Search results for: severity index

Authors: Sachin Singh, Thomas Penzel, Dinesh Nandan

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Accurate identification of Sleep Apnea Hypopnea Syndrom Diagnosis is difficult problem for human expert because of variability among persons and unwanted noise. This paper proposes the diagonosis of Sleep Apnea Hypopnea Syndrome (SAHS) using airflow, ECG, Pulse and SaO2 signals. The features of each type of these signals are extracted using statistical methods and ANN learning methods. These extracted features are used to approximate the patient's Apnea Hypopnea Index(AHI) using sample signals in model. Advance signal processing is also applied to snore sound signal to locate snore event and SaO2 signal is used to support whether determined snore event is true or noise. Finally, Apnea Hypopnea Index (AHI) event is calculated as per true snore event detected. Experiment results shows that the sensitivity can reach up to 96% and specificity to 96% as AHI greater than equal to 5.

Keywords: neural network, AHI, statistical methods, autoregressive models

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Authors: Yose Rizal, Nuraini, Mirnawati, Maria Endo Mahata, Rio Darman, Dendi Kurniawan

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An experiment had been conducted to determine the effects of several levels of Neurospora crassa- fermented palm kernel cake in the diet on the production performance and egg-yolk quality of Arab laying-hens, and to obtain the appropriate level of this fermented palm kernel cake for reducing the utilization of concentrated feed in the diet. Three hundred Arab laying-hens of 72 weeks old were employed in this experiment, and randomly assigned to four treatments (0, 7.25, 10.15, and 13.05% fermented palm kernel cake in diets) in a completely randomized design with five replicates. Measured variables were production performance (feed consumption, egg-mass production, feed conversion, egg weight and hen-day egg production), and egg-yolk quality (ether extract and cholesterol contents, and egg-yolk color index). Results of experiment indicated that feed consumption, egg-mass production, feed conversion, egg weight, hen-day egg production and egg-yolk color index were not influenced (P>0.05) by diets. However, the ether extract and cholesterol contents of egg-yolk were very significantly reduced (P<0.01) by diets. In conclusion, Neurospora crassa-fermented palm kernel cake could be included up to 13.05% to effectively replace 45% concentrated feed in Arab laying-hens diet without adverse effect on the production performance.

Keywords: neurospora crassa-fermented palm kernel cake, Arab laying-hens, production performance, ether extract, cholesterol, egg-yolk color index

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Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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Authors: Sukhwinder Singh, Julian Park, Dinesh Kumar Benbi

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Although soil health, which is recognized as one of the key determinants of sustainable agricultural development, can be measured by a range of physical, chemical and biological parameters, the widely used parameters include pH, electrical conductivity (EC), organic carbon (OC), plant available phosphorus (P) and potassium (K). Soil health is largely affected by the occurrence of natural events or human activities and can be improved by various land management practices. A database of 120 soil samples collected from farmers’ fields spread across three major agro-climatic zones of Punjab suggested that the average pH, EC, OC, P and K was 8.2 (SD = 0.75, Min = 5.5, Max = 9.1), 0.27 dS/m (SD = 0.17, Min = 0.072 dS/m, Max = 1.22 dS/m), 0.49% (SD = 0.20, Min = 0.06%, Max = 1.2%), 19 mg/kg soil (SD = 22.07, Min = 3 mg/kg soil, Max = 207 mg/kg soil) and 171 mg/kg soil (SD = 47.57, Min = 54 mg/kg soil, Max = 288 mg/kg soil), respectively. Region-wise, pH, EC and K were the highest in south-western district of Ferozpur whereas farmers in north-eastern district of Gurdaspur had the best soils in terms of OC and P. The soils in the central district of Barnala had lower OC, P and K than the respective overall averages while its soils were normal but skewed towards alkalinity. Besides agro-climatic conditions, the size of landholding and farmer education showed a significant association with Soil Fertility Index (SFI), a composite index calculated using the aforementioned parameters’ normalized weightage. All the four stakeholder groups cited the current cropping patterns, burning of rice crop residue, and imbalanced use of chemical fertilizers for change in soil health. However, the current state of soil health in Punjab is unclear, which needs further investigation based on temporal data collected from the same field to see the short and long-term impacts of various crop combinations and varied cropping intensity levels on soil health.

Keywords: soil health, punjab agriculture, sustainability, soil fertility index

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Authors: Shah Fahad

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Managing the Urban Heat Island (UHI) effects is a pressing concern for achieving sustainable urban development and ensuring thermal comfort in major cities of developing nations, such as Lahore, Pakistan. The current UHI effect is mostly triggered by climate change and rapid urbanization. This study explored UHI over the Lahore district and its adjoining urban and rural-urban fringe areas. Landsat satellite data was utilized to investigate spatiotemporal patterns of Land Use and Land Cover changes (LULC), Land Surface Temperature (LST), UHI, Normalized Difference Built-up Index (NDBI), Normalized Difference Vegetation Index (NDVI), and Urban Thermal Field Variance Index (UTFVI). The built-up area increased very fast, with a coverage of 22.99% in 2000, 36.06% in 2010, and 47.17% in 2020, while vegetation covered 53.21 % in 2000 and 46.16 % in 2020. It also revealed a significant increase in the mean LST, from 33°C in 2000 to 34.8°C in 2020. The results indicated a significantly positive correlation between LST and NDBI, a weak correlation was also observed between LST and NDVI. The study used scatterplots to show the correlation between NDBI and NDVI with LST, results revealed that the NDBI and LST had an R² value of 0.6831 in 2000 and 0.06541 in 2022, while NDVI and LST had an R² value of 0.0235 in 1998 and 0.0295 in 2022. Proper environmental planning is vital in specific locations to enhance quality of life, protect the ecosystem, and mitigate climate change impacts.

Keywords: land use land cover, spatio-temporal analysis, remote sensing, land surface temperature, urban heat island, lahore pakistan

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Authors: Eheneden Iyobosa, Rongchang Wang, Adesina Odunayo Blessing, Gaoxiang Chen, Haijing Ren, Jianfu Zhao

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In the treatment of ammonium-rich wastewater with 500 μg/L sulfamethoxazole (SMX) antibiotic by a Microalgae-Bacteria Consortium, diverse parameters were monitored to assess treatment efficacy. Over 14 days, residual SMX concentrations decreased markedly from 500 μg/L to 45.6 μg/L, and removal rates declined from 102.4 to 9.9 μg/L/day. Biomass exhibited consistent growth, reaching a peak of 542.6 mg/L on day 10. Chlorophyll-a, chlorophyll-b, and carotenoid levels varied over time, reflecting fluctuations in microalgal activity. Extracellular polymeric substances (EPS) production showed temporal variations, with protein content ranging from 69.4 to 162.3 mg/g Dry cell weight (DCW) and polysaccharides content from 50.6 to 82.8 mg/g DCW. Ammonium nitrogen concentration decreased steadily from 300 mg/L to 5 mg/L throughout the treatment period. The bacterial community composition was significantly altered in the presence of antibiotics, with notable increases in Bacteroidota and Proteobacteria. Community richness and diversity indices were higher in the antibiotics-treated group than in the control group, as evidenced by the Chao index (258 compared to 181), Shannon index (1.8085 compared to 1.1545), and Simpson index (0.5032 compared to 0.6478), indicating notable shifts in microbial community structure. These findings demonstrate the efficacy of the Microalgae-Bacteria Consortium in removing SMX from wastewater and suggest its potential to mitigate antibiotic pollution while maintaining microbial diversity.

Keywords: ammonium-rich wastewater, microalgae-bacteria consortium, sulfamethoxazole removal, microbial community diversity, biomass growth

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Authors: Maria Miranda-Medina, Sara Salopek, Andras Vernes, Martin Jech

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Sliding lubricated surfaces induce the formation of tribofilms that reduce friction, wear and prevent large-scale damage of contact parts. Engine oils and lubricants use antiwear and antioxidant additives such as zinc dialkyldithiophosphate (ZDDP) from where protective tribofilms are formed by degradation. The ZDDP tribofilms are described as a two-layer structure composed of inorganic polymer material. On the top surface, the long chain polyphosphate is a zinc phosphate and in the bulk, the short chain polyphosphate is a mixed Fe/Zn phosphate with a gradient concentration. The polyphosphate chains are partially adherent to steel surface through a sulfide and work as anti-wear pads. In this contribution, ZDDP tribofilms formed on gray cast iron surfaces are studied. The tribofilms were generated in a reciprocating sliding tribometer with a piston ring-cylinder liner configuration. Fully formulated oil of SAE grade 5W-30 was used as lubricant during two tests at 40Hz and 50Hz. For the estimation of the tribofilm thicknesses, spectroscopic ellipsometry was used due to its high accuracy and non-destructive nature. Ellipsometry works under an optical principle where the change in polarisation of light reflected by the surface, is associated with the refractive index of the surface material or to the thickness of the layer deposited on top. Ellipsometrical responses derived from tribofilms are modelled by effective medium approximation (EMA), which includes the refractive index of involved materials, homogeneity of the film and thickness. The materials composition was obtained from x-ray photoelectron spectroscopic studies, where the presence of ZDDP, O and C was confirmed. From EMA models it was concluded that tribofilms formed at 40 Hz are thicker and more homogeneous than the ones formed at 50 Hz. In addition, the refractive index of each material is mixed to derive an effective refractive index that describes the optical composition of the tribofilm and exhibits a maximum response in the UV range, being a characteristic of glassy semitransparent films.

Keywords: effective medium approximation, reciprocating sliding tribometer, spectroscopic ellipsometry, zinc dialkyldithiophosphate

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Authors: Kyoungwoo Park, Gil Dong Kim, Seong Joon Moon, Ho Kil Lee

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The Urea-SCR is one of the most efficient technologies to reduce NOx emissions in diesel engines. In the present work, the computational prediction of internal flow and spray characteristics in the Urea-SCR system was carried out by using 3D-CFD simulation to evaluate NH3 uniformity index (NH3 UI) and its activation time according to the official New European Driving Cycle (NEDC). The number of nozzle and its diameter, two types of injection directions, and penetration length were chosen as the design variables. The optimal solutions were obtained by coupling the CFD analysis with Taguchi method. The L16 orthogonal array and small-the-better characteristics of the Taguchi method were used, and the optimal values were confirmed to be valid with 95% confidence and 5% significance level through analysis of variance (ANOVA). The results show that the optimal solutions for the NH3 UI and activation time (NH3 UI 0.22) are obtained by 0.41 and 0,125 second, respectively, and their values are improved by 85.0% and 10.7%, respectively, compared with those of the base model.

Keywords: computational fluid dynamics, NH3 uniformity index, optimization, Taguchi method, Urea-SCR system, UWS injector

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Authors: Mustafa M. Donma, Orkide Donma

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A well-defined insulin resistance (IR) is one of the requirements for the good understanding and evaluation of metabolic syndrome (MetS). However, underlying causes for the development of IR are not clear. Endothelial dysfunction also participates in the pathogenesis of this disease. IR indices are being determined in various obesity groups and also in diagnosing MetS. Components of MetS have been well established and used in adult studies. However, there are some ambiguities particularly in the field of pediatrics. The aims of this study were to compare the performance of fasting blood glucose (FBG), one of MetS components, with some other IR indices and check whether FBG may be replaced by some other parameter or ratio for a better evaluation of pediatric MetS. Five-hundred and forty-nine children were involved in the study. Five groups were constituted. Groups 109, 40, 100, 166, 110, 24 children were included in normal-body mass index (N-BMI), overweight (OW), obese (OB), morbid obese (MO), MetS with two components (MetS2) and MetS with three components (MetS3) groups, respectively. Age and sex-adjusted BMI percentiles tabulated by World Health Organization were used for the classification of obesity groups. MetS components were determined. Aside from one of the MetS components-FBG, eight measures of IR [homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of beta cell function (HOMA-%β), alanine transaminase-to-aspartate transaminase ratio (ALT/AST), alanine transaminase (ALT), insulin (INS), insulin-to-FBG ratio (INS/FBG), the product of fasting triglyceride and glucose (TyG) index, McAuley index] were evaluated. Statistical analyses were performed. A p value less than 0.05 was accepted as the statistically significance degree. Mean values for BMI of the groups were 15.7 kg/m², 21.0 kg/m², 24.7 kg/m², 27.1 kg/m², 28.7 kg/m², 30.4 kg/m² for N-BMI, OW, OB, MO, MetS2, MetS3, respectively. Differences between the groups were significant (p < 0.001). The only exception was MetS2-MetS3 couple, in spite of an increase detected in MetS3 group. Waist-to-hip circumference ratios significantly differed only for N-BMI vs, OB, MO, MetS2; OW vs MO; OB vs MO, MetS2 couples. ALT and ALT/AST did not differ significantly among MO-MetS2-MetS3. HOMA-%β differed only between MO and MetS2. INS/FBG, McAuley index and TyG were not significant between MetS2 and MetS3. HOMA-IR and FBG were not significant between MO and MetS2. INS was the only parameter, which showed statistically significant differences between MO-MetS2, MO-MetS3, and MetS2-MetS3. In conclusion, these findings have suggested that FBG presently considered as one of the five MetS components, may be replaced by INS during the evaluation of pediatric morbid obesity and MetS.

Keywords: children, insulin resistance indices, metabolic syndrome, obesity

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Authors: Orkide Donma, Mustafa M. Donma

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Association between insulin resistance (IR) and hematological parameters has long been a matter of interest. Within this context, body mass index (BMI), red blood cells, white blood cells and platelets were involved in this discussion. Parameters related to platelets associated with IR may be useful indicators for the identification of IR. Platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) are being questioned for their possible association with IR. The aim of this study was to investigate the association between platelet (PLT) count as well as PLT indices and the surrogate indices used to determine IR in morbid obese (MO) children. A total of 167 children participated in the study. Three groups were constituted. The number of cases was 34, 97 and 36 children in the normal BMI, MO and metabolic syndrome (MetS) groups, respectively. Sex- and age-dependent BMI-based percentile tables prepared by World Health Organization were used for the definition of morbid obesity. MetS criteria were determined. BMI values, homeostatic model assessment for IR (HOMA-IR), alanine transaminase-to-aspartate transaminase ratio (ALT/AST) and diagnostic obesity notation model assessment laboratory (DONMA-lab) index values were computed. PLT count and indices were analyzed using automated hematology analyzer. Data were collected for statistical analysis using SPSS for Windows. Arithmetic mean and standard deviation were calculated. Mean values of PLT-related parameters in both control and study groups were compared by one-way ANOVA followed by Tukey post hoc tests to determine whether a significant difference exists among the groups. The correlation analyses between PLT as well as IR indices were performed. Statistically significant difference was accepted as p-value < 0.05. Increased values were detected for PLT (p < 0.01) and PCT (p > 0.05) in MO group compared to those observed in children with N-BMI. Significant increases for PLT (p < 0.01) and PCT (p < 0.05) were observed in MetS group in comparison with the values obtained in children with N-BMI (p < 0.01). Significantly lower MPV and PDW values were obtained in MO group compared to the control group (p < 0.01). HOMA-IR (p < 0.05), DONMA-lab index (p < 0.001) and ALT/AST (p < 0.001) values in MO and MetS groups were significantly increased compared to the N-BMI group. On the other hand, DONMA-lab index values also differed between MO and MetS groups (p < 0.001). In the MO group, PLT was negatively correlated with MPV and PDW values. These correlations were not observed in the N-BMI group. None of the IR indices exhibited a correlation with PLT and PLT indices in the N-BMI group. HOMA-IR showed significant correlations both with PLT and PCT in the MO group. All of the three IR indices were well-correlated with each other in all groups. These findings point out the missing link between IR and PLT activation. In conclusion, PLT and PCT may be related to IR in addition to their identities as hemostasis markers during morbid obesity. Our findings have suggested that DONMA-lab index appears as the best surrogate marker for IR due to its discriminative feature between morbid obesity and MetS.

Keywords: children, insulin resistance, metabolic syndrome, plateletcrit, platelet indices

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Authors: Mariana Floria, Elena-Diana Năfureanu, Diana-Mihaela Gălăţanu, Anca-Ecaterina Grumeza, Cristina Gorea-Bocîncă, Diana-Elena Iov, Aurelian-Corneliu Moraru, Dragoș-Marian Popescu

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SARS-CoV-2 is the most deadly and devastating virus of the last one hundred years, being more highly contagious than EBOLA, HIV, Swine Influenza, Severe Acute Respiratory Syndrome, or Middle Eastern Respiratory Syndrome. After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. The aim of this study was to analyze the costs for hospital stay in patients with predominantly moderate forms of COVID-19 in a support military hospital located in Nord-East of Romania. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes (DRG payment), in a Covid-19 support military hospital were analyzed. From August 2020 through June 2021, 241 patientswere hospitalized. Our national protocol for the treatment of Covid-19 infection was applied. The main COVID-19 manifestations were: 69% respiratory (18% with severe pneumonia, 2.9% with pulmonary embolism, diagnosed by angio-computed tomography), 3.3% cardiac, 28% digestive, and 33% psychiatric (most common anxiety) manifestations. According to COVID-19 severity, most of the patients had moderate (104 patients – 43%) and severe (50 patients - 21%) forms. Seven patients with severe form died because of multiple comorbidities, and 30 patients were transferred in hospitals with COVID-19 intensive care units.Only two patients have had procalcitonin>10 ng/mL (high probability of severe sepsis or septic shock), and 1 patient had moderate risk for septic shock (0.5 - 2 ng/mL). The average estimated costs were about 3000€/patient, without significantly differences depending on disease severity. Equipment costs were 2 times higher than for drugs and 4 times than for laboratory tests. In a Covid-19 support military hospital that took care for predominantly moderate forms of COVID-19, the costs for equipment were much higher than that for treatment. Therefore, new criteria for hospitalization of these forms of COVID-19 deserve to be analyzed to avoid useless costs.

Keywords: Covid-19, costs, hospital stay, military hospital

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Authors: Ilirjan Malollari, Redi Buzo, Lorina Lici

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This study was done for the characterization of polyphenols changes of anthocyanins, flavonoids, the color intensity and total polyphenols index, maturity and oxidation index during the process of micro-oxygenation of wine that comes from a specific geographic area in the southeastern region of the country. Also, through mathematical modeling of the oxygen distribution within solution of wort for wine fermentation, was shown the strong impact of carbon dioxide present in the liquor. Analytical results show periodic increases of color intensity and tonality, reduction level of free anthocyanins and flavonoids free because of polycondensation reactions between tannins and anthocyanins, increased total polyphenols index and decrease the ratio between the flavonoids and anthocyanins offering a red stabilize wine proved by sensory degustation tasting for color intensity, tonality, body, tannic perception, taste and remained back taste which comes by specific area associated with environmental indications. Micro-oxygenation of wine is a wine-making technique, which consists in the addition of small and controlled amounts of oxygen in the different stages of wine production but more efficiently after end of alcoholic fermentation. The objectives of the process include improved mouth feel (body and texture), color enhanced stability, increased oxidative stability, and decreased vegetative aroma during polyphenols changes process. A very important factor is polyphenolics organic grape composition strongly associated with the environment geographical specifics area in which it is grown the grape.

Keywords: micro oxygenation, polyphenols, environment, wine stability, diffusion modeling

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Authors: Kwaku Damoah

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The agricultural sector is characterized by continuous transformation, driven by factors such as demographic shifts, evolving consumer preferences, climate change, and migration trends. This dynamic environment presents complex challenges for key stakeholders including farmers, governments, and investors, who must navigate these changes to achieve optimal investment returns. To effectively predict market trends and uncover promising investment opportunities, a systematic, data-driven approach is essential. This paper introduces the Structural Evolution Index (SEI), a machine learning-based methodology. SEI is specifically designed to analyse long-term trends and forecast the potential of emerging agricultural products for investment. Versatile in application, it evaluates various agricultural metrics such as production, yield, trade, land use, and consumption, providing a comprehensive view of the evolution within agricultural markets. By harnessing data from the UN Food and Agricultural Organisation (FAOSTAT), this study demonstrates the SEI's capabilities through Comparative Exploratory Analysis and evaluation of international trade in agricultural products, focusing on Malaysia and Singapore. The SEI methodology reveals intricate patterns and transitions within the agricultural sector, enabling stakeholders to strategically identify and capitalize on emerging markets. This predictive framework is a powerful tool for decision-makers, offering crucial insights that help anticipate market shifts and align investments with anticipated returns.

Keywords: agricultural investment, algorithm, comparative exploratory analytics, machine learning, market trends, predictive analytics, structural evolution index

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Authors: Chiahsu Yang, Peiling Wu, Ted Ho

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From emphasizing economic development to stressing public happiness, the international community mainly hopes to be able to understand whether the quality of life for the public is becoming better. The Better Life Index (BLI) constructed by OECD uses living conditions and quality of life as starting points to cover 11 areas of life and to convey the state of the general public’s well-being. In light of the BLI framework, the Directorate General of Budget, Accounting and Statistics (DGBAS) of the Executive Yuan instituted the Gross National Happiness Index to understand the needs of the general public and to measure the progress of the aforementioned conditions in residents across the island. Whereas living conditions consist of income and wealth, jobs and earnings, and housing conditions, health status, work and life balance, education and skills, social connections, civic engagement and governance, environmental quality, personal security. The ICT area consists of health care, living environment, ICT-enabled communication, transportation, government, education, pleasure, purchasing, job & employment. In the wake of further science and technology development, rapid formation of information societies, and closer integration between lifestyles and information societies, the public’s well-being within information societies has indeed become a noteworthy topic. the Board of Science and Technology of the Executive Yuan use the OECD’s BLI as a reference in the establishment of the Taiwan-specific ICT-Enabled Better Life Index. Using this index, the government plans to examine whether the public’s quality of life is improving as well as measure the public’s satisfaction with current digital quality of life. This understanding will enable the government to gauge the degree of influence and impact that each dimension of digital services has on digital life happiness while also serving as an important reference for promoting digital service development. The content of the ICT Enabled Better Life Index. Information and communications technology (ICT) has been affecting people’s living styles, and further impact people’s quality of life (QoL). Even studies have shown that ICT access and usage have both positive and negative impact on life satisfaction and well-beings, many governments continue to invest in e-government programs to initiate their path to information society. This research is the few attempts to link the e-government benchmark to the subjective well-being perception, and further address the gap between user’s perception and existing hard data assessment, then propose a model to trace measurement results back to the original public policy in order for policy makers to justify their future proposals.

Keywords: information and communications technology, quality of life, satisfaction, well-being

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Authors: B. Prashantha, S. Anish

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The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.

Keywords: atherosclerotic plaque, oscillatory shear index, stenosis nature, wall shear stress

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Authors: Sara Alzahrani, Samia Bokari, Patan Khan, Muneera Alshareef, Rania Safwat, Mohammed Galal, Hamdi Alqadi, Ameerah Alzahrani, Rehab Alboraie

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Introduction & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized .Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated via Microsoft Excel tool. Mortality rates were calculated by percentages. The results monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study. Financial saving come from rapid turnover of beds. The mortality was 2.5 % compared to reported 7.3% in a major study, reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.

Keywords: diabetes, covid-19, management, mortality

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Authors: Hamed Abshari, M. Reza Emami Azadi, Madjid Sadegh Azar

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For studying the overall instability of members of steel structures, there are several methods in which overall buckling and geometrical imperfection effects are considered in analysis. In first section, these methods are compared and ability of software to apply these methods is studied. Buckling loads determined from theoretical methods and software is compared for 2D one bay, one and two stories steel frames. To consider actual condition, buckling loads of three steel frames that have various dimensions are calculated and compared. Also, uncertainties that exist in loading and modeling of structures such as geometrical imperfection, yield stress, and modulus of elasticity in buckling load of 2D framed steel structures have been studied. By performing these uncertainties to each reliability analysis procedures (first-order, second-order, and simulation methods of reliability), one index of reliability from each procedure is determined. These values are studied and compared.

Keywords: buckling, second-order theory, reliability index, steel columns

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Authors: Rachmat Mauludin, Dita Sasri Primaviri, Irda Fidrianny

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Propolis contains several antioxidant compounds which can be used in topical application to protect skin against free radical, prevent skin cancer and skin aging. Previous study showed that 70% ethanolic extract of propolis (EEP) provided the greatest antioxidant activity. Since EEP has very small solubility in water, the extract was prepared in nanoemulsion (NE). Nanoemulsion is chosen as cosmetic dosage forms according to its properties namely to decrease the risk of skin’s irritation, increase penetration, prolong its time to remain in our skin, and improve stability. Propolis was extracted using reflux methods and concentrated using rotavapor. EEP was characterized with several tests such as phytochemical screening, density, and antioxidant activity using DPPH method. Optimation of total surfactant, co-surfactant, oil, and amount of EEP that can be included in NE were required to get the best NE formulation. The evaluations included to organoleptic observation, globul size, polydispersity index, morphology using TEM, viscosity, pH, centrifuge, stability, Freeze and Thaw test, radical scavenging activity using DPPH method, and primary irritation test. The yield extracts was 11.12% from raw propolis contained of steroid/triterpenoid, flavonoid, and saponin based on phytochemical screening. EEP had the value of DPPH scavenging activity 61.14% and IC50 0.41629 ppm. The best NE formulation consisted of 26.25% Kolliphor RH40; 8.75% glycerine; 5% rice bran oil; and 3% EEP. NE was transparant, had globul size of 21.9 nm; polydispersity index of 0.338; and pH of 5.67. Based on TEM morphology, NE was almost spherical and has particle size below 50 nm. NE propolis revealed to be physically stable after stability test within 63 days at 25oC, centrifuged for 30 mins at 13.000 rpm, and passed 6 cycles of Freeze and Thaw test without separated. NE propolis reduced 58% of free radical DPPH similar to antioxidant activity of the original extracts. Antioxidant activity of NE propolis is relatively stable after stored for 6 weeks. NE Propolis was proven to be safe by primary irritation test with the value of primary irritation index (OECD) was 0. The best formulation for NE propolis contained of 26.25% Kolliphor RH40; 8.75% glycerine; 5% rice bran oil; and 3% EEP with globul size of 21.9 nm and polydispersity index of 0.338. NE propolis was stable and had antioxidant activity similar to EEP.

Keywords: propolis, antioxidant, nanoemulsion, irritation test

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Authors: Hilal Keklicek, Fatih Erbahceci, Elif Kirdi, Ali Yalcin, Semra Topuz, Ozlem Ulger, Gul Sener

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Objectives and Goals: The stride-to-stride fluctuations in gait is a determinant of qualified locomotion as known as gait variability. Gait variability is an important predictive factor of fall risk and useful for monitoring the effects of therapeutic interventions and rehabilitation. Comparison of gait variability in individuals with trans-tibial lower limb loss and trans femoral lower limb loss was the aim of the study. Methods: Ten individuals with traumatic unilateral trans femoral limb loss(TF), 12 individuals with traumatic transtibial lower limb loss(TT) and 12 healthy individuals(HI) were the participants of the study. All participants were evaluated with treadmill. Gait characteristics including mean step length, step length variability, ambulation index, time on each foot of participants were evaluated with treadmill. Participants were walked at their preferred speed for six minutes. Data from 4th minutes to 6th minutes were selected for statistical analyses to eliminate learning effect. Results: There were differences between the groups in intact limb step length variation, time on each foot, ambulation index and mean age (p < .05) according to the Kruskal Wallis Test. Pairwise analyses showed that there were differences between the TT and TF in residual limb variation (p=.041), time on intact foot (p=.024), time on prosthetic foot(p=.024), ambulation index(p = .003) in favor of TT group. There were differences between the TT and HI group in intact limb variation (p = .002), time on intact foot (p<.001), time on prosthetic foot (p < .001), ambulation index result (p < .001) in favor of HI group. There were differences between the TF and HI group in intact limb variation (p = .001), time on intact foot (p=.01) ambulation index result (p < .001) in favor of HI group. There was difference between the groups in mean age result from HI group were younger (p < .05).There were similarity between the groups in step lengths (p>.05) and time of prosthesis using in individuals with lower limb loss (p > .05). Conclusions: The pilot study provided basic data about gait stability in individuals with traumatic lower limb loss. Results of the study showed that to evaluate the gait differences between in different amputation level, long-range gait analyses methods may be useful to get more valuable information. On the other hand, similarity in step length may be resulted from effective prosthetic using or effective gait rehabilitation, in conclusion, all participants with lower limb loss were already trained. The differences between the TT and HI; TF and HI may be resulted from the age related features, therefore, age matched population in HI were recommended future studies. Increasing the number of participants and comparison of age-matched groups also recommended to generalize these result.

Keywords: lower limb loss, amputee, gait variability, gait analyses

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Authors: Teresa Smith, Farrah Jacquez

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Health-risk behaviors (e.g., smoking, poor diet) directly increase the risk for chronic disease and morbidity. There is substantial evidence of a negative association between socioeconomic status (SES) and engagement in health-risk behaviors. However, due to the complexity of SES, researchers have suggested looking beyond this factor to fully understand the mechanisms that underlie engagement in health-risk behaviors. Stress is one plausible mechanism through which SES impacts health-risk behaviors. Currently, it remains unclear how stress occurring across the life course might impact health behaviors and explain the association between SES and these behaviors. To address the gaps in the literature, 172 adults between the ages of 18-49 were surveyed about their lifetime stress exposure, sociodemographic variables, and health-risk behaviors via an online recruitment portal, Prolific. Five major findings emerged from the current study. First, SES was negatively associated with engagement in health-risk behaviors and lifetime stress above and beyond current stress and other relevant demographics. Second, lifetime stress was significantly associated with health-risk behaviors above and beyond current stress and relevant demographic variables. Third, lifetime stress fully mediated the association between SES and health-risk behaviors above and beyond current stress and other demographics. Fourth, the severity of stress experienced emerged as the most significant lifetime stress variable that explains the relation between SES and health-risk behaviors. Fifth and finally, lower SES and experiencing financial and legal/crime stressors increased the likelihood of engaging in health-risk behaviors. The current study results align with previous research and suggest that stress occurring over the lifespan impacts the relation between SES and health-risk behaviors, which are in turn known to impact health outcomes. However, our findings move the current literature forward by providing a more nuanced understanding of the specific aspects of stress that influence this association. Specifically, the severity of stress experienced across the entire lifespan was the most important aspect of stress when examining the association between SES and health-risk behaviors. Further, individuals most at risk for engaging in health-risk behaviors are those of the lowest SES and experience financial and legal/crime stressors. These findings have the potential to inform interventions and policies aimed at addressing health-risk behaviors by providing a more sophisticated understanding of the impact of stress.

Keywords: stress, health behaviors, socioeconomic status, health

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Authors: Roger L. Goodwin

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The US Consumer Price Indices (CPIs) measures hundreds of items in the US economy. Many social programs and government benefits index to the CPIs. In mid to late 1990, much research went into changes to the CPI by a Congressional Advisory Committee. One thing can be said from the research is that, aside from there are alternative estimators for the CPI; any fundamental change to the CPI will affect many government programs. The purpose of this project is to modernize an existing process. This paper will show the development of a small, visual, software product that documents the Economic Price Adjustment (EPA) for long-term contracts. The existing workbook does not provide the flexibility to calculate EPAs where the base-month and the option-month are different. Nor does the workbook provide automated error checking. The small, visual, software product provides the additional flexibility and error checking. This paper presents the feedback to project.

Keywords: Consumer Price Index, Economic Price Adjustment, contracts, visualization tools, database, reports, forms, event procedures

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Authors: Hamdy Khamis Korayem, Manal Yehia Tayel, Abeer Shawky El Hadedy, Emmanuel Kamal Aziz Saba, Shimaa Badr Abdelnaby Badr

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The aim of the current study was to demonstrate whether serum Interleukin-18 (IL-18) is increased in rheumatoid arthritis (RA) and its correlation with disease activity, functional disability and quality of life in RA patients. The study included 30 RA patients and 20 healthy normal control subjects. The RA patients were diagnosed according to the 2010 ACR/EULAR classification criteria for RA with the exclusion of those who had diabetes mellitus, endocrine disorders, associated rheumatologic diseases, viral hepatitis B or C and other diseases with increased serum IL-18 level. All patients were subjected to clinical evaluation of the musculoskeletal system. Disease activity was assessed by disease activity score 28 with 4 variables (DAS 28). Functional disability was assessed by health assessment questionnaire disability index (HAQ-DI). The quality of life was assessed by Short form-36 (SF-36) questionnaire. Radiological assessment of both hands and feet by Sharp/van der Heijde (SvH) scoring method. Laboratory parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were assessed in patients and serum level of IL-18 in both patients and control subjects. There was no statistically significant difference between patient and control group as regards age and sex. Among patients, 29 % were females and the age range was between 25 to 55 years. Extra-articular manifestations were presented in 56.7% of the patients. The mean of DAS 28 score was 5.73±1.46 and that of HAQ-DI was 1.22±0.72 while that of SF-36 was 40.03±13.96. The level of serum IL-18 was significantly higher in patients than in the control subjects (P= 0.030). Serum IL-18 was correlated with ACPA among the patient group. There were no statistically significant correlations between serum IL-18 and DAS28, HAQ-DI, SF-36, total SvH score and the other laboratory results. In conclusion, IL-18 is significantly higher in RA patient than in healthy control subjects and positively correlated with ACPA level. IL-18 is associated with extra-articular manifestations. However, it is not correlated with other laboratory parameters, disease activity, functional disability, quality of life nor radiological severity.

Keywords: disease activity score, Interleukin-18, quality of life assessment, rheumatoid arthritis

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Authors: Isabel Lopez-Oliva, Akshay Paropkari, Shweta Saraswat, Stefan Serban, Paola de Pablo, Karim Raza, Andrew Filer, Iain Chapple, Thomas Dietrich, Melissa Grant, Purnima Kumar

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Objective: We aimed to explicate the role of the subgingival microbiome in the causal link between rheumatoid arthritis (RA) and periodontitis (PD). Methods: Subjects with/without RA and with/without PD were randomized for treatment with scaling and root planing (SRP) or oral hygiene instructions. Subgingival biofilm, gingival crevicular fluid, and serum were collected at baseline and at 3- and 6-months post-operatively. Correlations were generated between 72 million 16S rDNA sequences, immuno-inflammatory mediators, circulating antibodies to oral microbial antigens, serum inflammatory molecules, and clinical metrics of RA. The dynamics of inter-microbial and host-microbial interactions were modeled using differential network analysis. Results: RA superseded periodontitis as a determinant of microbial composition, and DAS28 score superseded the severity of periodontitis as a driver of microbial assemblages (p=0.001, ANOSIM). RA subjects evidenced higher serum anti-PPAD (p=0.0013), anti-Pg-enolase (p=0.0031), anti-RPP3, anti- Pg-OMP and anti- Pi-OMP (p=0.001) antibodies than non-RA controls (with and without periodontitis). Following SRP, bacterial networks anchored by IL-1b, IL-4, IL-6, IL-10, IL-13, MIP-1b, and PDGF-b underwent ≥5-fold higher rewiring; and serum antibodies to microbial antigens decreased significantly. Conclusions: Our data suggest a circular relationship between RA and PD, beginning with an RA-influenced dysbiosis within the healthy subgingival microbiome that leads to exaggerated local inflammation in periodontitis and circulating antibodies to periodontal pathogens and positive correlation between severity of periodontitis and RA activity. Periodontal therapy restores host-microbial homeostasis, reduces local inflammation, and decreases circulating microbial antigens. Our data highlights the importance of integrating periodontal care into the management of RA patients.

Keywords: rheumatoid arthritis, periodontal, subgingival, DNA sequence analysis, oral microbiome

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Authors: Atif Naim, Faisal E. Ahmed, Sershen

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A field experiment was conducted for two consecutive winter seasons at the Demonstration Farm of the Faculty of Agriculture, University of Khartoum, Sudan, to study effects of different levels of irrigation regime and plant density on yield of introduced small seeded (desi type) chickpea cultivar (ILC 482). The experiment was laid out in a 3X3 factorial split-plot design with 4 replications. The treatments consisted of three irrigation regimes (designated as follows: I1 = optimum irrigation, I2 = moderate stress and I3 = severe stress; this corresponded with irrigation after drainage of 50%, 75% and 100% of available water based on 70%, 60% and 50% of field capacity, respectively) assigned as main plots and three plant densities (D₁=20, D₂= 40 and D₃= 60 plants/m²) assigned as subplots. The results indicated that the yield components (number of pods per plant, number of seeds per pod, 100 seed weight), seed yield per plant, harvest index and yield per unit area of chickpea were significantly (p < 0.05) affected by irrigation regime. Decreasing irrigation regime significantly (p < 0.05) decreased all measured parameters. Alternatively, increasing plant density significantly (p < 0.05) decreased the number of pods and seed yield per plant and increased seed yield per unit area. While number of seeds per pod and harvest index were not significantly (p > 0.05) affected by plant density. Interaction between irrigation regime and plant density was also significantly (p < 0.05) affected all measured parameters of yield, except for harvest index. It could be concluded that the best irrigation regime was full irrigation (after drainage of 50% available water at 70% field capacity) and the optimal plant density was 20 plants/m² under conditions of semi-arid regions.

Keywords: irrigation regime, Cicer arietinum, chickpea, plant density

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Authors: Xiaohua Zhu, Lingling Ma, Yongguang Zhao

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Leaf Area Index (LAI) is a key structural characteristic of crops and plays a significant role in precision agricultural management and farmland ecosystem modeling. However, LAI retrieved from different resolution data contain a scaling bias due to the spatial heterogeneity and model non-linearity, that is, there is scale effect during multi-scale LAI estimate. In this article, a typical farmland in semi-arid regions of Chinese Inner Mongolia is taken as the study area, based on the combination of PROSPECT model and SAIL model, a multiple dimensional Look-Up-Table (LUT) is generated for multiple crops LAI estimation from unmanned aerial vehicle (UAV) hyperspectral data. Based on Taylor expansion method and computational geometry model, a scale transfer model considering both difference between inter- and intra-class is constructed for scale effect analysis of LAI inversion over inhomogeneous surface. The results indicate that, (1) the LUT method based on classification and parameter sensitive analysis is useful for LAI retrieval of corn, potato, sunflower and melon on the typical farmland, with correlation coefficient R2 of 0.82 and root mean square error RMSE of 0.43m2/m-2. (2) The scale effect of LAI is becoming obvious with the decrease of image resolution, and maximum scale bias is more than 45%. (3) The scale effect of inter-classes is higher than that of intra-class, which can be corrected efficiently by the scale transfer model established based Taylor expansion and Computational geometry. After corrected, the maximum scale bias can be reduced to 1.2%.

Keywords: leaf area index (LAI), scale effect, UAV-based hyperspectral data, look-up-table (LUT), remote sensing

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Authors: Yessenia Parrado, Ana Barbosa, Daniela Mahe, Sebastian Toro, Jhon Garcia

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The purpose of this work is to present the identification and characterization of the barriers and enablers to public innovation in the Central Region of Colombia from a mixed methodology in a research carried out in 2020 by the Laboratory of Innovation, Creativity and New Technologies of the National University of Colombia in alliance with the National Planning Department. Based on the research, the index of barriers to regional and departmental public innovation was built, which reflects the level of difficulty of the territorial entities to overcome the barriers present around three dimensions: organizational structure of the entity, generation of public value, and governance processes. The index was built from the item response methodology and the multiple correspondence analysis from the application of an institutional information form for public entities and a perception form for public servants. This investigation had the participation of 36 entities and 1038 servers and servants from the departments of Huila, Meta, Boyacá, Cundinamarca, Tolima, and the Capital District. In this exercise, it was identified that the departmental indices range between 13 and 44 and that the regional index was 30 out of 100. From the analysis of the information, it was possible to establish that the main barriers are the lack of specialized agencies for public innovation exercises, lack of qualified personnel and work methodologies for public innovation, inadequate information management, lack of feedback between the learning from governmental and non-governmental entities, the inability of the initiatives to generate binding participation mechanisms and the lack of qualification of citizens to participate in these processes.

Keywords: item response, public innovation, quantitative analysis, compared analysis

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Authors: Mario Belseran

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The issue of climate change become world attention where one of them increase in air temperature due to greenhouse gas emissions. This climate change is caused by gases in the atmosphere, one of which is CO2. DKI Jakarta as the capital has a dense population with a variety of existing land use. Land use that is dominated by settlements resulting in fewer green space, which functions to absorb atmospheric CO2. Image interpretation SPOT-7 is used to determine the greenness level of vegetation on a green space using the vegetation index NDVI, EVI, GNDVI and OSAVI. Measuring the diameter and height of trees were also performed to obtain the value of biomass that will be used as the CO2 absorption value. The CO2 absorption value that spread in Jakarta are classified into three classes: high, medium, and low. The distribution pattern of CO2 absorption value at green space in Jakarta dominance in the medium class with the distribution pattern is located in South Jakarta, East Jakarta, North Jakarta and West Jakarta. The distribution pattern of green space in Jakarta scattered randomly and more dominate in East Jakarta and South Jakarta

Keywords: carbon dioxide, DKI Jakarta, green space, SPOT-7, vegetation index

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Authors: C. Chhorn, S. H. Han, S. W. Lee

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Roller-compacted concrete (RCC) has been used for decades in many pavement applications due to its economic cost and high construction speed. However, due to the lack of deep researches and experiences, this material has not been widely employed. An RCC mixture with appropriate consistency can induce high compacted density, while high density can induce good aggregate interlock and high strength. Consistency of RCC is mainly known to define its constructability. However, it was not well specified how this property may affect other properties of a constructed RCC pavement (RCCP). This study suggested the possibility of an ideal range of consistency that may provide adequate quality of RCCP. In this research, five sections of RCCP consisted of both 13 mm and 19 mm aggregate sections were investigated. The effects of consistency on compacted depth, strength, international roughness index (IRI), skid resistance are examined. From this study, a new range of consistency is suggested for RCCP application.

Keywords: compacted depth, consistency, international roughness index (IRI), pavement, roller-compacted concrete (RCC), skid resistance, strength

Procedia PDF Downloads 238

Authors: Asma Chbani, Douaa Salim, Josephine Al Alam, Pascale De Caro

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Penicillium digitatum, the causal agent of citrus green mold, is responsible for 90% of post-harvest losses. Chemical fungicides remain the most used products for protection against this pathogen but are also responsible for damage to human health and the environment. The aim of this study is to evaluate the ability of Spinacia oleracea extract to serve as biological control agents, an alternative to harmful synthetic fungicides, against orange decay for storing fruit caused by P. digitatum. In this study, we studied the implication of a crude extract of a green plant, Spinacia oleracea, in the protection of oranges against P. digitatum. Thus, in vivo antifungal tests as well as adhesion test were done. For in vivo antifungal test, oranges were pulverized with the prepared crude extracts at different concentrations ranged from 25 g L⁻¹ to 200 g L⁻¹, contaminated by the fungus and then observed during 8 weeks for their macroscopic changes at 24°C. For adhesion test, the adhesion index is defined as the number of Penicillium digitatum spores fixed per orange cell. An index greater than 25 is the indicator of a strong adhesion, whereas for an index less than 10, the adhesion is low. Ten orange cells were examined in triplicate for each extract, and the averages of adherent cells were calculated. Obtained results showed an inhibitory activity of the Penicillium development with the aqueous extract of dry Spinacia oleracea with a concentration of 50 g L⁻¹ considered as the minimal protective concentration. The prepared extracts showed a greater inhibition of the development of P. digitatum up to 10 weeks, even greater than the fungicide control Nystatin. Adhesion test’s results showed that the adhesion of P. digitatum spores to the epidermal cells of oranges in the presence of the crude spinach leaves extract is weak; the mean of the obtained adhesion index was estimated to 2.7. However, a high adhesion was observed with water used a negative control. In conclusion, all these results confirm that the use of this green plant highly rich in chlorophyll having several phytotherapeutic activities, could be employed as a great treatment for protection of oranges against mold and also as an alternative for chemical fungicides.

Keywords: Penicillium digitatum, Spinacia oleracea, oranges, biological control, postharvest diseases

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Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

Procedia PDF Downloads 118