Search results for: cooperative language learning

Authors: Li Hui, Riyadh Hindi

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In the United States, bridge construction often employs overhang brackets to support the deck overhang, the weight of fresh concrete, and loads from construction equipment. This approach, however, can lead to significant torsional moments on the exterior girders, potentially causing excessive girder rotation. Such rotations can result in various safety and maintenance issues, including thinning of the deck, reduced concrete cover, and cracking during service. Traditionally, these issues are addressed by installing temporary lateral bracing systems and conducting comprehensive torsional analysis through detailed finite element analysis for the construction of bridge deck overhang. However, this process is often intricate and time-intensive, with the spacing between temporary lateral bracing systems usually relying on the field engineers’ expertise. In this study, a deep neural network model is introduced to limit exterior girder rotation during bridge deck construction. The model predicts the optimal spacing between temporary bracing systems. To train this model, over 10,000 finite element models were generated in SAP2000, incorporating varying parameters such as girder dimensions, span length, and types and spacing of lateral bracing systems. The findings demonstrate that the deep neural network provides an effective and efficient alternative for limiting the exterior girder rotation for bridge deck construction. By reducing dependence on extensive finite element analyses, this approach stands out as a significant advancement in improving safety and maintenance effectiveness in the construction of bridge decks.

Keywords: bridge deck construction, exterior girder rotation, deep learning, finite element analysis

Procedia PDF Downloads 66

Authors: Fiona Armstrong, David Gaul, Michael Barrett, Lorraine D'Arcy

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Playing is an instinctive and universal human behavior, is a child’s way of learning and an outlet for their innate need of activity. Risky play can be defined as any play that is thrilling or exciting involving the risk of injury. The benefits of risky play have been acknowledged as helping children to explore and conquer fears, develop confidence, reduce anxiety, and develop risk-management skills. Studies indicate that children learn sound judgment by assessing and confronting risks in relation to their own capabilities through exposure to carefully managed play experiences. Risky play has been associated with danger and increased risk of injury, with families focusing on risk aversion and protecting children from the risks inherent in the modern world. Despite children needing cultural, social, emotional, physical, and geographical space to play, the opportunity for children to play is diminishing. Aim: This study explores play behaviors and risky play in an Irish context by investigating parental attitudes to risky play. Methodology: This is a mixed methods study involving the State of Play survey and semi-structured interviews exploring parental attitudes to risky play. Data will be quantitatively analyzed using descriptive and inferential statistics using IBM SPSS and qualitatively analyzed via thematic analysis using NVivo. Conclusion: The information gathered could advise stakeholders regarding the creation and provision of developmentally appropriate, challenging, stimulating, adaptable, accessible, and safe as necessary outdoor play areas. This research can inform parents, planners, architects, and authorities involved in creating environments for play and contribute to policy development.

Keywords: child development, parental attitudes, play opportunities, risky play

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Authors: Van-Thanh Ho, Jaiyoung Ryu

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In soft robotics, the optimization of fluid dynamics through pneumatic methods plays a pivotal role in enhancing operational efficiency and reducing energy loss. This is particularly crucial when replacing conventional techniques such as cable-driven electromechanical systems. The pneumatic model employed in this study represents a sophisticated framework designed to efficiently channel pressure from a high-pressure reservoir to various muscle locations on the robot's body. This intricate network involves a branching system of tubes. The study introduces a comprehensive pneumatic model, encompassing the components of a reservoir, tubes, and Pneumatically Actuated Muscles (PAM). The development of this model is rooted in the principles of shock tube theory. Notably, the study leverages experimental data to enhance the understanding of the interplay between the PAM structure and the surrounding fluid. This improved interactive approach involves the use of morphing motion, guided by a contraction function. The study's findings demonstrate a high degree of accuracy in predicting pressure distribution within the PAM. The model's predictive capabilities ensure that the error in comparison to experimental data remains below a threshold of 10%. Additionally, the research employs a machine learning model, specifically a surrogate model based on the Kriging method, to assess and quantify uncertainty factors related to the initial reservoir pressure and tube diameter. This comprehensive approach enhances our understanding of pneumatic soft robotics and its potential for improved operational efficiency.

Keywords: pneumatic artificial muscles, pressure drop, morhing motion, branched network, surrogate model

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Authors: Kamille Beye

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Critical thinking is a topic that has been disputed in the field of education for decades, but many resulting debates have centered around strengthening critical thinking capabilities in the societies, workforces, and educational centers of the global north. In contrast, this paper provides an analysis of the teaching of critical thinking in Liberia, which has been ravaged by years of war and a recent Ebola outbreak. These crises have decimated the Liberian education sector, leading to a loss of teaching capacities that are essential to providing critical thinking education. Until recently, critical thinking had no seat at the table when the future needs of the country were discussed by the government and non-governmental agencies. Now, the University of Liberia has a bold goal to become one of the top twenty universities in West Africa in the next seven years, which has led to a focus on teaching critical thinking skills to improve learning. This paper argues that critical thinking is essential to strengthening not only the Liberian education system, but for promoting peace amongst community members, and yet it suggests that commitments to the teaching of critical thinking in Liberia have hitherto been overly superficial. Based on an initial scoping study, this paper will examine the potential impacts of teaching critical thinking skills to undergraduate students in the William V. S. Tubman School of Education at the University of Liberia on continued peacebuilding and reconstruction efforts of the country. The research contends that if critical thinking skills are taught, practiced and continually utilized, teachers and students will have the ability to engage with information and negotiate challenges to solutions in ways that are beneficial to the communities in which they live. The research will use a variety of methods, that include the California Critical Thinking Disposition Inventory. This research will demonstrate that critical thinking skills are not only needed for entering the workforce, but necessary for negotiating and expressing the needs and desires of local communities in a peaceful way.

Keywords: critical thinking, higher education, Liberia, peacebuilding, post-conflict

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Authors: Wakkai Hosanna Hussaini

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A formal structure of the English clause is composed of at least two elements – subject and verb, in structural grammar and at least one element – predicate, in systemic (functional) and generative grammars. Each of the elements can be represented by a word or group (of words). In modern English structure, very often speakers merge two words as one with the use of an apostrophe. Each of the two words can come from different elements or belong to the same element. In either case, result of the merger is called contraction. Although contractions constitute a part of modern English structure, they are considered informal in nature (more frequently used in spoken than written English) that is why they were initially viewed as constituting an evidence of language deterioration. To our knowledge, no formal syntactic theory yet has been particular on the contractions because of its deviation from the formal rules of syntax that seek to identify the elements that form a clause in English. The inconsistency between the formal rules and a contraction is established when two words representing two elements in a non-contraction are merged as one element to form a contraction. Thus the paper presents the various syntactic issues as effects arising from converting non-contracted to contracted forms. It categorizes English contractions and describes each category according to its syntactic relations (position and relationship) and morphological formation (form and content) as integral part of modern structure of English. This is a position paper as such the methodology is observational, descriptive and explanatory/analytical based on existing related literature. The inventory of English contractions contained in books on syntax forms the data from where specific examples are drawn. It is noted as conclusion that the existing syntactic theories were not originally established to account for English contractions. The paper, when published, will further expose the inadequacies of the existing syntactic theories by giving more reasons for the establishment of a more comprehensive syntactic theory for analyzing English clause/sentence structure involving contractions. The method used reveals the extent of the inadequacies in applying the three major syntactic theories: structural, systemic (functional) and generative, on the English contractions. Although no theory is without scope, shying away from the three major theories from recognizing the English contractions need to be broken because of the increasing popularity of its use in modern English structure. The paper, therefore, recommends that as use of contraction gains more popular even in formal speeches today, there is need to establish a syntactic theory to handle its patterns of syntactic relations and morphological formation.

Keywords: application, effects, English contractions, syntactic theories

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Authors: Marini Kristina Situmeang, Siti Hazar Sitorus, Mukhammad Fatkhullah, Arfan Fadli

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This study aims to identify and explain how forms of treatment and community action include parents who have children with mental retardation while undergoing behavioral therapy that leads to habituation processes. Based on observations made there is inappropriate treatment such as labeling that child mental retardation is considered ‘crazy’ by some people in Aceh Besar region. Reflecting on the phenomenon of discriminatory treatment, the existence of children with mental retardation should be realized in concrete actions that can encourage the development of cognitive abilities, language, motor, and social, one of them through behavioral. The purpose of this research is to find out and explain how the social practices of children with mental retardation when undergoing behavioral therapy that leads to habituation process. This study focuses on families or parents who have children with mental retardation and do therapy of behavioral therapy at home or at physiotherapy clinics in Aceh Besar. The research method is qualitative with case study approach. Data collection techniques are conducted with in-depth interviews and Focus Group Discussion (FGD). The results showed that habituation process which is conducted by parents at home and in fisotherapy clinic have a positive effect on the development of children behavior of mental retardation, especially when dealing with the environment of the community around the residence. Habituation processes conducted through behavioral therapy practices are influenced by Habitus (Gestational and childcare at therapy) and Reinforcement (in this case family and social support). Habituation process is done in the form of habituation, the creation of the situation, and strengthening the character. For example, when a child's mental retardation commits a wrong act (disgraceful or inappropriate behavior) then the child gets punishment in accordance with the form of punishment in a normal child generally, and when he performs a good deed, then he is given a prize such as praise or a thing he likes. Through some of these actions, the child with mental retardation can behave in accordance with the character formed and expected by the community. The process of habituation done by parents accompanied by continuous support of physiotherapy can be one of the alternative booster of cognitive and social development of children mental retardation to then out of the ‘crazy’ label that has been given.

Keywords: behaviour therapy, habituation, habitus, mental retardation

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Authors: Dhruv Sharma, Lynne Blair, Stephen Clune

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Later life loneliness is a social issue that is increasing alongside an upward global population trend. As a society, one way that we have responded to this social challenge is through developing non-pharmacological interventions such as befriending services, activity clubs, meet-ups, etc. Through a systematic literature review, this paper suggests that currently there is an underrepresentation of radical innovation, and underutilization of digital technologies in developing loneliness interventions for older adults. This paper examines intervention studies that were published in English language, within peer reviewed journals between January 2005 and December 2014 across 4 electronic databases. In addition to academic databases, interventions found in grey literature in the form of websites, blogs, and Twitter were also included in the overall review. This approach yielded 129 interventions that were included in the study. A systematic approach allowed the minimization of any bias dictating the selection of interventions to study. A coding strategy based on a pattern analysis approach was devised to be able to compare and contrast the loneliness interventions. Firstly, interventions were categorized on the basis of their objective to identify whether they were preventative, supportive, or remedial in nature. Secondly, depending on their scope, they were categorized as one-to-one, community-based, or group based. It was also ascertained whether interventions represented an improvement, an incremental innovation, a major advance or a radical departure, in comparison to the most basic form of a loneliness intervention. Finally, interventions were also assessed on the basis of the extent to which they utilized digital technologies. Individual visualizations representing the four levels of coding were created for each intervention, followed by an aggregated visual to facilitate analysis. To keep the inquiry within scope and to present a coherent view of the findings, the analysis was primarily concerned the level of innovation, and the use of digital technologies. This analysis highlights a weak but positive correlation between the level of innovation and the use of digital technologies in designing and deploying loneliness interventions, and also emphasizes how certain existing interventions could be tweaked to enable their migration from representing incremental innovation to radical innovation for example. This analysis also points out the value of including grey literature, especially from Twitter, in systematic literature reviews to get a contemporary view of latest work in the area under investigation.

Keywords: ageing, loneliness, innovation, digital

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Authors: Amin AminiKhafri, James M. Dawson-Edwards, Ryan M. Simpson, Simaan M. AbouRizk

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Earned value management (EVM) has been introduced as an integrated method to combine schedule, budget, and work breakdown structure (WBS). EVM provides various indices to demonstrate project performance including the cost performance index (CPI). CPI is also used to forecast final project cost at completion based on the cost performance during the project execution. Knowing the final project cost during execution can initiate corrective actions, which can enhance project outputs. CPI, however, is not constant during the project, and calculating the final project cost using a variable index is an inaccurate and challenging task for practitioners. Since CPI is based on the cumulative progress values and because of the learning curve effect, CPI variation dampens and stabilizes as project progress. Although various definitions for the CPI stability have been proposed in literature, many scholars have agreed upon the definition that considers a project as stable if the CPI at 20% completion varies less than 0.1 from the final CPI. While 20% completion point is recognized as the stability point for military development projects, construction projects stability have not been studied. In the current study, an empirical study was first conducted using construction project data to determine the stability point for construction projects. Early findings have demonstrated that a majority of construction projects stabilize towards completion (i.e., after 70% completion point). To investigate the effect of CPI stability on cost forecast accuracy, the correlation between CPI stability and project cost at completion forecast accuracy was also investigated. It was determined that as projects progress closer towards completion, variation of the CPI decreases and final project cost forecast accuracy increases. Most projects were found to have 90% accuracy in the final cost forecast at 70% completion point, which is inlined with findings from the CPI stability findings. It can be concluded that early stabilization of the project CPI results in more accurate cost at completion forecasts.

Keywords: cost performance index, earned value management, empirical study, final project cost

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Authors: Samuel Asiedu-Addo, Jonathan Annan, Yarhands Dissou Arthur

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The study aims to explore the relational effect of lecturers’ personal attribute on student’s interest in statistics. In this study personal attributes of lecturers’ such as lecturer’s dynamism, communication strategies and rapport in the classroom as well as applied knowledge during lecture were examined. Here, exploratory research design was used to establish the effect of lecturer’s personal attributes on student’s interest. Data were analyzed by means of confirmatory factor analysis and structural equation modeling (SEM) using the SmartPLS 3 program. The study recruited 376 students from the faculty of technical and vocational education of the University of Education Winneba Kumasi campus, and Ghana Technology University College as well as Kwame Nkrumah University of science and Technology. The results revealed that personal attributes of an effective lecturer were lecturer’s dynamism, rapport, communication and applied knowledge contribute (52.9%) in explaining students interest in statistics. Our regression analysis and structural equation modeling confirm that lecturers personal attribute contribute effectively by predicting student’s interest of 52.9% and 53.7% respectively. The paper concludes that the total effect of a lecturer’s attribute on student’s interest is moderate and significant. While a lecturer’s communication and dynamism were found to contribute positively to students’ interest, they were insignificant in predicting students’ interest. We further showed that a lecturer’s personal attributes such as applied knowledge and rapport have positive and significant effect on tertiary student’s interest in statistic, whilst lecturers’ communication and dynamism do not significantly affect student interest in statistics; though positively related.

Keywords: student interest, effective teacher, personal attributes, regression and SEM

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Authors: Hussain Sajid, Jung-Hun Shin, Kum-Won Cho

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Image super-resolution is the most common computer vision problem with many important applications. Generative adversarial networks (GANs) have promoted remarkable advances in single-image super-resolution (SR) by recovering photo-realistic images. However, high memory requirements of GAN-based SR (mainly generators) lead to performance degradation and increased energy consumption, making it difficult to implement it onto resource-constricted devices. To relieve such a problem, In this paper, we introduce an optimized and highly efficient architecture for SR-GAN (generator) model by utilizing model compression techniques such as Knowledge Distillation and pruning, which work together to reduce the storage requirement of the model also increase in their performance. Our method begins with distilling the knowledge from a large pre-trained model to a lightweight model using different loss functions. Then, iterative weight pruning is applied to the distilled model to remove less significant weights based on their magnitude, resulting in a sparser network. Knowledge Distillation reduces the model size by 40%; pruning then reduces it further by 18%. To accelerate the learning process, we employ the Horovod framework for distributed training on a cluster of 2 nodes, each with 8 GPUs, resulting in improved training performance and faster convergence. Experimental results on various benchmarks demonstrate that the proposed compressed model significantly outperforms state-of-the-art methods in terms of peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and image quality for x4 super-resolution tasks.

Keywords: single-image super-resolution, generative adversarial networks, knowledge distillation, pruning

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Authors: Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh, Nizal Sarrafzadegan, Tamiru Shibru, Behzad Fatemi

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Markov model, like cardiovascular disease (CVD) policy model based simulation, is being used for evaluating the cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest, and all-cause mortality were included in this model. Hypertension is a risk factor for a number of vascular and cardiac complications and CVD outcomes. Objective: This systematic review was conducted to evaluate the comprehensiveness of this model across different regions globally. Methods: We searched articles written in the English language from PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, and Google scholar with a systematic search query. Results: Thirteen cohort studies involving a total of 2,165,770 (1,666,554 hypertensive adult population and 499,226 adults with treatment-resistant hypertension) were included in this scoping review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Association between HF and hypertension is variable across regions. Treatment resistant hypertension is associated with a higher relative risk of developing major cardiovascular events and all-cause mortality when compared with non-resistant hypertension. However, it is not included in the previous CVD policy model. Conclusion: The CVD policy model used can be used in most regions for the evaluation of the cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, the Caribbean, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment due to a lack of sufficient evidence. Researchers should consider the effect of treatment-resistant hypertension either by including it in the basic model or during setting the model assumptions.

Keywords: cardiovascular disease policy model, cost-effectiveness analysis, hypertension, systematic review, twelve major cardiovascular events

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Authors: Michael Lousis

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The systematic identification of the most conspicuous and significant errors made by learners during three-years of testing of their progress in learning Arithmetic throughout the development of the Kassel Project in England and Greece was accomplished. How much retentive these errors were over three-years in the officially provided school instruction of Arithmetic in these countries has also been shown. The learners’ errors in Arithmetic stemmed from a sample, which was comprised of two hundred (200) English students and one hundred and fifty (150) Greek students. The sample was purposefully selected according to the students’ participation in each testing session in the development of the three-year project, in both domains simultaneously in Arithmetic and Algebra. Specific teaching practices have been invented and are presented in this study for subverting these learners’ errors, which were found out to be retentive to the level of the nationally provided mathematical education of each country. The invention and the development of these proposed teaching practices were founded on the rationality of the theoretical accounts concerning the explanation, prediction and control of the errors, on the conceptual metaphor and on an analysis, which tried to identify the required cognitive components and skills of the specific tasks, in terms of Psychology and Cognitive Science as applied to information-processing. The aim of the implementation of these instructional practices is not only the subversion of these errors but the achievement of the mathematical competence, as this was defined to be constituted of three elements: appropriate representations - appropriate meaning - appropriately developed schemata. However, praxis is of paramount importance, because there is no independent of science ‘real-truth’ and because praxis serves as quality control when it takes the form of a cognitive method.

Keywords: arithmetic, cognitive science, cognitive psychology, information-processing paradigm, Kassel project, level of the nationally provided mathematical education, praxis, remedial mathematical teaching practices, retentiveness of errors

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Authors: Hassan Y. Kikhia, Jin P. Zhang, Khaldoon G. Albiatr

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The Enron and Arthur Andersen scandal has raised concerns internationally about auditor independence and audit quality. Furthermore, the debate continues about the relationship between audit fees, auditor tenure and audit quality in spite of extensive empirical evidence examining audit failures and earnings management. Therefore, the purpose of current research is to determine the effect of audit fee and audit tenure both partially and simultaneously on the audit quality. Using a sample of Chinese firms, an environment where we believe it provides us with an opportunity to test whether the development of market and legal institutions affects the impact of audit fees and auditor tenure on audit quality. We employ the standard deviation of residuals from regressions relating current accruals to cash flows as proxy for audit quality. The paper documents statistically significant negative association between audit fees and audit quality. These findings are consistent with economic bonding being a determinant of auditor behavior rather than auditor reputational concerns. Further, the current paper shows a positive association between auditor tenure and audit quality in the earlier years of audit tenure. These results support the proposition that when the Learning Effect dominates the Bonding Effect in the earlier years of tenure, then audit quality is likely to be higher. Taken audit fees and audit tenure together, the results suggest that there is positive association between audit fees and audit quality in the earlier years of auditor tenure. Interestingly, the findings of our study have important implications for auditors, policymakers, multinational firms, and users of financial reports. As the rapid growth of China's economy gains global recognition, the Chinese stock market is capturing the attention of international investors. To a lesser extent, our paper also differs from the prior studies in methodology and findings in the investigation of audit quality.

Keywords: audit quality, accruals quality, audit fees, auditor tenure

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Authors: Pedro Augusto Da Silva E Souza Miranda, Niloofar Jalali, Shweta Mistry

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BACKGROUND: Software developers utilize automated solutions to scrape users’ reviews to extract meaningful knowledge to identify problems (e.g., bugs, compatibility issues) and possible enhancements (e.g., users’ requests) to their solutions. However, most of these solutions do not consider the health risk aspects to users. Recent works have shed light on the importance of including health risk considerations in the development cycle of mHealth apps to prevent harm to its users. PROBLEM: The COVID-19 Pandemic in Canada (and World) is currently forcing physical distancing upon the general population. This new lifestyle made the usage of mHealth applications more essential than ever, with a projected market forecast of 332 billion dollars by 2025. However, this new insurgency in mHealth usage comes with possible risks to users’ health due to mHealth apps problems (e.g., wrong insulin dosage indication due to a UI error). OBJECTIVE: These works aim to raise awareness amongst mHealth developers of the importance of considering risks to users’ health within their development lifecycle. Moreover, this work also aims to help mHealth developers with a Proof-of-Concept (POC) solution to understand, process, and identify possible health risks to users of mHealth apps based on users’ reviews. METHODS: We conducted a mixed-method study design. We developed a crawler to mine the negative reviews from two samples of mHealth apps (my fitness, medisafe) from the Google Play store users. For each mHealth app, we performed the following steps: • The reviews are divided into two groups, before starting the COVID-19 (reviews’ submission date before 15 Feb 2019) and during the COVID-19 (reviews’ submission date starts from 16 Feb 2019 till Dec 2020). For each period, the Latent Dirichlet Allocation (LDA) topic model was used to identify the different clusters of reviews based on similar topics of review The topics before and during COVID-19 are compared, and the significant difference in frequency and severity of similar topics are identified. RESULTS: We successfully scraped, filtered, processed, and identified health-related topics in both qualitative and quantitative approaches. The results demonstrated the similarity between topics before and during the COVID-19.

Keywords: natural language processing (NLP), topic modeling, mHealth, COVID-19, software engineering, telemedicine, health risks

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Authors: Zakir Hossain

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Nowadays reading e-books on laptops, smartphones, and tablets have become a new leisure activity for Vietnamese youth. Since 2011 the copyrighted e-book market began to develop in Vietnam with the participation of five local enterprises. Over the last five years, thousands of e-books were published including the first online early education book series for children from 0 to 6 years old. Research shows that 61% Vietnamese find reading e-books is comfortable, and 45% feel convenient buying books online. More than half of the Vietnamese consider reading online far better than buying printed books, and surprisingly people over age 30 desire reading online while those under 18 prefer reading printed books. Hence with a market of more than 40 million regular internet users including 22 million smartphone users, Vietnam has ample opportunities to develop the e-book market and contribute a great deal to the diversity of the local reading culture which is essential for Building a Lifelong Learning Society, a state ambition of Vietnam by 2020. However, the e-book market in Vietnam is still in its infancy and is growing far too slowly than e-book producers had expected. All five e-book enterprises are facing numerous challenges. While the big profit that e-book technology can bring has been clearly recognised in other countries, e-books in Vietnam only make up less than 1% share of the book market. The objective of the study is to identify the difficulties and barriers to the development of the e-book market in Vietnam through an extensive literature review available in English. The study revealed that illegal e-books due to copyright infringement and an inconvenient payment system to purchase e-books are the major obstacles. The great potential of e-books in Vietnam is a reality but requires government enforcement of copyright protection laws, a new area of focus for the e-book market. Furthermore, Vietnamese readers should change their habits from using free and illegal e-books to develop the e-publishing industry in Vietnam.

Keywords: copyright, e-book, e-book reading, e-publishing, Vietnam

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Authors: Leora Branfield Day, Stephanie Saunders, Leah Steinberg, Shiphra Ginsburg, Christine Soong

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Introduction: Discordance between patients expressed and documented preferences at the end of life is common. Although junior trainees frequently lead goals of care (GOC) conversations, lack of training can result in poor communication. Based on a needs assessment, we developed an interactive electronic learning module (eModule) for conducting patient-centred GOC discussions. The purpose of this study was to evaluate the impact of the eModule on residents’ attitudes towards GOC conversations. Methods: First-year internal medicine residents (n=11) from the University of Toronto selected using purposive sampling underwent semi-structured interviews before and after completing a GOC eModule. Interviews were anonymized, transcribed and open-coded using NVivo. Using a constructivist grounded theory approach, we developed a framework to understand the attitudes of residents to GOC conversations before and after viewing the module. Results: Before the module, participants described limited training and negative emotions towards GOC conversations. Many focused on code status and procedure choices (e.g., ventilation) instead of eliciting patient-centered values. Pressure to “get the DNR" led to conflicting feelings and distress. After the module, participants’ approached conversations with a greater focus on patient values and process. They felt more prepared and comfortable, recognizing the complexity of conversations and the importance of patient-centeredness. Conclusions: A novel GOC eModule allowed residents to develop a patient-centered and standardized approach to GOC conversations while improving confidence and preparedness. This resource could be an effective strategy toward attaining a critical communication competency among learners with the potential to enhance accurate GOC documentation.

Keywords: goals of care conversations, communication skills, emodule, medical education

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Authors: Golnar Hasheminasab, Mehrdad Faizi, Mona Khoramjouy

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Introduction: Benzodiazepines (BZDs) have pharmacological effects, including anxiolytic, sedative-hypnotic, anticonvulsant, and muscle relaxant properties. However, they have adverse effects such as interaction with alcohol, ataxia, impaired learning, and psychological and physical dependence. According to the structure of zolpidem and on the basis of the structure-activity relationship of BZD receptor ligands, six novel derivatives of 2-fluorobenzyloxy 4,6- diphenylpyramidin-2-ol have been synthesized. We studied the hypnotic, sedative, and anticonvulsant effects of the novel compounds. Method: In this study, we used male mice (18 to 25 g). All the substances were injected intraperitoneally. The hypnotic effect of the compounds was examined by pentobarbital induced sleeping test. The locomotor activities and sedative effects of the novel compounds were evaluated by open field and loss of righting reflex test, respectively. The anticonvulsant effects of the novel compounds were assessed by PTZ and MES tests. Results: In the pentobarbital induced sleeping and open field tests, compound 4-(2-((2-fluorobenzyl)oxy)phenyl)-6-(p-tolyl) pyrimidine-2-ol with ED50=14.20 mg/kg and ED50=47.88 mg/kg, respectively, was the most effective compound. None of the novel compounds showed a significant anticonvulsant effect in the PTZ test. In MES test, compound 4-(2-((2-fluorobenzyl)oxy)phenyl)-6-(p-tolyl)pyrimidine-2-ol with ED50=12.92 mg/kg was the most effective compound. Flumazenil blocked the sedation and hypnosis of all the compounds. Conclusion: All of the novel derivatives showed significant sedative-hypnotic activities and caused the reduction of locomotor activities. The results show that the methyl lipophilic substitutes on the phenyl ring of 4,6-diphenylpyramidin-2-ol derivatives can increase the sedative and hypnotic effects of the derivatives. Flumazenil antagonized the sedative, and the hypnotic effects of the compounds indicate that BZD receptors are involved in the effects.

Keywords: BZD, sedative, hyptonic, anticonvulsant, zolpidem, MES, PTZ, benzodiazepine, locomotor activities, pentobarbital induced sleeping tests

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Authors: Kalidas Sarma

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Fraud is a social problem changing with social change and it has a regional and global impact. Introduction of private domain in higher education along with public institutions has led to commercialization of higher education which encourages unprecedented mushrooming of private institutions resulting in fraudulent activities in higher educational institutions in Assam, India. Presently, fraud has been noticed in in-service promotion, fake entry qualification by teachers in different levels of work-place by using fake master degrees, master of philosophy and doctor of philosophy degree certificates. The aim and objective of the study are to identify grey areas in maintenance of quality in higher educational institutions in Assam and also to draw the contour for planning and implementation. This study is based on both primary and secondary data collected through questionnaire and seeking information through Right to Information Act 2005. In Assam, there are 301 undergraduate and graduate colleges distributed in 27 (Twenty seven) administrative districts with 11000 (Eleven thousand) college teachers. Total 421 (Four hundred twenty one) college teachers from the 14 respondent colleges have been taken for analysis. Data collected has been analyzed by using 'Hypertext Pre-processor' (PhP) application with My Sequel Structure Query Language (MySQL) and Google Map Application Programming Interface (APIs). Graph has been generated by using open source tool Chart.js. Spatial distribution maps have been generated with the help of geo-references of the colleges. The result shows: (i) the violation of University Grants Commission's (UGCs) Regulation for the awards of M. Phil/Ph.D. clearly exhibits. (ii) There is a gap between apex regulatory bodies of higher education at national and as well as state level to check fraud. (iii) Mala fide 'No Objection Certificate' (NOC) issued by the Government of Assam have played pivotal role in the occurrence of fraudulent practices in higher educational institutions of Assam. (iv) Violation of verdict of the Hon'ble Supreme Court of India regarding territorial jurisdiction of Universities for the awards of Ph.D. and M. Phil degrees in distance mode/study centre is also a responsible factor for the spread of these academic frauds in Assam and other states. The challenges and mitigation of these issues have been discussed.

Keywords: Assam, fraud, higher education, mitigation

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Authors: Lennon Furtado, Sandro Oliveira

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The importance of an effective measurement program lies in the ability to control and predict what can be measured. Thus, the measurement program has the capacity to provide bases in decision-making to support the interests of an organization. Therefore, it is only possible to apply for an effective measurement program with a team of software engineers well trained in the measurement area. However, the literature indicates that are few computer science courses that have in their program the teaching of the software measurement process. And even these, generally present only basic theoretical concepts of said process and little or no measurement in practice, which results in the student's lack of motivation to learn the measurement process. In this context, according to some experts in software process improvements, one of the most used approaches to maintaining the motivation and commitment to software process improvements program is the use of the gamification. Therefore, this paper aims to present a proposal of teaching the measurement process by gamification. Which seeks to improve student motivation and performance in the assimilation of tasks related to software measurement, by incorporating elements of games into the practice of measurement process, making it more attractive for learning. And as a way of validating the proposal will be made a comparison between two distinct groups of 20 students of Software Quality class, a control group, and an experiment group. The control group will be the students that will not make use of the gamification proposal to learn software measurement process, while the experiment group, will be the students that will make use of the gamification proposal to learn software measurement process. Thus, this paper will analyze the objective and subjective results of each group. And as objective result will be analyzed the student grade reached at the end of the course, and as subjective results will be analyzed a post-course questionnaire with the opinion of each student about the teaching method. Finally, this paper aims to prove or refute the following hypothesis: If the gamification proposal to teach software measurement process does appropriate motivate the student, in order to attribute the necessary competence to the practical application of the measurement process.

Keywords: education, gamification, software measurement process, software engineering

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Authors: Lucy Adesomon Okukpon, Margaret Omolara Akerele

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Higher Education in Nigeria is sought after by women, they believe that the economic power and growth lies in the attainment and pursuit of higher Education. No nation in the world can boast of developmental growth when the women are not fully empowered educationally. The attainment of higher education spurs women to contribute meaningfully towards the growth and development of the Nigerian workforce. Recent innovations and trends reveal that over fifty per cent of Nigerian women have attained higher education within and outside the country. Women in Nigeria have expressed their growing concern of what becomes of the remaining 50 per cent who are unable to attain basic education. This concern has brought about the issue of funding which is a practical challenge towards the attainment of education for these vulnerable women. Another challenging factor is that most women often seek the permission of their husbands, brothers, fathers and uncles to enable them attain educational pursuit, especially when the institution is miles away from their place of abode. The solution to this problems from research findings reveal that the umbrella body which co-ordinates education for women in Nigeria (The National Council of Women Societies, NCWS) have taken it upon itself to provide educational learning centres in all the states of the Federation including Abuja the Nations capital city. This is to stem the ugly trend and enable women gain access to educational facilities provided for their growth and development. This positive stride has brought succour to women who hitherto have no hope of attaining any form of education. Moreover, awareness creation concerning higher education is translated into different Nigerian languages so that the women at the grassroots can benefit immensely and contribute towards the growth and development of the Nation. Their educational progress attest to the fact that Nigerian Women are happy for the educational opportunities provided and have vowed to attain greater heights particularly where higher education is concerned.

Keywords: developmental growth, educational attainment, higher education, women in higher education, Nigeria

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Authors: Cagdas Agirdas

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Background: The Affordable Care Act (ACA) requires non-grandfathered private insurance plans, starting with plan years on or after September 23rd, 2010, to provide certain preventive care services without any cost sharing in the form of deductibles, copayments or co-insurance. This requirement may affect racial and ethnic disparities in preventive care as it provides the largest copay reduction in preventive care. Objectives: We ask whether the ACA’s free preventive care benefits are associated with a reduction in racial and ethnic disparities in the utilization of four preventive services: cholesterol screenings, colonoscopies, mammograms, and pap smears. Methods: We use a data set of over 6,000 individuals from the 2009, 2010, and 2013 Medical Expenditure Panel Surveys (MEPS). We restrict our data set only to individuals who are old enough to be eligible for each preventive service. Our difference-in-differences logistic regression model classifies privately-insured Hispanics, African Americans, and Asians as the treatment groups and 2013 as the after-policy year. Our control group consists of non-Hispanic whites on Medicaid as this program already covered preventive care services for free or at a low cost before the ACA. Results: After controlling for income, education, marital status, preferred interview language, self-reported health status, employment, having a usual source of care, age and gender, we find that the ACA is associated with increases in the probability of the median, privately-insured Hispanic person to get a colonoscopy by 3.6% and a mammogram by 3.1%, compared to a non-Hispanic white person on Medicaid. Similarly, we find that the median, privately-insured African American person’s probability of receiving these two preventive services improved by 2.3% and 2.4% compared to a non-Hispanic white person on Medicaid. We do not find any significant improvements for any racial or ethnic group for cholesterol screenings or pap smears. Furthermore, our results do not indicate any significant changes for Asians compared to non-Hispanic whites in utilizing the four preventive services. These reductions in racial/ethnic disparities are robust to reconfigurations of time periods, previous diagnosis, and residential status. Conclusions: Early effects of the ACA’s provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.

Keywords: preventive care, Affordable Care Act, cost sharing, racial disparities

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Authors: Sepideh Nikounejad, Mostafa Ghaderi, Nematollah Azizi, Per-Olof Thang, Mohamad Reza Neyestani

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From an educational perspective, an effective and efficient relationship between university and industry can be considered as an important means by which not only both sides are improved but also it brings many advantages and benefits for both parties. It means more specifically, mutual collaboration between universities and industry can not only reduce youth unemployment, but it can improve the quality of teaching and learning in higher education settings while providing more qualified people to industrial enterprises. Indeed the lack of effective interaction between Iranian universities and industry has confronted the country and created many challenges include in increasing number of unskillful and unemployed graduates. However, in order to suggest appropriate practical strategies, it is very important to see how this issue has been tackled by Swedish universities, which have had a good background in this collaboration and how they are connected to the industry in particular and labour market in general. The research aims to study and compare the mechanisms, processes, and policies of the current model in the relationships between university and industry in Iran and Sweden. As a qualitative study, grounded theory was applied. Data were collected via semi-structured interviews. Participants were selected purposefully and by the snowball sampling method. The findings indicate that despite reported needs from both sides for close collaborations between universities and industries in Iran, current policies and practices, including internship, laboratory, and financial support, need to be revised critically. However, in light of our findings on the Swedish policies and practices for linking universities and industries, some practical strategies will be suggested for the Iranian higher education context. In conclusion, cooperation models between universities and industries in Iran and Sweden will be described.

Keywords: cooperation, higher education, industry, comparative

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Authors: Leila Sadeghi

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Gender equality is a critical concern in the workplace, particularly in Iran, where legal and social barriers contribute to significant disparities. This abstract presents a case study of Dahi Bondad Co., a company based in Tehran, Iran that recognized the urgency of addressing the gender gap within its organization. Through a comprehensive investigation, the company identified issues related to biased recruitment, pay disparities, promotion biases, internal barriers, and everyday boundaries. This abstract highlights the strategies implemented by Dahi Bondad Co. to combat these challenges and foster gender equality. The company revised its recruitment policies, eliminated gender-specific language in job advertisements, and implemented blind resume screening to ensure equal opportunities for all applicants. Comprehensive pay equity analyses were conducted, leading to salary adjustments based on qualifications and experience to rectify pay disparities. Clear and transparent promotion criteria were established, and training programs were provided to decision-makers to raise awareness about unconscious biases. Additionally, mentorship and coaching programs were introduced to support female employees in overcoming self-limiting beliefs and imposter syndrome. At the same time, practical workshops and gamification techniques were employed to boost confidence and encourage women to step out of their comfort zones. The company also recognized the importance of dress codes and allowed optional hijab-wearing, respecting local traditions while promoting individual freedom. As a result of these strategies, Dahi Bondad Co. successfully fostered a more equitable and empowering work environment, leading to increased job satisfaction for both male and female employees within a short timeframe. This case study serves as an example of practical approaches that human resource managers can adopt to address gender inequality in the workplace, providing valuable insights for organizations seeking to promote gender equality in similar contexts.

Keywords: gender equality, human resource strategies, legal barrier, social barrier, successful result, successful strategies, workplace in Iran

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Authors: Rishi Agarwal

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Digital twins are emerging as a strong technology used to imitate and monitor physical objects digitally in real time across sectors. It is not only dealing with the digital space, but it is also actuating responses in the physical space in response to the digital space processing like storage, modeling, learning, simulation, and prediction. This paper explores the application of digital twins for enhancing physical security in retail stores. The retail sector still relies on outdated physical security practices like manual monitoring and metal detectors, which are insufficient for modern needs. There is a lack of real-time data and system integration, leading to ineffective emergency response and preventative measures. As retail automation increases, new digital frameworks must control safety without human intervention. To address this, the paper proposes implementing an intelligent digital twin framework. This collects diverse data streams from in-store sensors, surveillance, external sources, and customer devices and then Advanced analytics and simulations enable real-time monitoring, incident prediction, automated emergency procedures, and stakeholder coordination. Overall, the digital twin improves physical security through automation, adaptability, and comprehensive data sharing. The paper also analyzes the pros and cons of implementation of this technology through an Emerging Technology Analysis Canvas that analyzes different aspects of this technology through both narrow and wide lenses to help decision makers in their decision of implementing this technology. On a broader scale, this showcases the value of digital twins in transforming legacy systems across sectors and how data sharing can create a safer world for both retail store customers and owners.

Keywords: digital twin, retail store safety, digital twin in retail, digital twin for physical safety

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Authors: Fentahun Ayu Muche

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This review investigates the application of digital twin technology in 3D-printed concrete (3DPC) structures, with a primary focus on the early-age behavior of concrete. The integration of digital twins into 3DPC construction holds significant promise for monitoring, predicting, and optimizing structural performance during critical early stages, such as curing and setting. Digital twin technology integrates a range of advanced systems, including 3D modeling, machine learning, physical modeling, simulation technologies, communication technologies, and IOT. 3DPC, an additive manufacturing (AM) technology, constructs concrete structures layer by layer without deformation. The process begins with the mixer tank, pump, and nozzle system. Compared to traditional concrete construction methods, 3DPC offers numerous advantages, such as enhanced design flexibility, material efficiency, faster construction speed, reduced costs, higher quality, minimal material wastage, and elimination of formwork, reduced errors, and decreased labor requirements. Concrete, the most widely used construction material globally, is composed of materials such as cement, aggregates, admixtures, additives, supplementary cementitious materials (SCMs), fibers, and geopolymer components. At early ages, properties such as fresh state behavior, mechanical characteristics, hydration processes, microstructure, and chemical properties are particularly critical. This paper synthesizes current research, identifies key challenges, and highlights future directions in the evolving field of digital twins in 3DPC, emphasizing their transformative potential for advancing construction technologies.

Keywords: digital twin, 3DCP, concrete, early age properties, material composition

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Authors: Aminu Ololade Matilda

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Child abuse is a significant issue worldwide, affecting the socio-development and mental and physical health of young individuals. It is the maltreatment of a child by an adult or a child. This paper focuses on child abuse in Communities in Lagos State. The aim of this study is to investigate the extent of child abuse and its impact on the mood, social activities, self-worth, concentration, and academic performance of children in Communities in Lagos State. The primary research instrument used in this study was the interview (Forensic), which consisted of two sections. The first section gathered data on the details of the child and the forms and impacts of abuse experienced, while the second section focused on parental style. The study found that children who experienced various forms of abuse, such as emotional, neglect, physical, or sexual abuse, were hesitant to report it out of fear of threats or even death from the abuser. These abused children displayed withdrawn behaviour, depression, and low self-worth and underperformed academically compared to their peers who did not experience abuse. The findings align with socio-learning and intergenerational transmission of violence theories, which suggest that parents and caregivers who engage in child abuse often do so because they themselves experienced or witnessed abuse as children, thereby normalizing violence. The study highlights the prevalent issue of child abuse in Lagos State and emphasizes the need for advocacy programs and capacity building to raise awareness about child abuse and prevention. The distribution of the Child’s Rights Act in various sectors is also recommended to underscore the importance of protecting the rights of children. Additionally, the inclusion of courses on child abuse in the school curriculum is proposed to ensure children are educated on recognizing and reporting abuse.

Keywords: abuse, child, awareness, effects, emotional, neglect, physical, psychological, sexual, recognize, reporting, right

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Authors: Adel Al Hashlan

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Parent and family engagement plays a crucial role in supporting the success of students with special needs in educational settings. This paper explores the significance of parental involvement in special education, examining its impact on academic achievement, social-emotional development, and overall well-being. Meaningful collaboration between educators, parents, and families can promote positive outcomes for students with diverse learning needs. The study employs a mixed-methods approach, incorporating both qualitative and quantitative techniques. Data were collected through structured interviews, focus groups, and surveys involving students with special needs, their parents, and educators across diverse educational settings. The analysis identifies patterns, themes, and correlations to understand the impact of parent and family engagement on student outcomes. Major findings reveal that effective parent and family involvement initiatives, characterized by strong communication strategies, collaboration frameworks, and partnership-building approaches, significantly enhance students’ academic performance, social-emotional development, and overall well-being. The study also identifies common barriers to parental involvement, such as cultural differences and accessibility issues, and suggests strategies for overcoming these challenges. In conclusion, the study underscores the importance of systemic support and resource allocation to facilitate meaningful partnerships between schools and families. Ongoing research and professional development are crucial to enhancing the effectiveness of parent and family engagement initiatives in special education, ultimately maximizing student achievement and well-being.

Keywords: parental involvement, special education, student success, collaborative partnerships

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Authors: Ramkumar R., Gaurav Shinde, Pratik Shroff, Sachin Kumar Jain, Nagesh Walke

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Advancements in electric vehicles have significantly reduced the powertrain noise and moving components of vehicles. As a result, in-cab noises have become more noticeable to passengers inside the car. To ensure a comfortable ride for drivers and other passengers, it has become crucial to eliminate undesirable component noises during the development phase. Standard practices are followed to identify the severity of noises based on subjective ratings, but it can be a tedious process to identify the severity of each development sample and make changes to reduce it. Additionally, the severity rating can vary from jury to jury, making it challenging to arrive at a definitive conclusion. To address this, an automotive component was identified to evaluate squeak and rattle noise issue. Physical tests were carried out for random and sine excitation profiles. Aim was to subjectively assess the noise using jury rating method and objectively evaluate the same by measuring the noise. Suitable jury evaluation method was selected for the said activity, and recorded sounds were replayed for jury rating. Objective data sound quality metrics viz., loudness, sharpness, roughness, fluctuation strength and overall Sound Pressure Level (SPL) were measured. Based on this, correlation co-efficients was established to identify the most relevant sound quality metrics that are contributing to particular identified noise issue. Regression analysis was then performed to establish the correlation between subjective and objective data. Mathematical model was prepared using artificial intelligence and machine learning algorithm. The developed model was able to predict the subjective rating with good accuracy.

Keywords: BSR, noise, correlation, regression

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Authors: Monika Zalewska

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Hans Kelsen was a versatile legal thinker whose achievements in the fields of legal theory, international law, and the theory of democracy are remarkable. All of the fields tackled by Kelsen are regarded as part of his “pure theory of law.” While the link between international law and Kelsen’s pure theory of law is apparent, the same cannot be said about the link between the theory of democracy and his pure theory of law. On the contrary, the general thinking concerning Kelsen’s thought is that it can be used to legitimize authoritarian regimes. The aim of this presentation is to address this concern by identifying the common ground between Kelsen’s pure theory of law and his theory of democracy and to show that they are compatible in a way that his pure theory of law and authoritarianism cannot be. The conceptual analysis of the purity of Kelsen’s theory and his goal of creating ideology-free legal science hints at how Kelsen’s pure theory of law and the theory of democracy are brought together. The presentation will first demonstrate that these two conceptions have common underlying values and meta-ethical convictions. Both are founded on relativism and a rational worldview, and the aim of both is peaceful co-existence. Second, it will be demonstrated that the separation of law and morality provides the maximum space for deliberation within democratic processes. The conclusion of this analysis is that striking similarities exist between Kelsen’s legal theory and his theory of democracy. These similarities are grounded in the Enlightenment tradition and its values, including rationality, a scientific worldview, tolerance, and equality. This observation supports the claim that, for Kelsen, legal positivism and the theory of democracy are not two separate theories but rather stem from the same set of values and from Kelsen’s relativistic worldview. Furthermore, three main issues determine Kelsen’s orientation toward a positivistic and democratic outlook. The first, which is associated with personality type, is the distinction between absolutism and relativism. The second, which is associated with the values that Kelsen favors in the social order, is peace. The third is legality, which creates the necessary condition for democracy to thrive and reveals that democracy is capable of fulfilling Kelsen’s ideal of law at its fullest. The first two categories exist in the background of Kelsen’s pure theory of law, while the latter is an inherent part of Kelsen’s concept of law. The analysis of the text concerning natural law doctrine and democracy indicates that behind the technical language of Kelsen’s pure theory of law is a strong concern with the trends that appeared after World War I. Despite his rigorous scientific mind, Kelsen was deeply humanistic. He tried to create a powerful intellectual weapon to provide strong arguments for peaceful coexistence and a rational outlook in Europe. The analysis provided by this presentation facilitates a broad theoretical, philosophical, and political understanding of Kelsen’s perspectives and, consequently, urges a strong endorsement of Kelsen’s approach to constitutional democracy.

Keywords: hans kelsen, democracy, legal positivism, pure theory of law

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Authors: Juliana Bom-Tempo

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The proposed composition occurs between images, performances, clinics and philosophies. For this enterprise we depart for what is not known beforehand, so with a question as a compass: "would it be in the creation, production and implementation of images in a performance a 'when' for the event of a poetic clinic?” In light of this, there are, in order to think a 'when' of the event of a poetic clinic, images in performances created, produced and executed in partnerships with the author of this text. Faced with this composition, we built four indicators to find spatiotemporal coordinates that would spot that "when", namely: risk zones; the mobilizations of the signs; the figuring of the flesh and an education of the affections. We dealt with the images in performances; Crútero; Flesh; Karyogamy and the risk of abortion; Egg white; Egg-mouth; Islands, threads, words ... germs; Egg-Mouth-Debris, taken as case studies, by engendering risks areas to promote individuations, which never actualize thoroughly, thus always something of pre-individual and also individuating a environment; by mobilizing the signs territorialized by the ordinary, causing them to vary the language and the words of order dictated by the everyday in other compositions of sense, other machinations; by generating a figure of flesh, disarranging the bodies, isolating them in the production of a ground force that causes the body to leak out and undo the functionalities of the organs; and, finally, by producing an education of affections, by placing the perceptions in becoming and disconnecting the visible in the production of small deserts that call for the creation of a people yet to come. The performance is processed as a problematizing of the images fixed by the ordinary, producing gestures that precipitate the individuation of images in performance, strange to the configurations that gather bodies and spaces in what we call common. Lawrence proposes to think of "people" who continually use umbrellas to protect themselves from chaos. These have the function of wrapping up the chaos in visions that create houses, forms and stabilities; they paint a sky at the bottom of the umbrella, where people march and die. A chaos, where people live and wither. Pierce the umbrella for a desire of chaos; a poet puts himself as an enemy of the convention, to be able to have an image of chaos and a little sun that burns his skin. The images in performances presented, thereby, were moving in search for the power of producing a spatio-temporal "when" putting the territories in risk areas, mobilizing the signs that format the day-to-day, opening the bodies to a disorganization and the production of an education of affections for the event of a poetic clinic.

Keywords: Experimentations , Images in Performances, Poetic Clinic, Risk

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