Search results for: quality culture
2963 Psychological Contract and Job Embeddedness Perspectives to Understand Cynicism as a Behavioural Response to Pressures in the Workplace
Authors: Merkouche Wassila, Marchand Alain, Renaud Stéphane
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Organizations are facing competitive pressures constraining them to modify their practices and change initial work conditions of employees, however, these modifications have to sustain initial quality of work and engagements toward the workforce. We focus on the importance of promises in the perspective of psychological contract. According to this perspective, employees perceiving a breach of the expected obligations from the employer may become unsatisfied at work and develop organizational withdrawal behaviors. These are negative counterproductive behaviours aiming to damage the organisation according to the principle of reciprocity and social exchange. We present an integrative model of the determinants and manifestations of organizational withdrawal (OW), a set of behaviors allowing the employee to leave his job or avoid his assigned work. OW contains two main components often studied in silos: work withdrawal (delays, absenteeism and other adverse behaviors) and job withdrawal (turnover). We use the systemic micro, meso and macro sociological approach designing the individual at the heart of a system containing individual, organizational, and environmental determinants. Under the influence of these different factors, the individual assesses the type of behavior to adopt. We provide better lighting for understanding OW using both psychological contract approach through the perception of its respect by the organization and job embeddedness approach which explains why the employee does not leave the organization and then remains in his post while practicing negative and counterproductive behaviors such as OW. We study specifically cynicism as a type of OW as it is a dimension of burnout. We focus on the antecedents of cynicism to try to prevent it in the workplace.Keywords: burnout, cynicism, job embeddedness, organizational withdrawal, psychological contract
Procedia PDF Downloads 2522962 An Integrated Approach for Optimal Selection of Machining Parameters in Laser Micro-Machining Process
Authors: A. Gopala Krishna, M. Lakshmi Chaitanya, V. Kalyana Manohar
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In the existent analysis, laser micro machining (LMM) of Silicon carbide (SiCp) reinforced Aluminum 7075 Metal Matrix Composite (Al7075/SiCp MMC) was studied. While machining, Because of the intense heat generated, A layer gets formed on the work piece surface which is called recast layer and this layer is detrimental to the surface quality of the component. The recast layer needs to be as small as possible for precise applications. Therefore, The height of recast layer and the depth of groove which are conflicting in nature were considered as the significant manufacturing criteria, Which determines the pursuit of a machining process obtained in LMM of Al7075/10%SiCp composite. The present work formulates the depth of groove and height of recast layer in relation to the machining parameters using the Response Surface Methodology (RSM) and correspondingly, The formulated mathematical models were put to use for optimization. Since the effect of machining parameters on the depth of groove and height of recast layer was contradictory, The problem was explicated as a multi objective optimization problem. Moreover, An evolutionary Non-dominated sorting genetic algorithm (NSGA-II) was employed to optimize the model established by RSM. Subsequently this algorithm was also adapted to achieve the Pareto optimal set of solutions that provide a detailed illustration for making the optimal solutions. Eventually experiments were conducted to affirm the results obtained from RSM and NSGA-II.Keywords: Laser Micro Machining (LMM), depth of groove, Height of recast layer, Response Surface Methodology (RSM), non-dominated sorting genetic algorithm
Procedia PDF Downloads 3452961 A Comprehensive Characterization of Cell-free RNA in Spent Blastocyst Medium and Quality Prediction for Blastocyst
Authors: Huajuan Shi
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Background: The biopsy of the preimplantation embryo may increase the potential risk and concern of embryo viability. Clinically discarded spent embryo medium (SEM) has entered the view of researchers, sparking an interest in noninvasive embryo screening. However, one of the major restrictions is the extremelty low quantity of cf-RNA, which is difficult to efficiently and unbiased amplify cf-RNA using traditional methods. Hence, there is urgently need to an efficient and low bias amplification method which can comprehensively and accurately obtain cf-RNA information to truly reveal the state of SEM cf-RNA. Result: In this present study, we established an agarose PCR amplification system, and has significantly improved the amplification sensitivity and efficiency by ~90 fold and 9.29 %, respectively. We applied agarose to sequencing library preparation (named AG-seq) to quantify and characterize cf-RNA in SEM. The number of detected cf-RNAs (3533 vs 598) and coverage of 3' end were significantly increased, and the noise of low abundance gene detection was reduced. The increasing percentage 5' end adenine and alternative splicing (AS) events of short fragments (< 400 bp) were discovered by AG-seq. Further, the profiles and characterizations of cf-RNA in spent cleavage medium (SCM) and spent blastocyst medium (SBM) indicated that 4‐mer end motifs of cf-RNA fragments could remarkably differentiate different embryo development stages. Significance: This study established an efficient and low-cost SEM amplification and library preparation method. Not only that, we successfully described the characterizations of SEM cf-RNA of preimplantation embryo by using AG-seq, including abundance features fragment lengths. AG-seq facilitates the study of cf-RNA as a noninvasive embryo screening biomarker and opens up potential clinical utilities of trace samples.Keywords: cell-free RNA, agarose, spent embryo medium, RNA sequencing, non-invasive detection
Procedia PDF Downloads 642960 An Investigation into the Gaps in Green Building Education and Training Offerings in Nigeria
Authors: Adebayo A. Abimbola, Anifowose O. Joseph, Olanrewaju S. Taiwo
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Green building (GB) practices have the potential to save energy, save money, and improve the quality of human habitat. They can also contribute to water conservation, more efficient use of raw materials, and ecosystem health around the globe. The Intergovernmental Panel on Climate Change (IPCC) singled out the building sector as having the most cost-effective opportunities for reducing carbon emissions—in fact, many building-related opportunities are cost-neutral, or even cost-positive, to the building owner. These benefits have made green building practices the fastest-growing trend in the building industry, but they still represent only a fraction of new construction, and the enormous stock of existing buildings has barely been touched at all. To effectively deliver the kind of (GB) that can become a force for positive change at global, regional and local scales, all workforce sectors need new skills that are both technical and interpersonal in nature. A prominent bottleneck is seen to be education and training. This paper investigates the major gaps in current GB education and training offerings in Nigeria. A questionnaire survey was developed to capture the perception of construction professionals and academics in relevant professions regarding the significance of the identified gaps as it affects GB education and training. Based on Likert scale ranking, research result shows that perception of training in specific technical fields and financial benefits and evaluation are identified as the top gaps in GB training and education offerings. The paper concludes with suggestions and actions that can enhance capabilities of the GB workforce in Nigeria.Keywords: education and training, gaps, green building, workforce
Procedia PDF Downloads 3182959 Creative Resolutions to Intercultural Conflicts: The Joint Effects of International Experience and Cultural Intelligence
Authors: Thomas Rockstuhl, Soon Ang, Kok Yee Ng, Linn Van Dyne
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Intercultural interactions are often challenging and fraught with conflicts. To shed light on how to interact effectively across cultures, academics and practitioners alike have advanced a plethora of intercultural competence models. However, the majority of this work has emphasized distal outcomes, such as job performance and cultural adjustment, rather than proximal outcomes, such as how individuals resolve inevitable intercultural conflicts. As a consequence, the processes by which individuals negotiate challenging intercultural conflicts are not well understood. The current study advances theorizing on intercultural conflict resolution by exploring antecedents of how people resolve intercultural conflicts. To this end, we examine creativity – the generation of novel and useful ideas – in the context of resolving cultural conflicts in intercultural interactions. Based on the dual-identity theory of creativity, we propose that individuals with greater international experience will display greater creativity and that the relationship is accentuated by individual’s cultural intelligence. Two studies test these hypotheses. The first study comprises 84 senior university students, drawn from an international organizational behavior course. The second study replicates findings from the first study in a sample of 89 executives from eleven countries. Participants in both studies provided protocols of their strategies for resolving two intercultural conflicts, as depicted in two multimedia-vignettes of challenging intercultural work-related interactions. Two research assistants, trained in intercultural management but blind to the study hypotheses, coded all strategies for their novelty and usefulness following scoring procedures for creativity tasks. Participants also completed online surveys of demographic background information, including their international experience, and cultural intelligence. Hierarchical linear modeling showed that surprisingly, while international experience is positively associated with usefulness, it is unrelated to novelty. Further, a person’s cultural intelligence strengthens the positive effect of international experience on usefulness and mitigates the effect of international experience on novelty. Theoretically, our findings offer an important theoretical extension to the dual-identity theory of creativity by identifying cultural intelligence as an important individual difference moderator that qualifies the relationship between international experience and creative conflict resolution. In terms of novelty, individuals higher in cultural intelligence seem less susceptible to rigidity effects of international experiences. Perhaps they are more capable of assessing which aspects of culture are relevant and apply relevant experiences when they brainstorm novel ideas. For utility, individuals high in cultural intelligence are better able to leverage on their international experience to assess the viability of their ideas because their richer and more organized cultural knowledge structure allows them to assess possible options more efficiently and accurately. In sum, our findings suggest that cultural intelligence is an important and promising intercultural competence that fosters creative resolutions to intercultural conflicts. We hope that our findings stimulate future research on creativity and conflict resolution in intercultural contexts.Keywords: cultural Intelligence, intercultural conflict, intercultural creativity, international experience
Procedia PDF Downloads 1482958 A Retrospective Study on the Age of Onset for Type 2 Diabetes Diagnosis
Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Majed Ahmed Al-Mansoub, Muhammad Qamar
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There is a progressive increase in the prevalence of early onset Type 2 diabetes mellitus. Early detection of Type 2 diabetes enhances the length and/or quality of life which might result from a reduction in the severity, frequency or prevent or delay of its long-term complications. The study aims to determine the onset age for the first diagnosis of Type 2 diabetes mellitus. A retrospective study conducted in the endocrine clinic at Hospital Pulau Pinang in Penang, Malaysia, January- December 2016. Records of 519 patients with Type 2 diabetes mellitus were screened to collect demographic data and determine the age of first-time diabetes mellitus diagnosis. Patients classified according to the age of diagnosis, gender, and ethnicity. The study included 519 patients with age (55.6±13.7) years, female 265 (51.1%) and male 254 (48.9%). The ethnicity distribution was Malay 191 (36.8%), Chinese 189 (36.4%) and Indian 139 (26.8%). The age of Type 2 diabetes diagnosis was (42±14.8) years. The female onset of diabetes mellitus was at age (41.5±13.7) years, while male (42.6±13.7) years. Distribution of diabetic onset by ethnicity was Malay at age (40.7±13.7) years, Chinese (43.2±13.7) years and Indian (42.3±13.7) years. Diabetic onset was classified by age as follow; ≤20 years’ cohort was 33 (6.4%) cases. Group >20- ≤40 years was 190 (36.6%) patients, and category >40- ≤60 years was 270 (52%) subjects. On the other hand, the group >60 years was 22 (4.2%) patients. The range of diagnosis was between 10 and 73 years old. Conclusion: Malay and female have an earlier onset of diabetes than Indian, Chinese and male. More than half of the patients had diabetes between 40 and 60 years old. Diabetes mellitus is becoming more common in younger age <40 years. The age at diagnosis of Type 2 diabetes mellitus has decreased with time.Keywords: age of onset, diabetes diagnosis, diabetes mellitus, Malaysia, outpatients, type 2 diabetes, retrospective study
Procedia PDF Downloads 4142957 The Effect of Socio-Affective Variables in the Relationship between Organizational Trust and Employee Turnover Intention
Authors: Paula A. Cruise, Carvell McLeary
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Employee turnover leads to lowered productivity, decreased morale and work quality, and psychological effects associated with employee separation and replacement. Yet, it remains unknown why talented employees willingly withdraw from organizations. This uncertainty is worsened as studies; a) priorities organizational over individual predictors resulting in restriction in range in turnover measurement; b) focus on actual rather than intended turnover thereby limiting conceptual understanding of the turnover construct and its relationship with other variables and; c) produce inconsistent findings across cultures, contexts and industries despite a clear need for a unified perspective. The current study addressed these gaps by adopting the theory of planned behavior (TPB) framework to examine socio-cognitive factors in organizational trust and individual turnover intentions among bankers and energy employees in Jamaica. In a comparative study of n=369 [nbank= 264; male=57 (22.73%); nenergy =105; male =45 (42.86)], it was hypothesized that organizational trust was a predictor of employee turnover intention, and the effect of individual, group, cognitive and socio-affective variables varied across industry. Findings from structural equation modelling confirmed the hypothesis, with a model of both cognitive and socio-affective variables being a better fit [CMIN (χ2) = 800.067, df = 364, p ≤ .000; CFI = 0.950; RMSEA = 0.057 with 90% C.I. (0.052 - 0.062); PCLOSE = 0.016; PNFI = 0.818 in predicting turnover intention. The findings are discussed in relation to socio-cognitive components of trust models and predicting negative employee behaviors across cultures and industries.Keywords: context-specific organizational trust, cross-cultural psychology, theory of planned behavior, employee turnover intention
Procedia PDF Downloads 2482956 Pilot-free Image Transmission System of Joint Source Channel Based on Multi-Level Semantic Information
Authors: Linyu Wang, Liguo Qiao, Jianhong Xiang, Hao Xu
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In semantic communication, the existing joint Source Channel coding (JSCC) wireless communication system without pilot has unstable transmission performance and can not effectively capture the global information and location information of images. In this paper, a pilot-free image transmission system of joint source channel based on multi-level semantic information (Multi-level JSCC) is proposed. The transmitter of the system is composed of two networks. The feature extraction network is used to extract the high-level semantic features of the image, compress the information transmitted by the image, and improve the bandwidth utilization. Feature retention network is used to preserve low-level semantic features and image details to improve communication quality. The receiver also is composed of two networks. The received high-level semantic features are fused with the low-level semantic features after feature enhancement network in the same dimension, and then the image dimension is restored through feature recovery network, and the image location information is effectively used for image reconstruction. This paper verifies that the proposed multi-level JSCC algorithm can effectively transmit and recover image information in both AWGN channel and Rayleigh fading channel, and the peak signal-to-noise ratio (PSNR) is improved by 1~2dB compared with other algorithms under the same simulation conditions.Keywords: deep learning, JSCC, pilot-free picture transmission, multilevel semantic information, robustness
Procedia PDF Downloads 1202955 An Acerbate Psychotics Symptoms, Social Support, Stressful Life Events, Medication Use Self-Efficacy Impact on Social Dysfunction: A Cross Sectional Self-Rated Study of Persons with Schizophrenia Patient and Misusing Methamphetamines
Authors: Ek-Uma Imkome, Jintana Yunibhand, Waraporn Chaiyawat
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Background: Persons with schizophrenia patient and misusing methamphetamines suffering from social dysfunction that impact on their quality of life. Knowledge of factors related to social dysfunction will guide the effective intervention. Objectives: To determine the direct effect, indirect effect and total effect of an acerbate Psychotics’ Symptoms, Social Support, Stressful life events, Medication use self-efficacy impact on social dysfunction in Thai schizophrenic patient and methamphetamine misuse. Methods: Data were collected from schizophrenic and methamphetamine misuse patient by self report. A linear structural relationship was used to test the hypothesized path model. Results: The hypothesized model was found to fit the empirical data and explained 54% of the variance of the psychotic symptoms (X2 = 114.35, df = 92, p-value = 0.05, X2 /df = 1.24, GFI = 0.96, AGFI = 0.92, CFI = 1.00, NFI = 0.99, NNFI = 0.99, RMSEA = 0.02). The highest total effect on social dysfunction was psychotic symptoms (0.67, p<0.05). Medication use self-efficacy had a direct effect on psychotic symptoms (-0.25, p<0.01), and social support had direct effect on medication use self efficacy (0.36, p <0.01). Conclusions: Psychotic symptoms and stressful life events were the significance factors that influenced direct on social dysfunctioning. Therefore, interventions that are designed to manage these factors are crucial in order to enhance social functioning in this population.Keywords: psychotic symptoms, methamphetamine, schizophrenia, stressful life events, social dysfunction, social support, medication use self efficacy
Procedia PDF Downloads 2082954 Impact of Using Pyrolytic Carbon Black as Asphalt Modifier on Wearing Course of Flexible Pavement
Authors: Samiya Siddique, Taslima Akter Elma, Shahrina Mahzabin, Tamanna Jerin, Mohammed Russedul Islam
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In the maneuver and designing of highway engineering, pavement performance is a principal concern. Quality of construction and materials, traffic volume, climate, etc. are the factors that affect the performance of asphalt concrete. Modified asphalt requires to attain greater strength and stability even at inimical circumstances. In this point of view, pyrolytic carbon black (PCB), which is a by-product of waste tire pyrolysis, holds incomparable properties that individualizes it from other conventional fillers by making it an imminent modifier of bitumen. Optimum asphalt content of 60/70 penetration grade asphalt is determined 5% through the Marshall Stability and Flow test for the wearing course of flexible pavement. 5, 10, and 15 percentages of PCB are then used with neat asphalt for modification. Deviations of physical and rheological properties are investigated on both PCB modified and neat asphalt by going through several laboratory tests such as penetration, softening point, and ductility tests. The obtained results reveal that the performance of paving asphalt can be upgraded by modifying it with PCB. With the increasing percentage of PCB, ductility is gradually decreased, and also penetration grade is gradually reduced from 60/70 to 30/40. Furthermore, asphalt mixtures modified with PCB demonstrate higher stability and lower flow values. The research discloses that the apposite percentage of PCB used in asphalt concrete plays a significant role in the advancement of pavement performances and reutilizing of waste tires.Keywords: asphalt modification, pavement performances, pyrolytic carbon black, marshall stability, wearing course
Procedia PDF Downloads 1492953 Country Experience on Regulation of Traditional Medicine in Eritrea
Authors: Liya Abraham
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Eritrea is located along the Red Sea, north of the Horn of Africa, between Djibouti and Sudan and has a population of about 3.2 million as of 2010. It has six administrative regions; Anseba, Debub, Debubawi K’eyih Bahri, Gash-Barka, Ma'akel, and Semenawi K’eyih Bahri. Eritrea has got its independence in 1991 after 30 years war of liberation. The country is blessed with various medicinal flora and fauna, and marine and terrestrial biodiversity. Traditional Medicine (TM) has been an integral part of the Eritrean culture for centuries. So far, more than 19 TM modalities have been recognized, and are broadly categorized as; herbal, procedure-based and spiritual. Despite the availability of modern medicine to the majority of the population, TM is still widely practiced. The rationale behind widespread use is accessibility, affordability and cultural acceptability. Hence, TM is of great contribution to the Eritrean health care system. As a matter of fact, harnessing the potential contribution of effective and safe TM in order to attain Universal Health Coverage (UHC) has been emphasized in the WHO TM strategy 2014-2023. The Eritrean TM, however, was operating without regulation and reliable scientific justification behind its safety and efficacy. Thus, the Ministry of Health (MoH), in recognition of the role of TM in primary healthcare and safeguard public health, established a regulatory body for TM so-called as Traditional Medicine Unit (TMU) in 2012. The mission of the unit is to ensure rational TM use through an integrated health service delivery system and contribute to the country’s economic and social development. The unit has established its national TM policy in 2017. The activities of the unit are guided by the National TM Advisory Committee (TMAC), responsible for the provision of technical assistance and advisory role. Moreover, the Legal Framework and Code of Ethics and Practice which provide a legal basis for the regulation of TM have also been drafted. In recognition of the importance of TM research and development, the unit launched a nationwide TM survey in 2017 and had surveyed two zones (Gash-Barka and Debub). The findings of the survey were subjected to a research dissemination workshop and publication in international journals. Furthermore, TM-related adverse events reporting tool (Green Form) aiming to guide regulatory interventions and researches have been established by the unit, and ever since reports are flowing. The unit has also been offering training to THPs, pharmacy students and health care professionals regarding TM and its regulatory activities. In addition, as part of the establishment of the national medicinal plants' database and herbal monograph, more than 329 and 30 medicinal plants, have been compiled respectively. In conclusion, TM is still widely accepted and practiced in Eritrea. The TMU ever since its establishment is endeavoring to ensure the safety and efficacy of the TM, and its integration in the mainstream health service delivery system.Keywords: efficacy, regulation, safety, traditional medicine, traditional medicine unit, universal health coverage
Procedia PDF Downloads 1872952 An Image Processing Scheme for Skin Fungal Disease Identification
Authors: A. A. M. A. S. S. Perera, L. A. Ranasinghe, T. K. H. Nimeshika, D. M. Dhanushka Dissanayake, Namalie Walgampaya
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Nowadays, skin fungal diseases are mostly found in people of tropical countries like Sri Lanka. A skin fungal disease is a particular kind of illness caused by fungus. These diseases have various dangerous effects on the skin and keep on spreading over time. It becomes important to identify these diseases at their initial stage to control it from spreading. This paper presents an automated skin fungal disease identification system implemented to speed up the diagnosis process by identifying skin fungal infections in digital images. An image of the diseased skin lesion is acquired and a comprehensive computer vision and image processing scheme is used to process the image for the disease identification. This includes colour analysis using RGB and HSV colour models, texture classification using Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix and Local Binary Pattern, Object detection, Shape Identification and many more. This paper presents the approach and its outcome for identification of four most common skin fungal infections, namely, Tinea Corporis, Sporotrichosis, Malassezia and Onychomycosis. The main intention of this research is to provide an automated skin fungal disease identification system that increase the diagnostic quality, shorten the time-to-diagnosis and improve the efficiency of detection and successful treatment for skin fungal diseases.Keywords: Circularity Index, Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix, Local Binary Pattern, Object detection, Ring Detection, Shape Identification
Procedia PDF Downloads 2312951 Integrated Intensity and Spatial Enhancement Technique for Color Images
Authors: Evan W. Krieger, Vijayan K. Asari, Saibabu Arigela
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Video imagery captured for real-time security and surveillance applications is typically captured in complex lighting conditions. These less than ideal conditions can result in imagery that can have underexposed or overexposed regions. It is also typical that the video is too low in resolution for certain applications. The purpose of security and surveillance video is that we should be able to make accurate conclusions based on the images seen in the video. Therefore, if poor lighting and low resolution conditions occur in the captured video, the ability to make accurate conclusions based on the received information will be reduced. We propose a solution to this problem by using image preprocessing to improve these images before use in a particular application. The proposed algorithm will integrate an intensity enhancement algorithm with a super resolution technique. The intensity enhancement portion consists of a nonlinear inverse sign transformation and an adaptive contrast enhancement. The super resolution section is a single image super resolution technique is a Fourier phase feature based method that uses a machine learning approach with kernel regression. The proposed technique intelligently integrates these algorithms to be able to produce a high quality output while also being more efficient than the sequential use of these algorithms. This integration is accomplished by performing the proposed algorithm on the intensity image produced from the original color image. After enhancement and super resolution, a color restoration technique is employed to obtain an improved visibility color image.Keywords: dynamic range compression, multi-level Fourier features, nonlinear enhancement, super resolution
Procedia PDF Downloads 5542950 Comparison of Er:YAG Laser with Bur Prepared Cavities: A Systematic Review
Authors: Sarina Sahmeddini, Fahimeh Safarpour, Forough Pazhuheian
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With the concepts of minimally invasive treatment and preventive dentistry gaining more and more recognition by dentists, there are many published clinical trials comparing the use of the erbium laser with traditional drilling for caries removal. However, the efficacy of the erbium laser is still controversial. The aim of this review study is to compare the effects of tooth preparation by laser irradiation and conventional preparation by bur to identify the best means for cavity preparation and reduction of recurrent caries. Randomized controlled trials, controlled clinical trials, and prospective, and retrospective cohort studies were included in this review. The eligibility criteria included studies in humans’ permanent teeth in which cavities were conducted in their cervical third and proximal surfaces. PubMed, Google scholar, and Scopus about Er:YAG laser and bur prepared cavities were carried out. The studies’ details were organized in four tables according to the groups: (1) Microleakage; (2) Morphological changes; (3) Microhardness; and (4) Bond strength. The initial search resulted in 134 articles, 12 studies published from 2012 up to March 2020 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. Clinical implications: Er:YAG lasers with the energy levels between 250 to 300 mJ can be proper alternatives to conventional burs, as minimal invasive instruments with no significant differences or better results in microleakage, microhardness, and bond strength compared with conventional burs. In conclusion, Er:YAG laser irradiations accompanied by phosphoric acid etching can reduce the chance of recurrent carries.Keywords: lasers, drilling, caries, micro leakage
Procedia PDF Downloads 1312949 Rehabilitation Approach for Cancer Patients: Indication, Management and Outcome
Authors: Juliani Rianto, Emma Lumby, Tracey Smith
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Cancer patients’ survival are growing with the new approach and therapy in oncology medicine. Cancer is now a new chronic disease, and rehabilitation program has become an ongoing program as part of cancer care. The focus of Cancer rehabilitation is maximising person’s physical and emotional function, stabilising general health and reducing unnecessary hospital admission. In Australia there are 150000 newly diagnosed cancer every year, and the most common Cancer are prostate, Breast, Colorectal, Melanoma and Lung Cancer. Through referral from the oncology team, we recruited cancer patient into our cancer rehabilitation program. Patients are assessed by our multi-disciplinary team including rehabilitation specialist, physiotherapist, occupational therapist, dietician, exercise physiologist, and psychologist. Specific issues are identified, including pain, side effect of chemo and radiation therapy and mental well-being. The goals were identified and reassessed every fortnight. Common goals including nutritional status, improve endurance and exercise performance, working on balance and mobility, improving emotional and vocational state, educational program for insomnia and tiredness, and reducing hospitalisation are identified and assessed. Patients are given 2 hours exercise program twice a week for 6 weeks with focus on aerobic and weight exercises and education sessions. Patients are generally benefited from the program. The quality of life is improved, support and interaction from the therapist has played an important factor in directing patient for their goals.Keywords: cancer, exercises, benefit, mental health
Procedia PDF Downloads 602948 Agritourism Potentials in Oman: An Overview with Visionary for Adoption
Authors: A. Al Hinai, H. Jayasuriya, H. Kotagama
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Most Gulf Cooperation Council (GCC) countries with oil-based economy like Oman are looking for other potential revenue generation options as the crude oil price is regularly fluctuating due to changing geopolitical environment. Oman has advantage of possessing world-heritage nature tourism hotspots around the country and the government is making investments and strategies to uplift the tourism industry following Oman Vision 2040 strategies. Oman’s agriculture is not significantly contributing to the economy, but possesses specific and diversified arid cropping systems. Oman has modern farms; nevertheless some of the agricultural production activities are done with cultural practices and styles that would be attractive to tourists. The aim of this paper is to investigate the potentials for promoting agritourism industry in Oman; recognize potential sites, commodities and activities, and predict potential revenue generation as a projection from that of the tourism sector. Moreover, the study enables to foresee possible auxiliary advantages of agritourism such as, empowerment of women and youth, enhancement in the value-addition industry for agricultural produce through technology transfer and capacity building, and producing export quality products. Agritourism could increase employability, empowerment of women and youth, improve value-addition industry and export-oriented agribusiness. These efforts including provision of necessary technology-transfer and capacity-building should be rendered by the collaboration of academic institutions, relevant ministries and other public and private sector stakeholders.Keywords: agritourism, nature-based tourism, potentials, revenue generation, value addition
Procedia PDF Downloads 1372947 Study on the Addition of Solar Generating and Energy Storage Units to a Power Distribution System
Authors: T. Costa, D. Narvaez, K. Melo, M. Villalva
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Installation of micro-generators based on renewable energy in power distribution system has increased in recent years, with the main renewable sources being solar and wind. Due to the intermittent nature of renewable energy sources, such micro-generators produce time-varying energy which does not correspond at certain times of the day to the peak energy consumption of end users. For this reason, the use of energy storage units next to the grid contributes to the proper leveling of the buses’ voltage level according to Brazilian energy quality standards. In this work, the effect of the addition of a photovoltaic solar generator and a store of energy in the busbar voltages of an electric system is analyzed. The consumption profile is defined as the average hourly use of appliances in a common residence, and the generation profile is defined as a function of the solar irradiation available in a locality. The power summation method is validated with analytical calculation and is used to calculate the modules and angles of the voltages in the buses of an electrical system based on the IEEE standard, at each hour of the day and with defined load and generation profiles. The results show that bus 5 presents the worst voltage level at the power consumption peaks and stabilizes at the appropriate range with the inclusion of the energy storage during the night time period. Solar generator maintains improvement of the voltage level during the period when it receives solar irradiation, having peaks of production during the 12 pm (without exceeding the appropriate maximum levels of tension).Keywords: energy storage, power distribution system, solar generator, voltage level
Procedia PDF Downloads 1412946 The Physically Handicapped in the City
Authors: Bekhemmas Youcef
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The category of the disabled, like other social groups, is considered to have been affected by fate with a disability that led to a reduction in the fulfillment of its social roles to the fullest extent or led to its complete abandonment. Psychological, and until we understand its behavioral methods that express a lot of this complexity and intertwining, and despite all that, this category has not yet received the appropriate great interest from specialized researchers, and even officials, and it is natural that the category of people with disabilities has psychological and social requirements in order to regains their capabilities or some From her, it also needs to prepare the environment in which she lives in order to integrate into society As the motor disability is one of the most common types of disability in the world, and it is constantly increasing, considering the increase in the causes leading to it, such as the traffic accident, and the motor disability often affects individuals from a psychological point of view, but it also affects their social surroundings, whether close or extended, and thus it draws limits and quality For their way of life, as well as determining roles for them as actors of a special kind within their societies. The methodology is similar to the organizational framework for the production of any scientific knowledge and based on the fact that sociology is a project that aims to understand and interpret the social reality scientifically and through the nature of the subject studied in the framework of the reality of the disabled in the city and in order to get closer to the daily life of the physically disabled within the urban center, we adopted the qualitative approach A choice that complies with the spirit of Viberian sociology, especially since Max Weber insists on the need to search for the meaning that the social actor gives to his behavior. Through the results reached in this study, it was found that the city still suffers from several deficiencies at the level of equipment and urban planning in a way that keeps pace with the number of people with disabilities in the city.Keywords: physically, handicapped, in, the city
Procedia PDF Downloads 712945 Advances in Sesame Molecular Breeding: A Comprehensive Review
Authors: Micheale Yifter Weldemichael
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Sesame (Sesamum indicum L.) is among the most important oilseed crops for its high edible oil quality and quantity. Sesame is grown for food, medicinal, pharmaceutical, and industrial uses. Sesame is also cultivated as a main cash crop in Asia and Africa by smallholder farmers. Despite the global exponential increase in sesame cultivation area, its production and productivity remain low, mainly due to biotic and abiotic constraints. Notwithstanding the efforts to solve these problems, a low level of genetic variation and inadequate genomic resources hinder the progress of sesame improvement. The objective of this paper is, therefore, to review recent advances in the area of molecular breeding and transformation to overcome major production constraints and could result in enhanced and sustained sesame production. This paper reviews various researches conducted to date on molecular breeding and genetic transformation in sesame focusing on molecular markers used in assessing the available online database resources, genes responsible for key agronomic traits as well as transgenic technology and genome editing. The review concentrates on quantitative and semi-quantitative studies on molecular breeding for key agronomic traits such as improvement of yield components, oil and oil-related traits, disease and insect/pest resistance, and drought, waterlogging and salt tolerance, as well as sesame genetic transformation and genome editing techniques. Pitfalls and limitations of existing studies and methodologies used so far are identified and some priorities for future research directions in sesame genetic improvement are identified in this review.Keywords: abiotic stress, biotic stress, improvement, molecular breeding, oil, sesame, shattering
Procedia PDF Downloads 352944 Surveillance of Hepatitis C Virus Genotype Circulating in North India
Authors: Shantanu Prakash, Suruchi Shukla, Amita Jain
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Introduction: The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Injection drug use and individuals receiving blood and blood products are the primary modes of HCV transmission. Our study aims to establish the prevalent genotypes/ subtypes of HCV circulating in Uttar Pradesh, North India, as reported from a tertiary care hospital. Methods: It is a retrospective observational analysis of consecutive 404 HCV RNA positive cases referred to our hospital during September 2014 to April 2017. The study was approved by an institutional ethics committee. Written informed consent was taken from each participant. Clinical and demographic details of these patients were recorded using predesigned questionnaires. All the laboratory testing was carried on stored serum sample of enrolled cases. Genotyping of all 404 strains was done by Sanger’s sequencing of the core region. The phylogenetic analysis of 179 HCV strains with high -quality sequencing data was performed. Results: The distribution of prevalent genotypes/ subtypes as noted in the present study was; Genotype (GT)1a [n-101(25%)], GT1b [n-12(2.9%)], GT1c [1(0.25%)], GT3a [275(68.07%)], GT3b [9(2.2%)], GT3g [2(0.49%)], GT3i [3(0.74%)], and GT4a [1(0.24%)]. HCV genotypes GT2, GT5 and GT6 were not detected from our region. Sequence analysis showed high genotypic variability in HCV GT3. Phylogenetic analysis showed that HCV GT3 and GT1 circulating in our region were related to Indian strains reported earlier. Conclusions: HCV genotypes 3a and 1a are commonest circulating genotypes in Uttar Pradesh (UP), India.Keywords: Hepatitis C virus, genetic variation, bioinformatics, genotype, HCV
Procedia PDF Downloads 1582943 Utilizing Laser Cutting Method in Men's' Custom-Made Casualwear
Authors: M A. Habit, S. A. Syed-Sahil, A. Bahari
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Abstract—Laser cutting is a method of manufacturing process that uses laser in order to cut materials. It provides and ensures extreme accuracy which has a clean cut effect, CO2 laser dominate this application due to their good- quality beam combined with high output power. It comes with a small scale and it has a limitation in cutting sizes of materials, therefore it is more appropriate for custom- made products. The same laser cutting machine is also capable in cutting fine material such as fine silk, cotton, leather, polyester, etc. Lack of explorations and knowledge besides being unaware about this technology had caused many of the designers not to use this laser cutting method in their collections. The objectives of this study are: 1) To identify the potential of laser cutting technique in Custom-Made Garments for men’s casual wear: 2) To experiment the laser cutting technique in custom made garments: 3) To offer guidelines and formula for men’s custom- made casualwear designs with aesthetic value. In order to achieve the objectives, this research has been conducted by using mixed methods which are interviews with two (2) local experts in the apparel manufacturing industries and interviews via telephone with five (5) local respondents who are local emerging fashion designers, the questionnaires were distributed to one hundred (100) respondents around Klang Valley, in order to gain the information about their understanding and awareness regarding laser cutting technology. The experiment was conducted by using natural and man- made fibers. As a conclusion, all of the objectives had been achieved in producing custom-made men’s casualwear and with the production of these attires it will help to educate and enhance the innovation in fine technology. Therefore, there will be a good linkage and collaboration between the design experts and the manufacturing companies.Keywords: custom-made, fashion, laser cut, men’s wear
Procedia PDF Downloads 4412942 Study of a Few Additional Posterior Projection Data to 180° Acquisition for Myocardial SPECT
Authors: Yasuyuki Takahashi, Hirotaka Shimada, Takao Kanzaki
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A Dual-detector SPECT system is widely by use of myocardial SPECT studies. With 180-degree (180°) acquisition, reconstructed images are distorted in the posterior wall of myocardium due to the lack of sufficient data of posterior projection. We hypothesized that quality of myocardial SPECT images can be improved by the addition of data acquisition of only a few posterior projections to ordinary 180° acquisition. The proposed acquisition method (180° plus acquisition methods) uses the dual-detector SPECT system with a pair of detector arranged in 90° perpendicular. Sampling angle was 5°, and the acquisition range was 180° from 45° right anterior oblique to 45° left posterior oblique. After the acquisition of 180°, the detector moved to additional acquisition position of reverse side once for 2 projections, twice for 4 projections, or 3 times for 6 projections. Since these acquisition methods cannot be done in the present system, actual data acquisition was done by 360° with a sampling angle of 5°, and projection data corresponding to above acquisition position were extracted for reconstruction. We underwent the phantom studies and a clinical study. SPECT images were compared by profile curve analysis and also quantitatively by contrast ratio. The distortion was improved by 180° plus method. Profile curve analysis showed increased of cardiac cavity. Analysis with contrast ratio revealed that SPECT images of the phantoms and the clinical study were improved from 180° acquisition by the present methods. The difference in the contrast was not clearly recognized between 180° plus 2 projections, 180° plus 4 projections, and 180° plus 6 projections. 180° plus 2 projections method may be feasible for myocardial SPECT because distortion of the image and the contrast were improved.Keywords: 180° plus acquisition method, a few posterior projections, dual-detector SPECT system, myocardial SPECT
Procedia PDF Downloads 2952941 A Retrospective Study to Evaluate Verbal Scores of Autistic Children Who Received Hyperbaric Oxygen Therapy
Authors: Tami Peterson
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Hyperbaric oxygen therapy (HBOT) has been hypothesized as an effective treatment for increasing verbal language skills in individuals on the autism spectrum. A child’s ability to effectively communicate with peers, parents, and caregivers impacts their level of independence and quality of personal relationships. This retrospective study will compare the speech development of participants aged 2-17 years that received 40 sessions of HBOT at 2.0 ATA to those who had not. Both groups will have a verbal assessment every six months. There were 31 subjects in the HBO group and 32 subjects in the non-HBO group. The statistical analysis will focus on whether hyperbaric oxygen therapy made a significant difference in Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) or Assessment of Basic Language and Learning Skills (ABLLS) results. The evidence demonstrates a strong correlation between HBOT and an increased change from baseline verbal scores compared to the control group, even in difficult to grasp areas such as spontaneous vocalization. We suggest this is due to the anti-inflammatory effects of hyperbaric oxygen therapy. Neuroinflammation causes hypoperfusion of critical central nervous system areas responsible for the symptoms described within the autism spectrum, such as problems with thought processing, memory, and speech. Decreasing the inflammation allows the brain to function properly, which results in improved verbal scores for the participants that underwent HBOT.Keywords: assessment of basic language and learning skills, autism spectrum disorder, hyperbaric oxygen therapy, verbal behavior milestones assessment and placement program
Procedia PDF Downloads 2132940 Assessment and Prevalence of Burnout Syndrome and the Coping Strategies among Nurses in Lagos University Teaching Hospital, Lagos, Nigeria
Authors: Calassandra Nwokoro
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Introduction: The nursing profession requires a lot of commitment, effort, and time to efficiently manage patients and provide them quality healthcare services, this work load may eventually cause the nurses to become burned out and experience psychological distress. This study assessed the prevalence of burnout, risk factors, and the coping strategies among nurses working in Lagos University Teaching Hospital (LUTH), Lagos state, Nigeria. Methodology: A descriptive cross-sectional study design was conducted among 308 nurses working in LUTH. Simple random sampling was used in selection of study respondents. The questionnaire comprised three parts; the sociodemographic characteristics of the respondents, the extent of burnout syndrome using the Maslach Burnout Inventory, and the coping strategies used among the respondents using the BRIEF-COPE Inventory. Results: This study revealed relatively high levels of burnout among the nurses in LUTH with a prevalence of 16.9%, 31.2% and 20.1% for high emotional exhaustion, high depersonalization and reduced professional accomplishment respectively. It also showed that burnout was significantly associated with long working hours. Religion was found to be the most commonly used coping strategy overall, while emotional support was the most frequently used coping strategy among nurses who had burnout. Conclusion: This study has revealed a relatively high prevalence of burnout among the nurses in Lagos University Teaching Hospital. In order to minimize the negative health impacts of burnout, the government should collaborate with psychologists and psychiatrists to implement regular stress management and stress inoculation programs for nurses and other health professionals in the country.Keywords: burnout, nurses, coping strategies, healthcare
Procedia PDF Downloads 812939 Cross Professional Team-Assisted Teaching Effectiveness
Authors: Shan-Yu Hsu, Hsin-Shu Huang
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The main purpose of this teaching research is to design an interdisciplinary team-assisted teaching method for trainees and interns and review the effectiveness of this teaching method on trainees' understanding of peritoneal dialysis. The teaching research object is the fifth and sixth-grade trainees in a medical center's medical school. The teaching methods include media teaching, demonstration of technical operation, face-to-face communication with patients, special case discussions, and field visits to the peritoneal dialysis room. Evaluate learning effectiveness before, after, and verbally. Statistical analysis was performed using the SPSS paired-sample t-test to analyze whether there is a difference in peritoneal dialysis professional cognition before and after teaching intervention. Descriptive statistics show that the average score of the previous test is 74.44, the standard deviation is 9.34, the average score of the post-test is 95.56, and the standard deviation is 5.06. The results of the t-test of the paired samples are shown as p-value = 0.006, showing the peritoneal dialysis professional cognitive test. Significant differences were observed before and after. The interdisciplinary team-assisted teaching method helps trainees and interns to improve their professional awareness of peritoneal dialysis. At the same time, trainee physicians have positive feedback on the inter-professional team-assisted teaching method. This teaching research finds that the clinical ability development education of trainees and interns can provide cross-professional team-assisted teaching methods to assist clinical teaching guidance.Keywords: monitor quality, patient safety, health promotion objective, cross-professional team-assisted teaching methods
Procedia PDF Downloads 1432938 Interoperability Standard for Data Exchange in Educational Documents in Professional and Technological Education: A Comparative Study and Feasibility Analysis for the Brazilian Context
Authors: Giovana Nunes Inocêncio
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The professional and technological education (EPT) plays a pivotal role in equipping students for specialized careers, and it is imperative to establish a framework for efficient data exchange among educational institutions. The primary focus of this article is to address the pressing need for document interoperability within the context of EPT. The challenges, motivations, and benefits of implementing interoperability standards for digital educational documents are thoroughly explored. These documents include EPT completion certificates, academic records, and curricula. In conjunction with the prior abstract, it is evident that the intersection of IT governance and interoperability standards holds the key to transforming the landscape of technical education in Brazil. IT governance provides the strategic framework for effective data management, aligning with educational objectives, ensuring compliance, and managing risks. By adopting interoperability standards, the technical education sector in Brazil can facilitate data exchange, enhance data security, and promote international recognition of qualifications. The utilization of the XML (Extensible Markup Language) standard further strengthens the foundation for structured data exchange, fostering efficient communication, standardization of curricula, and enhancing educational materials. The IT governance, interoperability standards, and data management critical role in driving the quality, efficiency, and security of technical education. The adoption of these standards fosters transparency, stakeholder coordination, and regulatory compliance, ultimately empowering the technical education sector to meet the dynamic demands of the 21st century.Keywords: interoperability, education, standards, governance
Procedia PDF Downloads 702937 Preparation of Frozen Bivalent Babesial (Babesia Bovis and Babesia Bigemina) Vaccine from Field Isolates and Evaluation of Its Efficacy in Calves
Authors: Muhammad Fiaz Qamar, Ahmad Faraz, Muhammad Arfan Zaman, Kazim Ali, Waleed Akram
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Babesiosis is reflected as the most important disease of cattle that are transmitted by arthropods. In Pakistan, its prevalence is up to 29% in the cattle and buffalo population in different regions. Cattle show a long lasting and durable immunity by giving an infection of B.bovis, B. bigemina, or Babesiadivergens. this is used in cattle to immunize them in a few countries as anti-babesiosis vaccine. Development of frozen vaccine allows for complete testing after production of each batch, However, once thawed, its reduced its shelf life, frozen vaccines are more difficult to transport as well as expensive to produce as compared to chilled vaccine. The contamination of blood derived vaccine has the potential risk that makes pre-production and post-production quality control necessary. For the trail master seed production of whole blood frozen bivalent Babesia(Babesiabovis and Babesiabigemina), 100 blood samples of Babesial positive suspected cattle was taken and processed for separation microscopic detection and rectification by PCR. Vaccine passages were done to reduce the parasitaemiasis in live calves. After 8 passages, parasitemia of Babesia reduced from 80% to 15%. Infected donor calf’s blood was taken by jugular cannulation by using preservative free lithium heparin as an anticoagulant (5 International Units IU heparin/ml blood). In lab, parasite containing blood was mixed in equal volumes with 3 M glycerol in PBS supplemented with 5 mM glucose (final concentration of glycerol 1.5 M) at 37°C. The mixture was then equilibrized at 37°C for 30 minutes and were dispensed in required containers (e.g., 5 ml cryovials).Keywords: distribution, babesia, primer sequences, PCV
Procedia PDF Downloads 1042936 Pattern of Adverse Drug Reactions with Platinum Compounds in Cancer Chemotherapy at a Tertiary Care Hospital in South India
Authors: Meena Kumari, Ajitha Sharma, Mohan Babu Amberkar, Hasitha Manohar, Joseph Thomas, K. L. Bairy
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Aim: To evaluate the pattern of occurrence of adverse drug reactions (ADRs) with platinum compounds in cancer chemotherapy at a tertiary care hospital. Methods: It was a retrospective, descriptive case record study done on patients admitted to the medical oncology ward of Kasturba Hospital, Manipal from July to November 2012. Inclusion criteria comprised of patients of both sexes and all ages diagnosed with cancer and were on platinum compounds, who developed at least one adverse drug reaction during or after the treatment period. CDSCO proforma was used for reporting ADRs. Causality was assessed using Naranjo Algorithm. Results: A total of 65 patients was included in the study. Females comprised of 67.69% and rest males. Around 49.23% of the ADRs were seen in the age group of 41-60 years, followed by 20 % in 21-40 years, 18.46% in patients over 60 years and 12.31% in 1-20 years age group. The anticancer agents which caused adverse drug reactions in our study were carboplatin (41.54%), cisplatin (36.92%) and oxaliplatin (21.54%). Most common adverse drug reactions observed were oral candidiasis (21.53%), vomiting (16.92%), anaemia (12.3%), diarrhoea (12.3%) and febrile neutropenia (0.08%). The results of the causality assessment of most of the cases were probable. Conclusion: The adverse effect of chemotherapeutic agents is a matter of concern in the pharmacological management of cancer as it affects the quality of life of patients. This information would be useful in identifying and minimizing preventable adverse drug reactions while generally enhancing the knowledge of the prescribers to deal with these adverse drug reactions more efficiently.Keywords: adverse drug reactions, platinum compounds, cancer, chemotherapy
Procedia PDF Downloads 4292935 Interaction of Metals with Non-Conventional Solvents
Authors: Evgeny E. Tereshatov, C. M. Folden
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Ionic liquids and deep eutectic mixtures represent so-called non-conventional solvents. The former, composed of discrete ions, is a salt with a melting temperature below 100°С. The latter, consisting of hydrogen bond donors and acceptors, is a mixture of at least two compounds, resulting in a melting temperature depression in comparison with that of the individual moiety. These systems also can be water-immiscible, which makes them applicable for metal extraction. This work will cover interactions of In, Tl, Ir, and Rh in hydrochloric acid media with eutectic mixtures and Er, Ir, and At in a gas phase with chemically modified α-detectors. The purpose is to study chemical systems based on non-conventional solvents in terms of their interaction with metals. Once promising systems are found, the next step is to modify the surface of α-detectors used in the online element production at cyclotrons to get the detector chemical selectivity. Initially, the metal interactions are studied by means of the liquid-liquid extraction technique. Then appropriate molecules are chemisorbed on the surrogate surface first to understand the coating quality. Finally, a detector is covered with the same molecule, and the metal sorption on such detectors is studied in the online regime. It was found that chemical treatment of the surface can result in 99% coverage with a monolayer formation. This surface is chemically active and can adsorb metals from hydrochloric acid solutions. Similarly, a detector surface was modified and tested during cyclotron-based experiments. Thus, a procedure of detectors functionalization has been developed, and this opens an interesting opportunity of studying chemisorption of elements which do not have stable isotopes.Keywords: mechanism, radioisotopes, solvent extraction, gas phase sorption
Procedia PDF Downloads 1022934 Knowledge, Attitude and Practices Regarding Advance Directives among Resident Physicians in Vicente Sotto Memorial Medical Center
Authors: Marica Pidor-Quingco, Francis Cabatingan
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Background: One of the essential roles of a physician is to assess a patient’s worth and support them in making decisions regarding their future preferences when it comes to medical care. Advance Directives is a patient-centered approach which is liked to a better-quality treatment at the end of life. General Objective: To assess and describe the knowledge, attitudes and practices of resident physicians regarding advance directive among the resident physicians in Vicente Sotto Memorial Medical Study. Methods: An analytical cross-sectional study was conducted at Vicente Sotto Memorial Medical Center. There was a total of 129 respondents who gave their consent and was given survey questionnaire containing the demographic profile, knowledge, attitude and practices. Categorical variables were presented as frequency and percentage. Chi Square Test was used to determine the association of demographic profile with knowledge and attitude. Man-Whitney U test was utilized for the association of age with knowledge and attitude. Results: Out of 129 respondents, 36.59% were in favor towards self-determination and autonomy. Majority of the revealed an adequate knowledge and positive attitude regarding advance directives. Based on the results, there were no significant correlations between sociodemographic of the residents towards to knowledge and attitude. Over 66.7% of the respondents had used Advance Directives to their patients but 25% were not comfortable about it. Though most of the respondents was able to discuss AD with their patients, 7.0% of them are not willing to open the topic to the family. Conclusion: VSMMC is a tertiary hospital which also caters Hospice, Palliative and Supportive care to the patients. One of the services offered is initiating Advance Directives which may be a factor for a positive knowledge, attitude and practices towards this topic.Keywords: advance directives, philippines, physicians, palliative
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