is expected to vibrate less violently with a passive control force on top. Linear damper is considered in this application with an optimal damping coefficient determined from a preliminary parametric study. The damper is small in size in comparison with those adopted for building or bridge applications. Component test of the dampers has been carried out to make sure they meet the design requirement. Shake table tests have been further conducted to verify the proposed scheme under realistic earthquake conditions. Encouraging results have been achieved by effectively reducing the seismic responses of up to 60% and preventing the FOUPs from falling off the shelves that would otherwise be the case if left unprotected. Effectiveness of adopting a viscous fluid damper for seismic control of the stocker on top against the ceiling has been confirmed. This technique has been adopted by Macronix International Co., LTD for seismic retrofit of existing stockers. Demonstrative projects on the application of the proposed technique are planned underway for other companies in the display industry as well.

Keywords: hi-tech industries, seismic protection, automated stocker system, viscous fluid damper

Procedia PDF Downloads 335

Authors: Anil Kumar Gupta, Dronadula Venkata Sai Praneeth, Brajesh Dubey, Arundhuti Devi, Suravi Kalita, Khanindra Sharma

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Increase in urbanization and industrialization have led to improve in the standard of living. However, at the same time, the challenges due to improper solid waste management are also increasing. Municipal Solid Waste management is considered as a vital step in the development of urban infrastructure. The present study focuses on developing a solid waste management plan for an urban area in a developing country. The current scenario of solid waste management practices at various urban bodies in India is summarized. Guwahati city in the northeastern part of the country and is also one of the targeted smart cities (under the governments Smart Cities program) was chosen as case study to develop and implement the solid waste management plan. The whole city was divided into various divisions and waste samples were collected according to American Society for Testing and Materials (ASTM) - D5231-92 - 2016 for each division in the city and a composite sample prepared to represent the waste from the entire city. The solid waste characterization in terms of physical and chemical which includes mainly proximate and ultimate analysis were carried out. Existing primary and secondary collection systems were studied and possibilities of enhancing the collection systems were discussed. The composition of solid waste for the overall city was found to be as: organic matters 38%, plastic 27%, paper + cardboard 15%, Textile 9%, inert 7% and others 4%. During the conference presentation, further characterization results in terms of Thermal gravimetric analysis (TGA), pH and water holding capacity will be discussed. The waste management options optimizing activities such as recycling, recovery, reuse and reduce will be presented and discussed.

Keywords: proximate, recycling, thermal gravimetric analysis (TGA), solid waste management

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Authors: Osman Zorbaz, Selen Demirtas-Zorbaz, Ozlem Ulas

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The factors that cause adolescents to drop out school were several. One of the frameworks about school dropout focuses on the contextual factors around the adolescents whereas the other one focuses on individual factors. It can be said that both factors are important equally. In this study, both adolescent’s individual factors (anti-social behaviors, academic success) and contextual factors (parent academic involvement, parent academic support, number of siblings, living with parent) were examined in the term of school dropout. The study sample consisted of 346 high school students in the public schools in Ankara who continued their education in 2015-2016 academic year. One hundred eighty-five the students (53.5%) were girls and 161 (46.5%) were boys. In addition to this 118 of them were in ninth grade, 122 of them in tenth grade and 106 of them were in eleventh grade. Multiple regression and one-way ANOVA statistical methods were used. First, it was examined if the data meet the assumptions and conditions that are required for regression analysis. After controlling the assumptions, regression analysis was conducted. Parent academic involvement, parent academic support, number of siblings, anti-social behaviors, academic success variables were taken into the regression model and it was seen that parent academic involvement (t=-3.023, p < .01), anti-social behaviors (t=7.038, p < .001), and academic success (t=-3.718, p < .001) predicted school dropout whereas parent academic support (t=-1.403, p > .05) and number of siblings (t=-1.908, p > .05) didn’t. The model explained 30% of the variance (R=.557, R2=.300, F5,345=30.626, p < .001). In addition to this the variance, results showed there was no significant difference on high school students school dropout levels according to living with parents or not (F2;345=1.183, p > .05). Results discussed in the light of the literature and suggestion were made. As a result, academic involvement, academic success and anti-social behaviors will be considered as an important factors for preventing school drop-out.

Keywords: adolescents, anti-social behavior, parent academic involvement, parent academic support, school dropout

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Authors: Cheryl Teelucksingh

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Toronto is in the midst of an urban development and infrastructure boom. Population growth and concerns about urban sprawl and carbon emissions have led to pressure on the municipal and the provincial governments to re-think urban development. Toronto’s approach to climate change mitigation and adaptation has positioning of the emerging green economy as part of the solution. However, the emerging green economy many not benefit all Torontonians in terms of jobs, improved infrastructure, and enhanced quality of life. Community benefits agreements (CBAs) are comprehensive, negotiated commitments, in which founders and builders of major infrastructure projects formally agree to work with community interest groups based in the community where the development is taking place, toward mutually beneficial environmental and labor market outcomes. When community groups are equitably represented in the process, they stand not only to benefit from the jobs created from the project itself, but also from the longer-term community benefits related to the quality of the completed work, including advocating for communities’ environmental needs. It is believed that green employment initiatives in Toronto should give greater consideration to best practices learned from community benefits agreements. Drawing on the findings of a funded qualitative study in Toronto (Canada), “The Green Gap: Toward Inclusivity in Toronto’s Green Economy” (2013-2016), this paper examines the emergent CBA in Toronto in relation to the development of a light rail transit project. Theoretical and empirical consideration will be given to the research gaps around CBAs, the role of various stakeholders, and discuss the potential for CBAs to gain traction in the Toronto’s urban development context. The narratives of various stakeholders across Toronto’s green economy will be interwoven with a discussion of the CBA model in Toronto and other jurisdictions.

Keywords: green economy in Toronto, equity, community benefits agreements, environmental justice, community sustainability

Procedia PDF Downloads 322

Authors: Yidan Xu, Pim Martens, Thomas Krafft

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Marine fishing, an energy-intensive activity, directly emits greenhouse gases through fuel combustion, making it a significant contributor to oceanic greenhouse gas (GHG) emissions and worsening climate change. China is the world’s second-largest economy and the top emitter of GHG emissions, and it carries a significant energy conservation and emission reduction burden. However, the increasing GHG emissions from marine fishing is an easily overlooked but essential issue in China. This study offers a diverse perspective by integrating the concepts of total carbon emissions, carbon intensity, and per capita carbon emissions as indicators into calculation and discussion. To better understand the GHG emissions-Gross marine fishery product (GFP) relationship and influencing factors in Chinese marine fishing, the relationship between GHG emissions and economic development in marine fishing, a comprehensive framework is developed by combining the environmental Kuznets curve, the Tapio elasticity index, and the decomposition model. Results indicated that (1) The GHG emissions increased from 16.479 to 18.601 million tons in 2001-2020, in which trawlers and gillnetter are the main source in fishing operation. (2) Total carbon emissions (TC) and CI presented the same decline as GHG emissions, while per capita carbon emissions (PC) displayed an uptrend. (32) GHG emissions and gross marine fishery product (GFP) presented an inverted U-shaped relationship in China; the turning point came in the 13th Five-year Plan period (2016-2020). (43) Most provinces strongly decoupled GFP and CI. Still, PC and TC need more effort to decouple. (54) GHG emissions promoted by an industry structure driven, though carbon intensity and industry scale aid in GHG emissions reduced. (5) Compare with TC and PC, CI has been relatively affected by COVID-19 in 2020. The rise in fish and seafood prices during COVID-19 has boosted the GFP.

Keywords: marine fishing economy, greenhouse gas emission, fishery management, green development

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Authors: Hassen Mohammed, Michelle Clarke, Helen Marshall

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Maternal immunization is an effective strategy to protect pregnant women and their offspring from vaccine-preventable diseases. Despite the recommendation of maternal influenza and more recently pertussis immunization in Australia, uptake of these vaccines has been suboptimal. Monitoring the impact of the current funded vaccine programs for pregnant women is limited. The study aimed to assess the impact of the funded program and determine factors associated with vaccine uptake in pregnant women. This observational prospective study was undertaken between November 2014 and July 2016 at the Women’s and Children’s Hospital in South Australia (WCH). Demographic details and vaccination history from South Australian pregnant women who attended the WCH were reviewed. A standardized self-reported survey was conducted in antenatal care with a follow up telephone interview at 8-10 weeks post-delivery. A midwife delivered immunization program for pregnant women in antenatal clinic commenced in April 2015. Of the 180 pregnant women who completed the survey questionnaire, 75.5% and 80.5 % received maternal influenza and pertussis vaccines respectively. First-time mothers had twice the odds of having received influenza vaccine during pregnancy than multiparous women (OR 2.4; CI 1.14 - 4.94; p= 0.021). The proportion of women who received pertussis vaccine during pregnancy, following the introduction of the midwife delivered pertussis vaccination program (140/155, 90.3%) was significantly higher compared with women who received maternal pertussis vaccination prior to the introduction of the program (5/22, 23.7%, p < 0.001). The odds of women receiving maternal pertussis vaccine following the implementation of the midwife delivered program were 31 times higher than women who delivered babies prior to the program (OR 31.7, CI 10.24- 98.27; p < 0.001). High uptake of influenza and pertussis vaccines during pregnancy can be attained with health care provider recommendation and inclusion of maternal immunization as part of standard antenatal care.

Keywords: influenza, maternal immunization, pertussis, provider recommendation

Procedia PDF Downloads 255

Authors: Karen Bell

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While there is broad agreement among governments and civil society globally about the need to develop more sustainable societies, the best way to achieve this is still contested. In particular, there are differences regarding whether to continue to implement market-based approaches or to move to alternative redistributive-based approaches. In this paper, ‘Green Economy’ and ‘Living Well’ strategies are compared as examples of these two different strategies for achieving social, ecological and economic sustainability. The paper is based on a 3-year ESRC funded project on transitions to sustainability which examines the implementation of the ‘Green Economy’ paradigm in South Korea and the 'Living Well' paradigm in Bolivia. As well as outlining and analysing secondary data, the paper also draws on over 100 interviews with a range of local stakeholders in these countries carried out by the author between and including 2016 and 2018. The work indicates that the Living Well paradigm seems to better integrate social, ecological and economic concerns and may better deliver sustainability in the time frame necessary than the dominant Green Economy paradigm. This seems to be primarily because Living Well emphasises redistribution to reduce inequality and ensure human needs are met; living in harmony with nature, taking into account natural limits and cycles; respecting traditional values and practices where these support sustainability and human well-being; sovereignty and local control of natural resources; and participative decision-making, based on grassroots community organising. It is, therefore, argued that to achieve inclusive, just and effective transitions to sustainability we should aim to foster equality, respect planetary limits, build on local traditions, bring resources into public ownership and enhance participatory democracy. This will require a radically different approach to that offered within the market-based agenda currently dominating global sustainability debates and activities.

Keywords: environmental transition, green economy, inclusive sustainability, living well, sustainable transition

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

Procedia PDF Downloads 262

Authors: Xi Vivien Wu, Emily Neo Kim Ang, Yi Jung Tung, Wenru Wang

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Background and Objective: The increase in life expectancy and emphasis on self-reliance for the older adults are global phenomena. As such, lifelong learning in the community is considered a viable means of promoting successful and active aging. This systematic review aims to examine various lifelong learning programs for community-dwelling older adults and to synthesize the contents and outcomes of these lifelong learning programs. Methods: A systematic search was conducted in July to December 2016. Two reviewers were engaged in the process to ensure creditability of the selection process. Narrative description and analysis were applied with the support of a tabulation of key data including study design, interventions, and outcomes. Results: Eleven articles, which consisted of five randomized controlled trials and six quasi-experimental studies, were included in this review. Interventions included e-health literacy programs with the aid of computers and the Internet (n=4), computer and Internet training (n=3), physical fitness programs (n=2), music program (n=1), and intergenerational program (n=1). All studies used objective measurement tools to evaluate the outcomes of the study. Conclusion: The systematic review indicated lifelong learning programs resulted in positive outcomes in terms of physical health, mental health, social behavior, social support, self-efficacy and confidence in computer usage, and increased e-health literacy efficacy. However, the lifelong learning programs face challenges such as funding shortages, program cuts, and increasing costs. A comprehensive lifelong learning program could be developed to enhance the well-being of the older adults at a more holistic level. Empirical research can be done to explore the effectiveness of this comprehensive lifelong learning program.

Keywords: community-dwelling older adults, e-health literacy program, lifelong learning program, the wellbeing of the older adults

Procedia PDF Downloads 139