Search results for: emerging pathogens
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2387

Search results for: emerging pathogens

977 The Impact of Two Factors on EFL Learners' Fluency

Authors: Alireza Behfar, Mohammad Mahdavi

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Nowadays, in the light of progress in the world of science, technology and communications, mastery of learning international languages is a sure and needful matter. In learning any language as a second language, progress and achieving a desirable level in speaking is indeed important for approximately all learners. In this research, we find out how preparation can influence L2 learners' oral fluency with respect to individual differences in working memory capacity. The participants consisted of sixty-one advanced L2 learners including MA students of TEFL at Isfahan University as well as instructors teaching English at Sadr Institute in Isfahan. The data collection consisted of two phases: A working memory test (reading span test) and a picture description task, with a one-month interval between the two tasks. Speaking was elicited through speech generation task in which the individuals were asked to discuss four topics emerging in two pairs. The two pairs included one simple and one complex topic and was accompanied by planning time and without any planning time respectively. Each topic was accompanied by several relevant pictures. L2 fluency was assessed based on preparation. The data were then analyzed in terms of the number of syllables, the number of silent pauses, and the mean length of pauses produced per minute. The study offers implications for strategies to improve learners’ both fluency and working memory.

Keywords: two factors, fluency, working memory capacity, preparation, L2 speech production reading span test picture description

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976 L. rhamnosus GG Lysate Can Inhibit Cytotoxic Effects of S. aureus on Keratinocytes in vitro

Authors: W. Mohammed Saeed, A. J. Mcbain, S. M. Cruickshank, C. A. O’Neill

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In the gut, probiotics have been shown to protect epithelial cells from pathogenic bacteria through a number of mechanisms: 1-Increasing epithelial barrier function, 2-Modulation of the immune response especially innate immune response, 3-Inhibition of pathogen adherence and down regulation of virulence factors. Since probiotics have positive impacts on the gut, their potential effects on other body tissues, such as skin have begun to be investigated. The purpose of this project is to characterize the potential of probiotic bacteria lysate as therapeutic agent for preventing or reducing the S. aureus infection. Normal human primary keratinocytes (KCs) were exposed to S. aureus (106/ml) in the presence or absence of L. rhamnosus GG lysate (extracted from 108cfu/ml). The viability of the KCs was measured after 24 hours using a trypan blue exclusion assay. When KCs were treated with S aureus alone, only 25% of the KCs remained viable at 24 hours post infection. However, in the presence of L. rhamnosus GG lysate the viability of pathogen infected KCs increased to 58% (p=0.008, n=3). Furthermore, when KCs co-exposed, pre- exposed or post-exposed to L. rhamnosus GG lysate, the viability of the KCs increased to ≈60%, the L. rhamnosus GG lysate was afforded equal protection in different conditions. These data suggests that two possible separate mechanisms are involved in the protective effects of L. rhamnosus GG such as reducing S. aureus growth, or inhibiting of pathogenic adhesion. Interestingly, a lysate of L rhamnosus GG provided significant reduction in S. aureus growth and adhesion of S. aureus that being viable following 24 hours incubation with S aureus. Therefore, a series of Liquid Chromatography (RP-LC) methods were adopted to partially purify the lysate in combination with functional assays to elucidate in which fractions the efficacious molecules were contained. In addition, the Mass Spectrometry-based protein sequencing was used to identify putative proteins in the fractions. The data presented from purification process demonstrated that L. rhamnosus GG lysate has the potential to protect keratinocytes from the toxic effects of the skin pathogen, S. aureus. Three potential mechanisms were identified: inhibition of pathogen growth; competitive exclusion; and displacement of the pathogen from keratinocyte binding sites. In this study, ‘moonlight’ proteins were identified in the current study’s MS/MS data for L. rhamnosus GG lysate, which could elucidate the ability of lysate in the competitive exclusion and displacement of S. aureus from keratinocyte binding sites. Taken together, it can be speculated that L. rhamnosus GG lysate utilizes different mechanisms to protect keratinocytes from S. aureus toxicity. The present study indicates that the proteinaceous substances are involved in anti-adhesion activity. This is achieved by displacing the pathogen and preventing the severity of pathogen infection and the moonlight proteins might be involved in inhibiting the adhesion of pathogens.

Keywords: lysate, fractions, adhesion, L. rhamnosus GG, S. aureus toxicity

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975 Exploring the Impact of Artificial Intelligence (AI) in the Context of English as a Foreign Language (EFL): A Comprehensive Bibliometric Study

Authors: Kate Benedicta Amenador, Dianjian Wang, Bright Nkrumah

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This extensive bibliometric study explores the dynamic influence of artificial intelligence in the field of English as a Foreign Language (EFL) between 2012 and 2024. The study, which examined 4,500 articles from Google Scholar, Modern Language Association Linguistics Abstracts, Web of Science, Scopus, Researchgate, and library genesis databases, indicates that AI integration in EFL is on the rise. This notable increase is ascribed to a variety of transformative events, including increased academic funding for higher education and the COVID-19 epidemic. The results of the study identify leading contributors, prominent authors, publishers and sources, with the United States, China and the United Kingdom emerging as key contributors. The co-occurrence analysis of key terms reveals five clusters highlighting patterns in AI-enhanced language instruction and learning, including evaluation strategies, educational technology, learning motivation, EFL teaching aspects, and learner feedback. The study also discusses the impact of various AIs in enhancing EFL writing skills with software such as Grammarly, Quilbot, and Chatgpt. The current study recognizes limitations in database selection and linguistic constraints. Nevertheless, the results provide useful insights for educators, researchers and policymakers, inspiring and guiding a cross-disciplinary collaboration and creative pedagogical techniques and approaches to teaching and learning in the future.

Keywords: artificial intelligence, bibliometrics study, VOSviewer visualization, English as a foreign language

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974 Dental Ethics versus Malpractice, as Phenomenon with a Growing Trend

Authors: Saimir Heta, Kers Kapaj, Rialda Xhizdari, Ilma Robo

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Dealing with emerging cases of dental malpractice with justifications that stem from the clear rules of dental ethics is a phenomenon with an increasing trend in today's dental practice. Dentists should clearly understand how far the limit of malpractice goes, with or without minimal or major consequences, for the affected patient, which can be justified as a complication of dental treatment, in support of the rules of dental ethics in the dental office. Indeed, malpractice can occur in cases of lack of professionalism, but it can also come as a consequence of anatomical and physiological limitations in the implementation of the dental protocols, predetermined and indicated by the patient in the paragraph of the treatment plan in his personal card. This study is of the review type with the aim of the latest findings published in the literature about the problem of dealing with these phenomena. The combination of keywords is done in such a way with the aim to give the necessary space for collecting the right information in the networks of publications about this field, always first from the point of view of the dentist and not from that of the lawyer or jurist. From the findings included in this article, it was noticed the diversity of approaches towards the phenomenon depends on the different countries based on the legal basis that these countries have. There is a lack of or a small number of articles that touch on this topic, and these articles are presented with a limited number of data on the same topic. Conclusions: Dental malpractice should not be hidden under the guise of various dental complications that we justify with the strict rules of ethics for patients treated in the dental chair. The individual experience of dental malpractice must be published with the aim of serving as a source of experience for future generations of dentists.

Keywords: dental ethics, malpractice, professional protocol, random deviation

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973 The Risk of Hyperglycemia Associated with Use of Dolutegravir among Adults Living with HIV in Kampala, Uganda: A Case Control Study

Authors: Daphine Namara, Jeremy I. Schwartz, Andrew K. Tusubira, Willi McFarland, Caroline Birungi, Fred C. Semitala, Martin Muddu

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Emerging evidence suggests a possible association between hyperglycemia and dolutegravir (DTG), a preferred first-line antiretroviral agent in sub-Saharan Africa (SSA). There is a need for rigorous studies to validate this association in the face of increasing DTG use and the burden of non-communicable diseases among people living with HIV (PLHIV). We conducted a case-control study to assess the risk of hyperglycemia associated with the use of DTG among PLHIV attending Mulago ISS Clinic in Kampala. Cases had hyperglycemia, while controls had no hyperglycemia, as confirmed by fasting plasma glucose and oral glucose tolerance tests. Demographic, laboratory, and clinical data were collected using interviewer-administered questionnaires and medical record abstraction. The analysis compared cases and controls on DTG use prior to diagnosis of hyperglycemia while controlling for potential confounders using multivariable logistic regression. We included 204 cases and 231 controls. In multivariable analysis, patients with prior DTG use had seven times greater odds of subsequent diagnosis of hyperglycemia compared to those who had non-DTG-based regimens (adjusted odds ratio [aOR] 7.01, 95% CI 1.96-25.09). The odds of hyperglycemia also increased with age (56 years and above vs. 18-35, aOR 12.38, 95% CI 3.79-40.50) and hypertension (aOR 5.78, 95% CI 2.53-13.21). Our study demonstrates a strong association between prior DTG exposure and subsequent diagnosis of hyperglycemia. Given the benefits of DTG, wide-scale use, and the growing burden of diabetes mellitus (DM) in SSA, there is a need for systematic screening for hyperglycemia and consideration of alternate regimens for those at risk for DM.

Keywords: HIV, hyperglycemia, doluteravir, diabetes

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972 New Employee on-Boarding Program: Effective Tool for Reducing the Prevalence of Workplace Injuries/Accidents

Authors: U. Ugochukwu, J. Lee, P. Conley

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According to a recent survey by the UT Southwestern Workplace Safety Committee, the three most common on-the-job injuries reported by workers at the medical center are musculoskeletal injuries, slip-and-fall injuries and repetitive motion injuries. Last year alone, of the 650 documented workplace injuries and accidents, 45% were seen in employees in their first-two years of employment. UT Southwestern New Employee On-Boarding program was created and modeled to follows OSHA’s model that consist of: determining if training is needed, identifying training needs, identifying goals and objectives, developing learning activities, conducting the training, evaluating program effectiveness, and improving the program. The hospital’s management best practices were recreated to limit and control workplace injuries and accidents. Regular trainings and workshops on workplace safety and compliance were initiated for new employees. Various computer workstations were evaluated and recommendations were made to reduce musculoskeletal disorders. Post exposure protocols and workers protection programs were remodeled for infectious agents and chemicals used in the hospital, and medical surveillance programs were updated, for every emerging threat, to ensure they are in compliance with the US policy, regulatory and standard setting organizations. If ignorance of specific job hazards and of proper work practices is to blame for this higher injury rate, then training will help to provide a solution. Use of this program in training activities is just one of many ways UT Southwestern complied with the OSHA standards that relate to training while enhancing the safety and health of their employees.

Keywords: ergonomics, hazard, on-boarding, surveillance, workplace

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971 Short-Term Effects of Environmentally Relevant Concentrations of Organic UV Filters on Signal Crayfish Pacifastacus Leniusculus

Authors: Viktoriia Malinovska, Iryna Kuklina, Katerina Grabicova, Milos Buric, Pavel Kozak

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Personal care products, including organic UV filters, are considered emerging contaminants and their toxic effects have been a concern for the last decades. Sunscreen compounds continually enter the surface waters via sewage water treatment due to incomplete removal and during human recreational and laundry activities. Despite the environmental occurrence of organic UV filters in the freshwater environment, little is known about their impacts on aquatic biota. In this study, environmentally relevant concentrations of 5-Benzoyl-4-hydroxy-2-methoxybenzenesulfonic acid (BP-4, 2.5 µg/L) and 2-Phenylbenzimidazole-5-sulfonic acid (PBSA, 3 µg/L) were used to evaluate the cardiac and locomotor responses of signal crayfish Pacifastacus leniusculus during a short time period. The effects of these compounds were evident in experimental animals. Specimens exposed to both tested compounds exhibited significantly bigger changes in distance moved and time movement than controls. Significant differences in changes in mean heart rate were detected in both PBSA and BP-4 experimental groups compared to control groups. Such behavioral and physiological alterations demonstrate the ecological effects of selected sunscreen compounds during a short time period. Since the evidence of the impacts of sunscreen compounds is scarce, the knowledge of how organic UV filters influence aquatic organisms is of key importance for future research.

Keywords: aquatic pollutants, behavior, freshwaters, heart rate, invertebrate

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970 Evolution of Germany’s Feed-in Tariff Policy

Authors: Gaafar Muhammed, N. T. Ersoy

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The role of electricity in the economic development of any country is undeniable. The main goal of utilizing renewable sources in electricity generation, especially in the emerging countries, is to improve electricity access, economic development and energy sustainability. Germany’s recent transition from conventional to renewable energy technologies is overwhelming, this might not be associated with its abundant natural resources but owing to the policies in place. In line with the fast economic and technological developments recorded in recent years, Germany currently produces approximately 1059 GW of its energy from renewable sources. Hence, at the end of 2016, Germany is among the world leaders in terms of installed renewable energy capacity. As one of the most important factors that lead to renewable energy utilization in any nation is an effective policy, this study aims at examining the effect of policies on renewable energy (RE) development in Germany. Also, the study will focus on the evolution of the adopted feed-in tariff policies, as this evolution has affected the renewable energy capacity in Germany over a period of 15 years (2000 to 2015). The main contribution of the study is to establish a link between the feed-in tariff and the increase of RE in Germany’s energy mix. This is done by analyzing the characteristics of various feed-in tariff mechanisms adopted through the years. These characteristics include the feed-in-tariff rate, degression, special conditions, supported technology, etc. Then, the renewable energy development in Germany has been analyzed through the years along with the targets and the progress in reaching these targets. The study reveals that Germany’s renewable energy support policies (especially feed-in tariff) lead to several benefits and contribute towards the targets existing for renewable energy.

Keywords: feed-in tariff, Germany, policy, penewable energy

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969 Agency Cost, Firm Performance, Corporate Governance: Evidence from Indonesia

Authors: Arnold Sanda Layuk

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Fraud in the disclosure of financial statements by management shows that agency conflict is an important issue in the company. The conflict has consequences for the agency costs that must be borne and has an impact on the firm's performance. The effect of agency costs on firm performance is investigated in this study, as well as whether several variables such as corporate governance mechanisms can positively moderate the agency cost and firm performance relationship. The agency cost is measured by the asset utilization ratio and discretionary expenditure ratio. The firm's performance is represented by the return on equity. Data was collected from the manufacturing companies listed on the Indonesia Stock Exchange from 2015 to 2019, then regressed on the panel data using the panel corrected standard error model (PCSE). According to the findings, agency costs are negatively related to firm performance, which supports previous empirical research findings. It also found that the agency cost and firm performance relationship is significantly moderated by board size and ownership concentration as the representatives of corporate governance mechanisms. It suggests that corporate governance can become tools to reduce agency costs and increase firm performance as well. The empirical evidence adds to previous research on agency conflict, particularly in emerging markets. These findings are expected to supplement previous research and provide additional information to shareholders in order to control opportunistic management decisions that affect their investments and discretionary operational expenses.

Keywords: agency cost, corporate governance, asset utilization ratio, firm performance

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968 Compositional Dependence of Hydroxylated Indium-Oxide on the Reaction Rate of CO2/H2 Reduction

Authors: Joel Y. Y. Loh, Geoffrey A. Ozin, Charles A. Mims, Nazir P. Kherani

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A major goal in the emerging field of solar fuels is to realize an ‘artificial leaf’ – a material that converts light energy in the form of solar photons into chemical energy – using CO2 as a feedstock to generate useful chemical species. Enabling this technology will allow the greenhouse gas, CO2, emitted from energy and manufacturing production exhaust streams to be converted into valuable solar fuels or chemical products. Indium Oxide (In2O3) with surface hydroxyl (OH) groups have been shown to reduce CO2 in the presence of H2 to CO with a reaction rate of 15 μmol gcat−1 h−1. The likely mechanism is via a Frustrated Lewis Pair sites heterolytically splitting H2 to be absorbed and form protonic and hydric sites that can dissociate CO2. In this study, we investigate the dependence of oxygen composition of In2O3 on the CO2 reduction rate. In2O3-x films on quartz fiber paper were DC sputtered with an Indium target and varying O2/Ar plasma mixture. OH surface groups were then introduced by immersing the In2O3-x samples in KOH. We show that hydroxylated In2O3-x reduces more CO2 than non-hydroxylated groups and that a hydroxylated and higher O2/Ar ratio sputtered In2O3-x has a higher reaction rate of 45 μmol gcat-1 h-1. We show by electrical resistivity-temperature curves that H2 is adsorbed onto the surface of In2O3 whereas CO2 itself does not affect the indium oxide surface. We also present activation and ionization energy levels of the hydroxylated In2O3-x under vacuum, CO2 and H2 atmosphere conditions.

Keywords: solar fuels, photocatalysis, indium oxide nanoparticles, carbon dioxide

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967 Properties Optimization of Keratin Films Produced by Film Casting and Compression Moulding

Authors: Mahamad Yousif, Eoin Cunningham, Beatrice Smyth

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Every year ~6 million tonnes of feathers are produced globally. Due to feathers’ low density and possible contamination with pathogens, their disposal causes health and environmental problems. The extraction of keratin, which represents >90% of feathers’ dry weight, could offer a solution due to its wide range of applications in the food, medical, cosmetics, and biopolymer industries. One of these applications is the production of biofilms which can be used for packaging, edible films, drug delivery, wound healing etc. Several studies in the last two decades investigated keratin film production and its properties. However, the effects of many parameters on the properties of the films remain to be investigated including the extraction method, crosslinker type and concentration, and the film production method. These parameters were investigated in this study. Keratin was extracted from chicken feathers using two methods, alkaline extraction with 0.5 M NaOH at 80 °C or sulphitolysis extraction with 0.5 M sodium sulphite, 8 M urea, and 0.25-1 g sodium dodecyl sulphate (SDS) at 100 °C. The extracted keratin was mixed with different types and concentrations of plasticizers (glycerol and polyethylene glycol) and crosslinkers (formaldehyde (FA), glutaraldehyde, cinnamaldehyde, glyoxal, and 1,4-Butanediol diglycidyl ether (BDE)). The mixtures were either cast in a mould or compression moulded to produce films. For casting, keratin powder was initially dissolved in water to form a 5% keratin solution and the mixture was dried in an oven at 60 °C. For compression moulding, 10% water was added and the compression moulding temperature and pressure were in the range of 60-120 °C and 10-30 bar. Finally, the tensile properties, solubility, and transparency of the films were analysed. The films prepared using the sulphitolysis keratin had superior tensile properties to the alkaline keratin and formed successfully with lower plasticizer concentrations. Lowering the SDS concentration from 1 to 0.25 g/g feathers improved all the tensile properties. All the films prepared without crosslinkers were 100% water soluble but adding crosslinkers reduced solubility to as low as 21%. FA and BDE were found to be the best crosslinkers increasing the tensile strength and elongation at break of the films. Higher compression moulding temperature and pressure lowered the tensile properties of the films; therefore, 80 °C and 10 bar were considered to be the optimal compression moulding temperature and pressure. Nevertheless, the films prepared by casting had higher tensile properties than compression moulding but were less transparent. Two optimal films, prepared by film casting, were identified and their compositions were: (a) Sulphitolysis keratin, 20% glycerol, 10% FA, and 10% BDE. (b) Sulphitolysis keratin, 20% glycerol, and 10% BDE. Their tensile strength, elongation at break, Young’s modulus, solubility, and transparency were: (a) 4.275±0.467 MPa, 86.12±4.24%, 22.227±2.711 MPa, 21.34±1.11%, and 8.57±0.94* respectively. (b) 3.024±0.231 MPa, 113.65±14.61%, 10±1.948 MPa, 25.03±5.3%, and 4.8±0.15 respectively. A higher value indicates that the film is less transparent. The extraction method, film composition, and production method had significant influence on the properties of keratin films and should therefore be tailored to meet the desired properties and applications.

Keywords: compression moulding, crosslinker, film casting, keratin, plasticizer, solubility, tensile properties, transparency

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966 Blue Economy and Marine Mining

Authors: Fani Sakellariadou

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The Blue Economy includes all marine-based and marine-related activities. They correspond to established, emerging as well as unborn ocean-based industries. Seabed mining is an emerging marine-based activity; its operations depend particularly on cutting-edge science and technology. The 21st century will face a crisis in resources as a consequence of the world’s population growth and the rising standard of living. The natural capital stored in the global ocean is decisive for it to provide a wide range of sustainable ecosystem services. Seabed mineral deposits were identified as having a high potential for critical elements and base metals. They have a crucial role in the fast evolution of green technologies. The major categories of marine mineral deposits are deep-sea deposits, including cobalt-rich ferromanganese crusts, polymetallic nodules, phosphorites, and deep-sea muds, as well as shallow-water deposits including marine placers. Seabed mining operations may take place within continental shelf areas of nation-states. In international waters, the International Seabed Authority (ISA) has entered into 15-year contracts for deep-seabed exploration with 21 contractors. These contracts are for polymetallic nodules (18 contracts), polymetallic sulfides (7 contracts), and cobalt-rich ferromanganese crusts (5 contracts). Exploration areas are located in the Clarion-Clipperton Zone, the Indian Ocean, the Mid Atlantic Ridge, the South Atlantic Ocean, and the Pacific Ocean. Potential environmental impacts of deep-sea mining include habitat alteration, sediment disturbance, plume discharge, toxic compounds release, light and noise generation, and air emissions. They could cause burial and smothering of benthic species, health problems for marine species, biodiversity loss, reduced photosynthetic mechanism, behavior change and masking acoustic communication for mammals and fish, heavy metals bioaccumulation up the food web, decrease of the content of dissolved oxygen, and climate change. An important concern related to deep-sea mining is our knowledge gap regarding deep-sea bio-communities. The ecological consequences that will be caused in the remote, unique, fragile, and little-understood deep-sea ecosystems and inhabitants are still largely unknown. The blue economy conceptualizes oceans as developing spaces supplying socio-economic benefits for current and future generations but also protecting, supporting, and restoring biodiversity and ecological productivity. In that sense, people should apply holistic management and make an assessment of marine mining impacts on ecosystem services, including the categories of provisioning, regulating, supporting, and cultural services. The variety in environmental parameters, the range in sea depth, the diversity in the characteristics of marine species, and the possible proximity to other existing maritime industries cause a span of marine mining impact the ability of ecosystems to support people and nature. In conclusion, the use of the untapped potential of the global ocean demands a liable and sustainable attitude. Moreover, there is a need to change our lifestyle and move beyond the philosophy of single-use. Living in a throw-away society based on a linear approach to resource consumption, humans are putting too much pressure on the natural environment. Applying modern, sustainable and eco-friendly approaches according to the principle of circular economy, a substantial amount of natural resource savings will be achieved. Acknowledgement: This work is part of the MAREE project, financially supported by the Division VI of IUPAC. This work has been partly supported by the University of Piraeus Research Center.

Keywords: blue economy, deep-sea mining, ecosystem services, environmental impacts

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965 Combating Contraflow to Creativity Amongst Preservice Teachers in Teacher Arts Education

Authors: Michael Flannery, Annie ó Breacháin

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Teaching the creative arts in preservice teacher education can be challenging. Some students find artistic self-expression and its related creative processes overwhelming. Low creative self-efficacy levels and creative habits of mind can impede their levels of motivation, engagement and persistence. For some, creative arts engagement can induce a state of anxiety and distress as opposed to flow. Flow theory posits that learners are happiest when they are learning in a state of flow. During the flow state, students feel, think and perform their best. They become so involved in the learning experience that nothing else seems to matter. The creative flow state is a crucial conduit of artistic processes to enable learners to explore and produce their best work. Despite the research conducted on flow state across several contexts, the phenomenon of personal flow state remains quite elusive. While some research has examined flow in relation to characteristics, conditions and personality traits, no research has investigated individuals' personal experiences of flow in a visual and tangible manner nor explored a relationship between flow state and teachers’ artistic development. This explorative case study explores preservice teachers’ impressions of flow using an arts-based approach. It identifies, categorizes and discusses patterns of commonality and difference. Grounded by theory concerning flow, self-efficacy and creative habits, this study ponders how emerging findings regarding flow impressions might aid teacher arts educators in helping preservice teachers who struggle with creative self-expression.

Keywords: creative arts, flow theory, presence, self-efficacy, teacher education

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964 Control of an Outbreak of Vancomycin-Resistant Enterococci in a Tunisian Teaching Hospital

Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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963 Power Supply by Soil Battery and Production of Hydrogen Fuel for Greenhouse and Space Heating

Authors: Mohsen Azarmjoo, Yasaman Azarmjoo, Zahra Alikhani Koopaei

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The increasing global population and continued growth in energy consumption underscore the need for renewable and sustainable energy sources more than ever. Soil batteries are a method for generating electrical energy by using recycled materials. Recycled materials include galvanized and copper sheets and recycled tires. Additionally, hydrogen, being a clean and efficient fuel, has the potential to replace fossil fuels. Consequently, hydrogen production from water presents a sustainable solution for energy supply. By utilizing aged materials, hydrogen production becomes more cost-effective and environmentally friendly. This article focuses on energy-deprived agricultural lands, explaining how soil batteries and hydrogen can provide the necessary energy for agricultural equipment, such as irrigation, lighting, greenhouse ventilation, and heating. The article explores the benefits of utilizing this method, emphasizing its potential to reduce environmental pollution through the use of recyclable materials. It is worth mentioning that these technologies face challenges, but their progress toward achieving zero-energy consumer standards positions them as promising future technologies for electricity generation. This article provides detailed insights into emerging technologies using a constructed case study involving soil batteries and a hydrogen fuel production device.

Keywords: electricity generation, soil batteries, tires, hydrogen, heat supply, water, aged materials, recycling, agricultural lands

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962 Counselor and Object of Hate: A Case Study of Latina Clinician and Two White Supremacist Patients

Authors: Reagan Rodriguez

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The following research is a case study of two white patients with white extremist values and their Latina Clinician. Researchers suggest that white supremacy as an ideology has been documented in the United States since the early 1800s. Ethnicity and race were growing key factors linked to central motives behind hate crimes in U.S., which may suggest that we are living in another wave of white supremacist and domestic terrorism that seek to eradicate a threatening and dangerous “other”. This research seeks to address and contribute a qualitative perspective to white supremacist ideology within a bio-psycho-social framework. The current research seeks to contribute to address the gap in literature on ethnic minority clinicians and white patients with racist ideology. The research also seeks to examine the themes not commonly found in racially matched and gendered matched therapeutic dyads where patients hold white extremist values. This case study examines white supremacist ideology from a psychodynamic perspective, examining themes such as “feeling forgotten”, reduced empathy related to “broken promises”, sexualization of the passing minority counselor, and utilizing minimal autonomy in verbal and non-verbal signals. A thematic analysis of case notes and quotes are used to further contextualize emerging therapeutic themes and the psychodynamic analysis of the manifestation of white supremacist actions ranging from active to passive forms of violence.

Keywords: case study, extremism, race and gender, white supremacist ideology

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961 A Preliminary Literature Review of Digital Transformation Case Studies

Authors: Vesna Bosilj Vukšić, Lucija Ivančić, Dalia Suša Vugec

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While struggling to succeed in today’s complex market environment and provide better customer experience and services, enterprises encompass digital transformation as a means for reaching competitiveness and foster value creation. A digital transformation process consists of information technology implementation projects, as well as organizational factors such as top management support, digital transformation strategy, and organizational changes. However, to the best of our knowledge, there is little evidence about digital transformation endeavors in organizations and how they perceive it – is it only about digital technologies adoption or a true organizational shift is needed? In order to address this issue and as the first step in our research project, a literature review is conducted. The analysis included case study papers from Scopus and Web of Science databases. The following attributes are considered for classification and analysis of papers: time component; country of case origin; case industry and; digital transformation concept comprehension, i.e. focus. Research showed that organizations – public, as well as private ones, are aware of change necessity and employ digital transformation projects. Also, the changes concerning digital transformation affect both manufacturing and service-based industries. Furthermore, we discovered that organizations understand that besides technologies implementation, organizational changes must also be adopted. However, with only 29 relevant papers identified, research positioned digital transformation as an unexplored and emerging phenomenon in information systems research. The scarcity of evidence-based papers calls for further examination of this topic on cases from practice.

Keywords: digital strategy, digital technologies, digital transformation, literature review

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960 Critically Analyzing the Application of Big Data for Smart Transportation: A Case Study of Mumbai

Authors: Tanuj Joshi

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Smart transportation is fast emerging as a solution to modern cities’ approach mobility issues, delayed emergency response rate and high congestion on streets. Present day scenario with Google Maps, Waze, Yelp etc. demonstrates how information and communications technologies controls the intelligent transportation system. This intangible and invisible infrastructure is largely guided by the big data analytics. On the other side, the exponential increase in Indian urban population has intensified the demand for better services and infrastructure to satisfy the transportation needs of its citizens. No doubt, India’s huge internet usage is looked as an important resource to guide to achieve this. However, with a projected number of over 40 billion objects connected to the Internet by 2025, the need for systems to handle massive volume of data (big data) also arises. This research paper attempts to identify the ways of exploiting the big data variables which will aid commuters on Indian tracks. This study explores real life inputs by conducting survey and interviews to identify which gaps need to be targeted to better satisfy the customers. Several experts at Mumbai Metropolitan Region Development Authority (MMRDA), Mumbai Metro and Brihanmumbai Electric Supply and Transport (BEST) were interviewed regarding the Information Technology (IT) systems currently in use. The interviews give relevant insights and requirements into the workings of public transportation systems whereas the survey investigates the macro situation.

Keywords: smart transportation, mobility issue, Mumbai transportation, big data, data analysis

Procedia PDF Downloads 179
959 Social Media Marketing in Indonesian Social Enterprise: The Effect of Members' Level of Participation on Brand Trust and Brand Commitment

Authors: Irsanti Hasyim, Christian Wibisono, Angela Teressia

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Social enterprises, as one of the way of doing business are on the rise and emerging from the innovations of decades of social initiatives. In simple way, social enterprises use the business platform to achieve social and/or environmental objectives whilst simultaneously seeking a financial return. In Indonesia, the number of social enterprises rapidly grows and most of them were using social media as their business platform. Social Media are perceived as tools for creating online communities of users who share interests, activities, and objectives. Many companies view the use of online communities in social media as a profitable marketing tool from which they can derive several benefits. Through social media, consumers share experiences with and suggest ideas to others while developing new relationships within their communities. Therefore, this study intends to identify the benefits that participants in online communities seek and examine the relationships between members’ levels of participation, brand trust, and brand commitment. Using convenience sampling method, 236 fully answered questioner was collected and used as a sample of this research. The sample of this research consisted of member or follower in several social media from selected social enterprise in Indonesia. Data collected in this research were process by using Partial Least Square and came up with the result that functional benefit and monetary benefit, are only two from five benefits that proposed were the only variable that has significant result even though from APC, ARS and AARS outcomes show that the model can be claimed to be significant.

Keywords: brand trust, brand commitment, social enterprise, social media

Procedia PDF Downloads 237
958 To Cloudify or Not to Cloudify

Authors: Laila Yasir Al-Harthy, Ali H. Al-Badi

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As an emerging business model, cloud computing has been initiated to satisfy the need of organizations and to push Information Technology as a utility. The shift to the cloud has changed the way Information Technology departments are managed traditionally and has raised many concerns for both, public and private sectors. The purpose of this study is to investigate the possibility of cloud computing services replacing services provided traditionally by IT departments. Therefore, it aims to 1) explore whether organizations in Oman are ready to move to the cloud; 2) identify the deciding factors leading to the adoption or rejection of cloud computing services in Oman; and 3) provide two case studies, one for a successful Cloud provider and another for a successful adopter. This paper is based on multiple research methods including conducting a set of interviews with cloud service providers and current cloud users in Oman; and collecting data using questionnaires from experts in the field and potential users of cloud services. Despite the limitation of bandwidth capacity and Internet coverage offered in Oman that create a challenge in adopting the cloud, it was found that many information technology professionals are encouraged to move to the cloud while few are resistant to change. The recent launch of a new Omani cloud service provider and the entrance of other international cloud service providers in the Omani market make this research extremely valuable as it aims to provide real-life experience as well as two case studies on the successful provision of cloud services and the successful adoption of these services.

Keywords: cloud computing, cloud deployment models, cloud service models, deciding factors

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957 Commercialization of Research Outputs in Kenyan Universities

Authors: John Ayisi, Gideon M. Kivengea, George A. Ombakho

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In this emerging era of knowledge economy, universities, as major centres of learning and research, are becoming increasingly important as sources of ideas, knowledge, skills, innovation and technological advances. These ideas can be turned into new products, processes and systems needed to drive their respective national economies, and thus placing universities at the centre of the national innovation systems. Thus, commercialization of research outputs from universities to industry has become an area of strong policy interest in African countries. To assess the level of commercialization of research outputs in Kenyan universities, a standardized questionnaire covering seven sub-sections, namely: University Commercialization Environment, Management of Commercialization Activities, Commercialization Office, Intellectual Property Rights (IPRs), Early Stage Financing and Venture Capital; Industrial Linkages; and Technology Parks and Incubators was administered among a few selected public and private universities. Results show that all the universities have a strategic plan; though not all have innovation and commercialization as part of it. Half the nineteen surveyed universities indicated they have created designated offices for fostering commercialization. Majority have guidelines on IPRs which advocate IP to be co-owned by researcher/university. University-industry linkages are weak. Most universities are taking precursory steps to incentivise and encourage entrepreneurial activities among their academic staff and students, even though the level of resources devoted to them is low. It is recommended that building capacity in entrepreneurship among staff and students and committing more resources to R&D activities hold potential to increased commercialization of university research outputs.

Keywords: commercialization, knowledge, R&D, university

Procedia PDF Downloads 447
956 Knowledge Management for Competitiveness and Performances in Higher Educational Institutes

Authors: Jeyarajan Sivapathasundram

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Knowledge management has been recognised as an emerging factor for being competitive among institutions and performances in firms. As such, being recognised as knowledge rich institution, higher education institutes have to be recognised knowledge management based resources for achieving competitive advantages. Present research picked result out of postgraduate research conducted in knowledge management at non-state higher educational institutes of Sri Lanka. Besides, the present research aimed to discover knowledge management for competition and firm performances of higher educational institutes out of the result produced by the postgraduate study. Besides, the results are found in a pair that developed out of knowledge management practices and the reason behind the existence of the practices. As such, the present research has developed a filter to pick the pairs that satisfy its condition of competition and performance of the firm. As such, the pair, such as benchmarking is practised to be ethically competing through conducting courses. As the postgraduate research tested results of foreign researches in a qualitative paradigm, the finding of the present research are generalise fact for knowledge management for competitiveness and performances in higher educational institutes. Further, the presented research method used attributes which explain competition and performance in its filter to discover the pairs relevant to competition and performances. As such, the fact in regards to knowledge management for competition and performances in higher educational institutes are presented in the publication that the presentation is out of the generalised result. Therefore, knowledge management for competition and performance in higher educational institutes are generalised.

Keywords: competition in and among higher educational institutes, performances of higher educational institutes, noun based filtering, production out of generalisation of a research

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955 Direct Assessment of Cellular Immune Responses to Ovalbumin with a Secreted Luciferase Transgenic Reporter Mouse Strain IFNγ-Lucia

Authors: Martyna Chotomska, Aleksandra Studzinska, Marta Lisowska, Justyna Szubert, Aleksandra Tabis, Jacek Bania, Arkadiusz Miazek

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Objectives: Assessing antigen-specific T cell responses is of utmost importance for the pre-clinical testing of prototype vaccines against intracellular pathogens and tumor antigens. Mainly two types of in vitro assays are used for this purpose 1) enzyme-linked immunospot (ELISpot) and 2) intracellular cytokine staining (ICS). Both are time-consuming, relatively expensive, and require manual dexterity. Here, we assess if a straightforward detection of luciferase activity in blood samples of transgenic reporter mice expressing a secreted Lucia luciferase under the transcriptional control of IFN-γ promoter parallels the sensitivity of IFNγ ELISpot assay. Methods: IFN-γ-LUCIA mouse strain carrying multiple copies of Lucia luciferase transgene under the transcriptional control of IFNγ minimal promoter were generated by pronuclear injection of linear DNA. The specificity of transgene expression and mobilization was assessed in vitro using transgenic splenocytes exposed to various mitogens. The IFN-γ-LUCIA mice were immunized with 50mg of ovalbumin (OVA) emulsified in incomplete Freund’s adjuvant three times every two weeks by subcutaneous injections. Blood samples were collected before and five days after each immunization. Luciferase activity was assessed in blood serum. Peripheral blood mononuclear cells were separated and assessed for frequencies of OVA-specific IFNγ-secreting T cells. Results: We show that in vitro cultured splenocytes of IFN-γ-LUCIA mice respond by 2 and 3 fold increase in secreted luciferase activity to T cell mitogens concanavalin A and phorbol myristate acetate, respectively but fail to respond to B cell-stimulating E.coli lipopolysaccharide. Immunization of IFN-γ-LUCIA mice with OVA leads to over 4 fold increase in luciferase activity in blood serum five days post-immunization with a barely detectable increase in OVA-specific, IFNγ-secreting T cells by ELISpot. Second and third immunizations, further increase the luciferase activity and coincidently also increase the frequencies of OVA-specific T cells by ELISpot. Conclusions: We conclude that minimally invasive monitoring of luciferase secretions in blood serum of IFN-γ-LUCIA mice constitutes a sensitive method for evaluating primary and memory Th1 responses to protein antigens. As such, this method may complement existing methods for rapid immunogenicity assessment of prototype vaccines.

Keywords: ELISpot, immunogenicity, interferon-gamma, reporter mice, vaccines

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954 Internet Economy: Enhancing Information Communication Technology Adaptation, Service Delivery, Content and Digital Skills for Small Holder Farmers in Uganda

Authors: Baker Ssekitto, Ambrose Mbogo

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The study reveals that indeed agriculture employs over 70% of Uganda’s population, of which majority are youth and women. The study further reveals that over 70% of the farmers are smallholder farmers based in rural areas, whose operations are greatly affected by; climate change, weak digital skills, limited access to productivity knowledge along value chains, limited access to quality farm inputs, weak logistics systems, limited access to quality extension services, weak business intelligence, limited access to quality markets among others. It finds that the emerging 4th industrial revolution powered by artificial intelligence, 5G and data science will provide possibilities of addressing some of these challenges. Furthermore, the study finds that despite rapid development of ICT4Agric Innovation, their uptake is constrained by a number of factors including; limited awareness of these innovations, low internet and smart phone penetration especially in rural areas, lack of appropriate digital skills, inappropriate programmes implementation models which are project and donor driven, limited articulation of value addition to various stakeholders among others. Majority of farmers and other value chain actors lacked knowledge and skills to harness the power of ICTs, especially their application of ICTs in monitoring and evaluation on quality of service in the extension system and farm level processes.

Keywords: artificial intelligence, productivity, ICT4agriculture, value chain, logistics

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953 Unintended Health Inequity: Using the Relationship Between the Social Determinants of Health and Employer-Sponsored Health Insurance as a Catalyst for Organizational Development and Change

Authors: Dinamarie Fonzone

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Employer-sponsored health insurance (ESI) strategic decision-making processes rely on financial analysis to guide leadership in choosing plans that will produce optimal organizational spending outcomes. These financial decision-making methods have not abated ESI costs. Previously unrecognized external social determinants, the impact on ESI plan spending, and other organizational strategies are emerging and are important considerations for organizational decision-makers and change management practitioners. The purpose of thisstudy is to examine the relationship between the social determinants of health (SDoH), employer-sponsored health insurance (ESI) plans, andthe unintended consequence of health inequity. A quantitative research design using selectemployee records from an existing employer human capital management database will be analyzed. Statistical regressionmethods will be used to study the relationships between certainSDoH (employee income, neighborhood geographic living area, and health care access) and health plan utilization, cost, and chronic disease prevalence. The discussion will include an application of the social gradient of health theory to the study findings, organizational transformation through changes in ESI decision-making mental models, and the connection of ESI health inequity to organizational development and changediversity, equity, and inclusion strategies.

Keywords: employer-sponsored health insurance, social determinants of health, health inequity, mental models, organizational development, organizational change, social gradient of health theory

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952 Taking the Whole Picture to Your Supply Chain; Customers Will Take Selfies When Expectations Are Met

Authors: Marcelo Sifuentes López

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Strategic performance definition and follow-up processes have to be clear in order to provide value in today’s competitive world. Customer expectations must be linked to internal organization strategic objectives leading to profitability and supported by visibility and flexibility among others.By taking a whole picture of the supply chain, the executive, and its team will define the current supply chain situation and an insight into potential opportunities to improve processes and provide value to main stakeholders. A systematic performance evaluation process based on operational and financial indicators defined by customer requirements needs to be implemented and periodically reviewed in order to mitigate costs and risks on time.Supplier long term relationship and collaboration plays a key role using resources available, real-time communication, innovation and new ways to capitalize global opportunities like emerging markets; efforts have to focus on the reduction of uncertainties in supply and demand. Leadership has to promote consistency of communication and execution involving suppliers, customers, and the entire organization through the support of a strategic sourcing methodology that assure the targeted competitive strategy and sustainable growth. As customer requirements and expectations are met, results could be captured in a casual picture like a “selfie”; where outcomes could be perceived from any desired angle by them; or like most “selfies”, can be taken with a camera held at arm's length by a third party company rather than using a self-timer.

Keywords: supply chain management, competitive advantage, value creation, collaboration and innovation, global marketplace

Procedia PDF Downloads 442
951 Innovative Approaches to Water Resources Management: Addressing Challenges through Machine Learning and Remote Sensing

Authors: Abdelrahman Elsehsah, Abdelazim Negm, Eid Ashour, Mohamed Elsahabi

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Water resources management is a critical field that encompasses the planning, development, conservation, and allocation of water resources to meet societal needs while ensuring environmental sustainability. This paper reviews the key concepts and challenges in water resources management, emphasizing the significance of a holistic approach that integrates social, economic, and environmental factors. Traditional water management practices, characterized by supply-oriented strategies and centralized control, are increasingly inadequate in addressing contemporary challenges such as water scarcity, climate change impacts, and ecosystem degradation. Emerging technologies, particularly machine learning and remote sensing, offer innovative solutions to enhance decision-making processes in water management. Machine learning algorithms facilitate accurate water demand forecasting, quality monitoring, and leak detection, while remote sensing technologies provide vital data for assessing water availability and quality. This review highlights the need for integrated water management strategies that leverage these technologies to promote sustainable practices and foster resilience in water systems. Future research should focus on improving data quality, accessibility, and the integration of diverse datasets to optimize the benefits of these technological advancements.

Keywords: water resources management, water scarcity, climate change, machine learning, remote sensing, water quality, water governance, sustainable practices, ecosystem management

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950 Incorporating Morality Standards in eLearning Process at INU

Authors: Khader Musbah Titi

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In this era, traditional education systems do not meet the new challenges created by emerging technologies. On the other hand, eLearning offers all the necessary tools to meet these challenges. Using the Internet has brought numerous benefits to most educational institutions; it has also stretched traditional problems of plagiarism, cheating, stealing, vandalism, and spying into the cyberspace. This research discusses these issues in an eLearning environment. It attempts to provide suggestions and possible solutions to some of these issues. The main aim of this research is to conduct a survey at Irbid National University (INU), one of the oldest and biggest universities in Jordan, to study information related to moral and ethical issues in e-learning environment that affect the construction of the students’ characters in the future. The study will focus on student’s behavior and actions through the Internet using Learning Management System (LMS). Another aim of this research is to analyze the opinions of the instructors and last year students at INU about ethical behavior and interaction through LMS. The results show that educational institutes that use LMS should focus on student character development along with field knowledge. According to disadvantages, the results of the study showed that most of students behave unethically in their online activities (cheating, plagiarism, copy/paste etc.) while studying online courses through LMS. The result showed that instructors play a major role in the character development of students. The result also showed that academic institute must have variant mechanisms and strict policy in LMS to control unethical actions of students.

Keywords: LMS, cyber ethics, e-learning, IT ethics, students’ behaviors

Procedia PDF Downloads 243
949 Predictive Pathogen Biology: Genome-Based Prediction of Pathogenic Potential and Countermeasures Targets

Authors: Debjit Ray

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Horizontal gene transfer (HGT) and recombination leads to the emergence of bacterial antibiotic resistance and pathogenic traits. HGT events can be identified by comparing a large number of fully sequenced genomes across a species or genus, define the phylogenetic range of HGT, and find potential sources of new resistance genes. In-depth comparative phylogenomics can also identify subtle genome or plasmid structural changes or mutations associated with phenotypic changes. Comparative phylogenomics requires that accurately sequenced, complete and properly annotated genomes of the organism. Assembling closed genomes requires additional mate-pair reads or “long read” sequencing data to accompany short-read paired-end data. To bring down the cost and time required of producing assembled genomes and annotating genome features that inform drug resistance and pathogenicity, we are analyzing the performance for genome assembly of data from the Illumina NextSeq, which has faster throughput than the Illumina HiSeq (~1-2 days versus ~1 week), and shorter reads (150bp paired-end versus 300bp paired end) but higher capacity (150-400M reads per run versus ~5-15M) compared to the Illumina MiSeq. Bioinformatics improvements are also needed to make rapid, routine production of complete genomes a reality. Modern assemblers such as SPAdes 3.6.0 running on a standard Linux blade are capable in a few hours of converting mixes of reads from different library preps into high-quality assemblies with only a few gaps. Remaining breaks in scaffolds are generally due to repeats (e.g., rRNA genes) are addressed by our software for gap closure techniques, that avoid custom PCR or targeted sequencing. Our goal is to improve the understanding of emergence of pathogenesis using sequencing, comparative genomics, and machine learning analysis of ~1000 pathogen genomes. Machine learning algorithms will be used to digest the diverse features (change in virulence genes, recombination, horizontal gene transfer, patient diagnostics). Temporal data and evolutionary models can thus determine whether the origin of a particular isolate is likely to have been from the environment (could it have evolved from previous isolates). It can be useful for comparing differences in virulence along or across the tree. More intriguing, it can test whether there is a direction to virulence strength. This would open new avenues in the prediction of uncharacterized clinical bugs and multidrug resistance evolution and pathogen emergence.

Keywords: genomics, pathogens, genome assembly, superbugs

Procedia PDF Downloads 198
948 Innovations in International Trauma Education: An Evaluation of Learning Outcomes and Community Impact of a Guyanese trauma Training Graduate Program

Authors: Jeffrey Ansloos

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International trauma education in low and emerging economies requires innovative methods for capacity building in existing social service infrastructures. This study details the findings of a program evaluation used to assess the learning outcomes and community impact of an international trauma-focused graduate degree program in Guyana. Through a collaborative partnership between Lesley University, the Government of Guyana, and UNICEF, a 2-year low-residency masters degree graduate program in trauma-focused assessment, intervention, and treatment was piloted with a cohort of Guyanese mental health professionals. Through an analytical review of the program development, as well as qualitative data analysis of participant interviews and focus-groups, this study will address the efficacy of the programming in terms of preparedness of professionals to understand, evaluate and implement trauma-informed practices across various child, youth, and family mental health service settings. Strengths and limitations of this international trauma-education delivery model will be discussed with particular emphasis on the role of capacity-building interventions, community-based participatory curriculum development, innovative technological delivery platforms, and interdisciplinary education. Implications for further research and subsequent program development will be discussed.

Keywords: mental health promotion, global health promotion, trauma education, innovations in education, child, youth, mental health education

Procedia PDF Downloads 367