Search results for: three stage sample surveys
Commenced in January 2007
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Edition: International
Paper Count: 9915

Search results for: three stage sample surveys

8475 Trajectories of Depression Anxiety and Stress among Breast Cancer Patients: Assessment at First Year of Diagnosis

Authors: Jyoti Srivastava, Sandhya S. Kaushik, Mallika Tewari, Hari S. Shukla

Abstract:

Little information is available about the development of psychological well being over time among women who have been undergoing treatment for breast cancer. The aim of this study was to identify the trajectories of depression anxiety and stress among women with early-stage breast cancer. Of the 48 Indian women with newly diagnosed early-stage breast cancer recruited from surgical oncology unit, 39 completed an interview and were assessed for depression anxiety and stress (Depression Anxiety Stress Scale-DASS 21) before their first course of chemotherapy (baseline) and follow up interviews at 3, 6 and 9 months thereafter. Growth mixture modeling was used to identify distinct trajectories of Depression Anxiety and Stress symptoms. Logistic Regression analysis was used to evaluate the characteristics of women in distinct groups. Most women showed mild to moderate level of depression and anxiety (68%) while normal to mild level of stress (71%). But one in 11 women was chronically anxious (9%) and depressed (9%). Young age, having a partner, shorter education and receiving chemotherapy but not radiotherapy might characterize women whose psychological symptoms remain strong nine months after diagnosis. By looking beyond the mean, it was found that several socio-demographic and treatment factors characterized the women whose depression, anxiety and stress level remained severe even nine months after diagnosis. The results suggest that support provided to cancer patients should have a special focus on a relatively small group of patient most in need.

Keywords: psychological well being, growth mixture modeling, logistic regression analysis, socio-demographic factors

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8474 The Effects of Virtual Reality Technology in Maternity Delivery: A Systematic Review and Meta-Analysis

Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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8473 Subjectivity in Miracle Aesthetic Clinic Ambient Media Advertisement

Authors: Wegig Muwonugroho

Abstract:

Subjectivity in advertisement is a ‘power’ possessed by advertisements to construct trend, concept, truth, and ideology through subconscious mind. Advertisements, in performing their functions as message conveyors, use such visual representation to inspire what’s ideal to the people. Ambient media is advertising medium making the best use of the environment where the advertisement is located. Miracle Aesthetic Clinic (Miracle) popularizes the visual representation of its ambient media advertisement through the omission of face-image of both female mannequins that function as its ambient media models. Usually, the face of a model in advertisement is an image commodity having selling values; however, the faces of ambient media models in Miracle advertisement campaign are suppressed over the table and wall. This face concealing aspect creates not only a paradox of subjectivity but also plurality of meaning. This research applies critical discourse analysis method to analyze subjectivity in obtaining the insight of ambient media’s meaning. First, in the stage of textual analysis, the embedding attributes upon female mannequins imply that the models are denoted as the representation of modern women, which are identical with the identities of their social milieus. The communication signs aimed to be constructed are the women who lose their subjectivities and ‘feel embarrassed’ to flaunt their faces to the public because of pimples on their faces. Second, in the stage of analysis of discourse practice, it points out that ambient media as communication media has been comprehensively responded by the targeted audiences. Ambient media has a role as an actor because of its eyes-catching setting, and taking space over the area where the public are wandering around. Indeed, when the public realize that the ambient media models are motionless -unlike human- stronger relation then appears, marked by several responses from targeted audiences. Third, in the stage of analysis of social practice, soap operas and celebrity gossip shows on the television become a dominant discourse influencing advertisement meaning. The subjectivity of Miracle Advertisement corners women by the absence of women participation in public space, the representation of women in isolation, and the portrayal of women as an anxious person in the social rank when their faces suffered from pimples. The Ambient media as the advertisement campaign of Miracle is quite success in constructing a new trend discourse of face beauty that is not limited on benchmarks of common beauty virtues, but the idea of beauty can be presented by ‘when woman doesn’t look good’ visualization.

Keywords: ambient media, advertisement, subjectivity, power

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8472 Dynamics of Plant Communities with Chamaerops humilis in the Region of Tlemcen

Authors: O. Hasnaoui, A. Bekkouche, A. Mostefai, M. Bouazza

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The region of Tlemcen (west Algeria) is known by their very important floral diversity bound to the conjugation of the multiple factors. Chamaerops humilis covers a big surface in this region, which appears in the majority of the cases in the form of more or less degraded matorral. Our work is dedicated to the comparative analysis of the groupings in chamaeropaie of the mounts of Tlemcen and mounts of traras, based on a phytoécologique approach. Four representative stations of chamaeropaies were retained to make this work. 120 floristic surveys were realized by using a minimal area of 100 m2. The obtained results show that the Mounts of Tlemcen present a wealth more important than those met at the level of the Mounts of Traras. More we go away from the coast towards the Mounts of Tlemcen, we notice a regressive evolution and a transformation of the plant carpet towards a thérophytisation, as well as an accentuation of the aridity.

Keywords: Tlemcen, west Algeria, Chamaerops humilis L., phytoécological, floristic survey, thérophytisation

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8471 Usability Issues of Smart Phone Applications: For Visually Challenged People

Authors: Anam Ashraf, Arif Raza

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In this era of globalization, adoption of technology is quite difficult for people with physical disabilities compared to people with normal abilities. The advancement in mobile based accessible applications has opened up several different avenues for the visually challenged across the globe. Smartphones applications are not very common for blind people, but they access and use these applications in their daily lives to some extent. Several smartphone applications have a number of usability issues for the visually impaired. In this paper, we evaluate the usability of various android and iPhone applications for blind people through analysis and surveys. This paper aspires to provide guidance in order to increase smartphone application accessibility for the visually impaired. An abstract application design is also proposed to overcome usability issues in smartphone applications for visually challenged people.

Keywords: eyes-free shell, human computer interaction, usability engineering, visually challenged

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8470 Strategic Management Model for High Performance Sports Centers

Authors: Jose Ramon Sanabria Navarro, Yahilina Silveira Perez, Valentin Molina Moreno, Digna Dionisia Perez Bravo

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The general objective of this research is to conceive a model of strategic direction for Latin American high-performance sports centers for the improvement of their results. The sample is 62 managers, 187 trainers, 2930 athletes and 62 expert researchers from centers in Cuba, Venezuela, Ecuador, Colombia and Argentina, for 3241. The measurement instrument includes 12 key variables in the process of management strategies which are consolidated with the factorial analysis and the ANOVA of a factor through the SPSS 24.0. The reliability of the scale obtained an alpha higher than 0.7 in each sample. In this sense, a model is obtained that taxes the deficiencies detected in the diagnosis, based on the needs of the members of these organizations, considering criteria and theories of the strategic direction in the improvement of the organizational results. The validation of the model for high performance sports centers of the countries analyzed aims to develop joint strategies to generate synergies in their operational mode, which leads to enhance the sports organization.

Keywords: sports organization, information management, decision making, control

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8469 Assessing the Bioactivity and Cell Viability of Apatite-Wollastonite Glass Ceramics Prepared via Spray Pyrolysis

Authors: Andualem Workie

Abstract:

In this study, we examined the sinterability and bioactivity of MgO-SiO₂-P₂O₅-CaO-CaF₂ glass compositions created through spray pyrolysis. We evaluated the bioactivity of the materials by immersing them for varying periods of time in simulated bodily fluid (SBF) and found that bioactivity was related to the sintering temperature and soaking time. The material's pH value during immersion in SBF was within the range of 7.4-8.2, which is below 8.5 and improves compatibility and reduces toxicity in biological applications. We used X-ray diffraction and scanning electron microscopy to determine the phase compositions and morphologies of the samples and found that the 1100°C sintered A-W GC sample exhibited the highest bioactivity after soaking in SBF. This sample was dominated by fluorapatite, wollastonite, and whitlockite crystals scattered throughout the glass matrix. The crystallinity (%) of the A-W GC increased as its bioactivity improved, making it more suitable for use in pharmaceutical applications. We also conducted a cytotoxicity test on A-W GC samples sintered at different temperatures and found that the glass-ceramics were non-toxic to MC3T3-E1 cells at all extraction concentrations, except for those sintered at 700°C at concentrations of 250, 200, and 150 mg/ml where cell viability (%) was below the threshold of 70%.

Keywords: apatite wollastonite glass ceramics, bioactivity, calcination, cell viability

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8468 Cadmium and Lead Extraction from Environmental Samples with Complexes Matrix by Nanomagnetite Solid-Phase and Determine Their Trace Amounts

Authors: Hossein Tavallali, Mohammad Ali Karimi, Gohar Deilamy-Rad

Abstract:

In this study, a new type of alumina-coated magnetite nanoparticles (Fe3O4/Al2O3 NPs) with sodium dodecyl sulfate- 1-(2-pyridylazo)-2-naphthol (SDS-PAN) as a new sorbent solid phase extraction (SPE) has been successfully synthesized and applied for preconcentration and separation of Cd and Pb in environmental samples. Compared with conventional SPE methods, the advantages of this new magnetic Mixed Hemimicelles Solid-Phase Extraction Procedure (MMHSPE) still include easy preparation and regeneration of sorbents, short times of sample pretreatment, high extraction yields, and high breakthrough volumes. It shows great analytical potential in preconcentration of Cd and Pb compounds from large volume water samples. Due to the high surface area of these new sorbents and the excellent adsorption capacity after surface modification by SDS-PAN, satisfactory concentration factor and extraction recoveries can be produced with only 0.05 g Fe3O4/Al2O3 NPs. The metals were eluted with 3mL HNO3 2 mol L-1 directly and detected with the detection system Flame Atomic Absorption Spectrometry (FAAS). Various influencing parameters on the separation and preconcentration of trace metals, such as the amount of PAN, pH value, sample volume, standing time, desorption solvent and maximal extraction volume, amount of sorbent and concentration of eluent, were studied. The detection limits of this method for Cd and Pb were 0.3 and 0.7 ng mL−1 and the R.S.D.s were 3.4 and 2.8% (C = 28.00 ng mL-1, n = 6), respectively. The preconcentration factor of the modified nanoparticles was 166.6. The proposed method has been applied to the determination of these metal ions at trace levels in soil, river, tap, mineral, spring and wastewater samples with satisfactory results.

Keywords: Alumina-coated magnetite nanoparticles, Magnetic Mixed Hemimicell Solid-Phase Extraction, Cd and Pb, soil sample

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8467 A Review on Various Approaches for Energy Conservation in Green Cloud Computing

Authors: Sumati Manchanda

Abstract:

Cloud computing is one of the most recent developing engineering and is consistently utilized as a part of different IT firms so as to make benefits like expense sparing or financial minimization, it must be eco cordial also. In this manner, Green Cloud Computing is the need of the today's current situation. It is an innovation that is rising as data correspondence engineering. This paper surveys the unequivocal endeavors made by different specialists to make Cloud Computing more vitality preserving, to break down its vitality utilization focused around sorts of administrations gave furthermore to diminish the carbon foot shaped impression rate by colossal methodologies furthermore edify virtualization idea alongside different diverse methodologies which utilize virtual machines scheduling and migration. The summary of the proposed work by various authors that we have reviewed is also presented in the paper.

Keywords: cloud computing, green cloud computing, scheduling, migration, virtualization, energy efficiency

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8466 In-vitro Metabolic Fingerprinting Using Plasmonic Chips by Laser Desorption/Ionization Mass Spectrometry

Authors: Vadanasundari Vedarethinam, Kun Qian

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The metabolic analysis is more distal over proteomics and genomics engaging in clinics and needs rationally distinct techniques, designed materials, and device for clinical diagnosis. Conventional techniques such as spectroscopic techniques, biochemical analyzers, and electrochemical have been used for metabolic diagnosis. Currently, there are four major challenges including (I) long-term process in sample pretreatment; (II) difficulties in direct metabolic analysis of biosamples due to complexity (III) low molecular weight metabolite detection with accuracy and (IV) construction of diagnostic tools by materials and device-based platforms for real case application in biomedical applications. Development of chips with nanomaterial is promising to address these critical issues. Mass spectroscopy (MS) has displayed high sensitivity and accuracy, throughput, reproducibility, and resolution for molecular analysis. Particularly laser desorption/ ionization mass spectrometry (LDI MS) combined with devices affords desirable speed for mass measurement in seconds and high sensitivity with low cost towards large scale uses. We developed a plasmonic chip for clinical metabolic fingerprinting as a hot carrier in LDI MS by series of chips with gold nanoshells on the surface through controlled particle synthesis, dip-coating, and gold sputtering for mass production. We integrated the optimized chip with microarrays for laboratory automation and nanoscaled experiments, which afforded direct high-performance metabolic fingerprinting by LDI MS using 500 nL of serum, urine, cerebrospinal fluids (CSF) and exosomes. Further, we demonstrated on-chip direct in-vitro metabolic diagnosis of early-stage lung cancer patients using serum and exosomes without any pretreatment or purifications. To our best knowledge, this work initiates a bionanotechnology based platform for advanced metabolic analysis toward large-scale diagnostic use.

Keywords: plasmonic chip, metabolic fingerprinting, LDI MS, in-vitro diagnostics

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8465 Three-Stage Least Squared Models of a Station-Level Subway Ridership: Incorporating an Analysis on Integrated Transit Network Topology Measures

Authors: Jungyeol Hong, Dongjoo Park

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The urban transit system is a critical part of a solution to the economic, energy, and environmental challenges. Furthermore, it ultimately contributes the improvement of people’s quality of lives. For taking these kinds of advantages, the city of Seoul has tried to construct an integrated transit system including both subway and buses. The effort led to the fact that approximately 6.9 million citizens use the integrated transit system every day for their trips. Diagnosing the current transit network is a significant task to provide more convenient and pleasant transit environment. Therefore, the critical objective of this study is to establish a methodological framework for the analysis of an integrated bus-subway network and to examine the relationship between subway ridership and parameters such as network topology measures, bus demand, and a variety of commercial business facilities. Regarding a statistical approach to estimate subway ridership at a station level, many previous studies relied on Ordinary Least Square regression, but there was lack of studies considering the endogeneity issues which might show in the subway ridership prediction model. This study focused on both discovering the impacts of integrated transit network topology measures and endogenous effect of bus demand on subway ridership. It could ultimately contribute to developing more accurate subway ridership estimation accounting for its statistical bias. The spatial scope of the study covers Seoul city in South Korea, and it includes 243 subway stations and 10,120 bus stops with the temporal scope set during twenty-four hours with one-hour interval time panels each. The subway and bus ridership information in detail was collected from the Seoul Smart Card data in 2015 and 2016. First, integrated subway-bus network topology measures which have characteristics regarding connectivity, centrality, transitivity, and reciprocity were estimated based on the complex network theory. The results of integrated transit network topology analysis were compared to subway-only network topology. Also, the non-recursive approach which is Three-Stage Least Square was applied to develop the daily subway ridership model as capturing the endogeneity between bus and subway demands. Independent variables included roadway geometry, commercial business characteristics, social-economic characteristics, safety index, transit facility attributes, and dummies for seasons and time zone. Consequently, it was found that network topology measures were significant size effect. Especially, centrality measures showed that the elasticity was a change of 4.88% for closeness centrality, 24.48% for betweenness centrality while the elasticity of bus ridership was 8.85%. Moreover, it was proved that bus demand and subway ridership were endogenous in a non-recursive manner as showing that predicted bus ridership and predicted subway ridership is statistically significant in OLS regression models. Therefore, it shows that three-stage least square model appears to be a plausible model for efficient subway ridership estimation. It is expected that the proposed approach provides a reliable guideline that can be used as part of the spectrum of tools for evaluating a city-wide integrated transit network.

Keywords: integrated transit system, network topology measures, three-stage least squared, endogeneity, subway ridership

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8464 Mathematical Programming Models for Portfolio Optimization Problem: A Review

Authors: Mazura Mokhtar, Adibah Shuib, Daud Mohamad

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Portfolio optimization problem has received a lot of attention from both researchers and practitioners over the last six decades. This paper provides an overview of the current state of research in portfolio optimization with the support of mathematical programming techniques. On top of that, this paper also surveys the solution algorithms for solving portfolio optimization models classifying them according to their nature in heuristic and exact methods. To serve these purposes, 40 related articles appearing in the international journal from 2003 to 2013 have been gathered and analyzed. Based on the literature review, it has been observed that stochastic programming and goal programming constitute the highest number of mathematical programming techniques employed to tackle the portfolio optimization problem. It is hoped that the paper can meet the needs of researchers and practitioners for easy references of portfolio optimization.

Keywords: portfolio optimization, mathematical programming, multi-objective programming, solution approaches

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8463 Defense Mechanism Maturity and the Severity of Mood Disorder Symptoms

Authors: Maja Pandža, Sanjin Lovrić, Iva Čolak, Josipa Mandarić, Miro Klarić

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This study explores the role of symptoms related to mood disorders salience on different types of defense mechanisms (mature, neurotic, immature) predominance. Total of 177 both clinical and non-clinical participants in Mostar, Bosnia & Herzegovina, completed a battery of questionnaires associated with defense mechanisms and self-reported depression and anxiety symptoms. The sample was additionally divided into four groups, given the level of symptoms experienced: 1. minimal, 2. mild, 3. moderate, 4. severe depression/anxiety. Participants with minimal anxiety and depression symptoms use mature defense mechanisms more often than other three groups. Immature mechanisms are most commonly used by the group with severe depression/anxiety levels in comparison with other groups. These differences are discussed on the dynamic level of analysis to have a better understanding of the relationship between defense mechanisms' maturity and degree of mood disorders' symptom severity. Also, results given could serve as an implication for the psychotherapeutic treatment plans.

Keywords: anxiety/depression symptoms, clinical/non-clinical sample, defense mechanism maturity, dynamic approach

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8462 Strain Based Failure Criterion for Composite Notched Laminates

Authors: Ibrahim A. Elsayed, Mohamed H. Elalfy, Mostafa M. Abdalla

Abstract:

A strain-based failure criterion for composite notched laminates is introduced where the most critical stress concentration factor for the anisotropic notched laminates could be related to the failure of the corresponding quasi-isotropic laminate and the anisotropy ratio of the laminate. The proposed criterion will simplify the design of composites to meet notched failure requirements by eliminating the need for the detailed specifications of the stacking sequence at the preliminary design stage. The designer will be able to design based on the stiffness of the laminate, then at a later stage, select an appropriate stacking sequence to meet the stiffness requirements. The failure strains for the notched laminates are computed using the material’s Omni-strain envelope. The concept of Omni-strain envelope concerns the region of average strain where the laminate is safe regardless of ply orientation. In this work, we use Hashin’s failure criteria and the strains around the hole are computed using Savin’s analytic solution. A progressive damage analysis study has been conducted where the failure loads for the notched laminates are computed using finite element analysis. The failure strains are computed and used to estimate the concentration factor. It is found that the correlation found using Savin’s analytic solution predicts the same ratio of concentration factors between anisotropic and quasi-isotropic laminates as the more expensive progressive failure analysis.

Keywords: anisotropy ratio, failure criteria, notched laminates, Omni-strain envelope, savin’s solution

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8461 Impact of Ethiopia's Productive Safety Net Program on Household Dietary Diversity and Child Nutrition in Rural Ethiopia

Authors: Tagel Gebrehiwot, Carolina Castilla

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Food insecurity and child malnutrition are among the most critical issues in Ethiopia. Accordingly, different reform programs have been carried to improve household food security. The Food Security Program (FSP) (among others) was introduced to combat the persistent food insecurity problem in the country. The FSP combines a safety net component called the Productive Safety Net Program (PSNP) started in 2005. The goal of PSNP is to offer multi-annual transfers, such as food, cash or a combination of both to chronically food insecure households to break the cycle of food aid. Food or cash transfers are the main elements of PSNP. The case for cash transfers builds on the Sen’s analysis of ‘entitlement to food’, where he argues that restoring access to food by improving demand is a more effective and sustainable response to food insecurity than food aid. Cash-based schemes offer a greater choice of use of the transfer and can allow a greater diversity of food choice. It has been proven that dietary diversity is positively associated with the key pillars of food security. Thus, dietary diversity is considered as a measure of household’s capacity to access a variety of food groups. Studies of dietary diversity among Ethiopian rural households are somewhat rare and there is still a dearth of evidence on the impact of PSNP on household dietary diversity. In this paper, we examine the impact of the Ethiopia’s PSNP on household dietary diversity and child nutrition using panel household surveys. We employed different methodologies for identification. We exploit the exogenous increase in kebeles’ PSNP budget to identify the effect of the change in the amount of money households received in transfers between 2012 and 2014 on the change in dietary diversity. We use three different approaches to identify this effect: two-stage least squares, reduced form IV, and generalized propensity score matching using a continuous treatment. The results indicate the increase in PSNP transfers between 2012 and 2014 had no effect on household dietary diversity. Estimates for different household dietary indicators reveal that the effect of the change in the cash transfer received by the household is statistically and economically insignificant. This finding is robust to different identification strategies and the inclusion of control variables that determine eligibility to become a PSNP beneficiary. To identify the effect of PSNP participation on children height-for-age and stunting we use a difference-in-difference approach. We use children between 2 and 5 in 2012 as a baseline because by then they have achieved long-term failure to grow. The treatment group comprises children ages 2 to 5 in 2014 in PSNP participant households. While changes in height-for-age take time, two years of additional transfers among children who were not born or under the age of 2-3 in 2012 have the potential to make a considerable impact on reducing the prevalence of stunting. The results indicate that participation in PSNP had no effect on child nutrition measured as height-for-age or probability of beings stunted, suggesting that PSNP should be designed in a more nutrition-sensitive way.

Keywords: continuous treatment, dietary diversity, impact, nutrition security

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8460 Tumor Size and Lymph Node Metastasis Detection in Colon Cancer Patients Using MR Images

Authors: Mohammadreza Hedyehzadeh, Mahdi Yousefi

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Colon cancer is one of the most common cancer, which predicted to increase its prevalence due to the bad eating habits of peoples. Nowadays, due to the busyness of people, the use of fast foods is increasing, and therefore, diagnosis of this disease and its treatment are of particular importance. To determine the best treatment approach for each specific colon cancer patients, the oncologist should be known the stage of the tumor. The most common method to determine the tumor stage is TNM staging system. In this system, M indicates the presence of metastasis, N indicates the extent of spread to the lymph nodes, and T indicates the size of the tumor. It is clear that in order to determine all three of these parameters, an imaging method must be used, and the gold standard imaging protocols for this purpose are CT and PET/CT. In CT imaging, due to the use of X-rays, the risk of cancer and the absorbed dose of the patient is high, while in the PET/CT method, there is a lack of access to the device due to its high cost. Therefore, in this study, we aimed to estimate the tumor size and the extent of its spread to the lymph nodes using MR images. More than 1300 MR images collected from the TCIA portal, and in the first step (pre-processing), histogram equalization to improve image qualities and resizing to get the same image size was done. Two expert radiologists, which work more than 21 years on colon cancer cases, segmented the images and extracted the tumor region from the images. The next step is feature extraction from segmented images and then classify the data into three classes: T0N0، T3N1 و T3N2. In this article, the VGG-16 convolutional neural network has been used to perform both of the above-mentioned tasks, i.e., feature extraction and classification. This network has 13 convolution layers for feature extraction and three fully connected layers with the softmax activation function for classification. In order to validate the proposed method, the 10-fold cross validation method used in such a way that the data was randomly divided into three parts: training (70% of data), validation (10% of data) and the rest for testing. It is repeated 10 times, each time, the accuracy, sensitivity and specificity of the model are calculated and the average of ten repetitions is reported as the result. The accuracy, specificity and sensitivity of the proposed method for testing dataset was 89/09%, 95/8% and 96/4%. Compared to previous studies, using a safe imaging technique (MRI) and non-use of predefined hand-crafted imaging features to determine the stage of colon cancer patients are some of the study advantages.

Keywords: colon cancer, VGG-16, magnetic resonance imaging, tumor size, lymph node metastasis

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8459 Investigation of Emotional Indicators of Schizophrenia Patients on Draw a Person Test in Pakistan

Authors: Shakir Iqbal, Muhammad Aqeel, Asghar Ali Shah, Aftab Hussain

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The present study was aimed to investigate and compare the emotional indicators of patients with schizophrenia on Draw a Person test in Pakistan. Draw a Person test was administered on a sample of 400 (Schizophrenia patients=200, Normal=200) age ranged from 20 to 50 years. The data was collected from two provinces of Pakistan (Punjab and Khyber Pakhtun Khwa). The sample was selected by the age levels. According to the Koppitz method of scoring a list of 40 Emotional indicators was selected that were derived from the literature review. It was found that 26 out of 40 emotional indicators (EIs) on Draw a Person test significantly differentiated between patients with schizophrenia and normal (healthy) population. Chi square analysis of the study indicated that 23 EIs were found significant at (p=.001) level, while three EIs were found significant at (P=.05) levels. It was also found that 9 exclusive and 4 frequent EIs on Human Figure Drawings may be significant diagnostic emotional indicators for schizophrenia. It was found that DAP test can be used as a diagnostic tool with the battery of psychological tests such as MCMI-III, MMPI, MSE, HTP for schizophrenia in Pakistan.

Keywords: draw a person test, normal population, Schizophrenia patients, psychological sciences

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8458 Adapting to College: Exploration of Psychological Well-Being, Coping, and Identity as Markers of Readiness

Authors: Marit D. Murry, Amy K. Marks

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The transition to college is a critical period that affords abundant opportunities for growth in conjunction with novel challenges for emerging adults. During this time, emerging adults are garnering experiences and acquiring hosts of new information that they are required to synthesize and use to inform life-shaping decisions. This stage is characterized by instability and exploration, which necessitates a diverse set of coping skills to successfully navigate and positively adapt to their evolving environment. However, important sociocultural factors result in differences that occur developmentally for minority emerging adults (i.e., emerging adults with an identity that has been or is marginalized). While the transition to college holds vast potential, not all are afforded the same chances, and many individuals enter into this stage at varying degrees of readiness. Understanding the nuance and diversity of student preparedness for college and contextualizing these factors will better equip systems to support incoming students. Emerging adulthood for ethnic, racial minority students presents itself as an opportunity for growth and resiliency in the face of systemic adversity. Ethnic, racial identity (ERI) is defined as an identity that develops as a function of one’s ethnic-racial group membership. Research continues to demonstrate ERI as a resilience factor that promotes positive adjustment in young adulthood. Adaptive coping responses (e.g., engaging in help-seeking behavior, drawing on personal and community resources) have been identified as possible mechanisms through which ERI buffers youth against stressful life events, including discrimination. Additionally, trait mindfulness has been identified as a significant predictor of general psychological health, and mindfulness practice has been shown to be a self-regulatory strategy that promotes healthy stress responses and adaptive coping strategy selection. The current study employed a person-centered approach to explore emerging patterns across ethnic identity development and psychological well-being criterion variables among college freshmen. Data from 283 incoming college freshmen at Northeastern University were analyzed. The Brief COPE Acceptance and Emotional Support scales, the Five Factor Mindfulness Questionnaire, and MIEM Exploration and Affirmation measures were used to inform the cluster profiles. The TwoStep auto-clustering algorithm revealed an optimal three-cluster solution (BIC = 848.49), which classified 92.6% (n = 262) of participants in the sample into one of the three clusters. The clusters were characterized as ‘Mixed Adjustment’, ‘Lowest Adjustment’, and ‘Moderate Adjustment.’ Cluster composition varied significantly by ethnicity X² (2, N = 262) = 7.74 (p = .021) and gender X² (2, N = 259) = 10.40 (p = .034). The ‘Lowest Adjustment’ cluster contained the highest proportion of students of color, 41% (n = 32), and male-identifying students, 44.2% (n = 34). Follow-up analyses showed higher ERI exploration in ‘Moderate Adjustment’ cluster members, also reported higher levels of psychological distress, with significantly elevated depression scores (p = .011), psychological diagnoses of depression (p = .013), anxiety (p = .005) and psychiatric disorders (p = .025). Supporting prior research, students engaging with identity exploration processes often endure more psychological distress. These results indicate that students undergoing identity development may require more socialization and different services beyond normal strategies.

Keywords: adjustment, coping, college, emerging adulthood, ethnic-racial identity, psychological well-being, resilience

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8457 Sustainable Traditional Urban Design of the Old City of Ghadames

Authors: Hazem Bunkheila

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Ghadames is an oasis on the edge of the Sahara Desert in southwestern Libya at the border with Algeria and Tunisia. It is the oldest oasis in the world that provides a fascinating example of traditional urban in the desert environment. The urban of the small city is considered a genuine adaptation to the harsh desert climate. The historic city of Ghadames remained unaffected by the rapid after oil changes. That makes it a good field to study sustainable, vernacular, earth architecture and urban design. The aim of this paper is to investigate the urban structure, concept, and fabric of the old oasis. The research also surveys the environmental considerations in the city that shades the sustainable features in this traditional residential area. In addition, the paper addresses the modern applications in the new city of Ghadams and sides of success and failure compared to the traditional urban fabric.

Keywords: dessert climate design, Ghadames, sustainable urban design, traditional urban design

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8456 Viscoelastic Separation and Concentration of Candida Using a Low Aspect Ratio Microchannel

Authors: Seonggil Kim, Jeonghun Nam, Chae Seung Lim

Abstract:

Rapid diagnosis of fungal infections is critical for rapid antifungal therapy. However, it is difficult to detect extremely low concentration fungi in blood sample. To address the limitation, separation and concentration of fungi in blood sample are required to enhance the sensitivity of PCR analysis. In this study, we demonstrated a sheathless separation and concentration of fungi, candida cells using a viscoelastic fluid. To validate the performance of the device, microparticle mixture (2 and 13 μm) was used, and those particles were successfully separated based on the size difference at high flow rate of 100 μl/min. For the final application, successful separation of the Candida cells from the white blood cells (WBCs) was achieved. Based on the viscoelastic lateral migration toward the equilibrium position, Candida cells were separated and concentrated by center focusing, while WBCs were removed by patterning into two streams between the channel center and the sidewalls. By flow cytometric analysis, the separation efficiency and the purity were evaluated as ~99% and ~ 97%, respectively. From the results, the device can be the powerful tool for detecting extremely rare disease-related cells.

Keywords: candida cells, concentration, separation, viscoelastic fluid

Procedia PDF Downloads 187
8455 Timetabling for Interconnected LRT Lines: A Package Solution Based on a Real-world Case

Authors: Huazhen Lin, Ruihua Xu, Zhibin Jiang

Abstract:

In this real-world case, timetabling the LRT network as a whole is rather challenging for the operator: they are supposed to create a timetable to avoid various route conflicts manually while satisfying a given interval and the number of rolling stocks, but the outcome is not satisfying. Therefore, the operator adopts a computerised timetabling tool, the Train Plan Maker (TPM), to cope with this problem. However, with various constraints in the dual-line network, it is still difficult to find an adequate pairing of turnback time, interval and rolling stocks’ number, which requires extra manual intervention. Aiming at current problems, a one-off model for timetabling is presented in this paper to simplify the procedure of timetabling. Before the timetabling procedure starts, this paper presents how the dual-line system with a ring and several branches is turned into a simpler structure. Then, a non-linear programming model is presented in two stages. In the first stage, the model sets a series of constraints aiming to calculate a proper timing for coordinating two lines by adjusting the turnback time at termini. Then, based on the result of the first stage, the model introduces a series of inequality constraints to avoid various route conflicts. With this model, an analysis is conducted to reveal the relation between the ratio of trains in different directions and the possible minimum interval, observing that the more imbalance the ratio is, the less possible to provide frequent service under such strict constraints.

Keywords: light rail transit (LRT), non-linear programming, railway timetabling, timetable coordination

Procedia PDF Downloads 57
8454 An Electromyographic Study of Muscle Coordination during Dynamic Glenohumeral Joint Elevation

Authors: Omid Khaiyat, David Hawkes

Abstract:

Introduction: There remains a lack of information on sophisticated coordination patterns across shoulder girdle muscles. Considering the stability of the shoulder being heavily dependent on coordinated muscle activity during its wide-ranging movements, it is important that key intermuscular relationships are well-defined for a better understanding of underlying pathology. This study investigated shoulder intermuscular coordination during different planes of shoulder elevation. Materials and Methods: EMG was recorded from 14 shoulder muscles in 20 healthy participants during shoulder flexion, scapula plane elevation, abduction, and extension. Cross-correlation by means of Pearson Correlation Coefficient (PCC) was used to examine the coordination between different muscles and muscle groups. Results: Coordination between rotator cuff and deltoid muscle groups was significantly higher (p =0.020-0.035) during the initial (PCC) = 0.79) and final (PCC = 0.74) phases of elevation compared to the mid-range (PCC = 0.34). Furthermore, a high level of coordination (PCC = 0.89) was noted between the deltoid group and the adductor group (latissimus dorsi and teres major) during the initial stage of shoulder elevation. Conclusion: The destabilising force of the deltoid during the initial stage of shoulder elevation is balanced by coordinated activity of rotator cuff, latissimus dorsi, and teres major. This is also the case for the end-range of movement, where increased demand for stability again leads to higher coordination between the deltoid and rotator cuff muscle groups. Appreciation of the sophistication of normal shoulder function evidence-based rehabilitation strategies for conditions such as subacromial impingement syndrome or shoulder instability can be developed.

Keywords: shoulder, coordination, EMG, muscle activity, upper limb

Procedia PDF Downloads 155
8453 The Use of Sustainability Criteria on Infrastructure Design to Encourage Sustainable Engineering Solutions on Infrastructure Projects

Authors: Shian Saroop, Dhiren Allopi

Abstract:

In order to stay competitive and to meet upcoming stricter environmental regulations and customer requirements, designers have a key role in designing civil infrastructure so that it is environmentally sustainable. There is an urgent need for engineers to apply technologies and methods that deliver better and more sustainable performance of civil infrastructure as well as a need to establish a standard of measurement for greener infrastructure, rather than merely use tradition solutions. However, there are no systems in place at the design stage that assesses the environmental impact of design decisions on township infrastructure projects. This paper identifies alternative eco-efficient civil infrastructure design solutions and developed sustainability criteria and a toolkit to analyse the eco efficiency of infrastructure projects. The proposed toolkit is aimed at promoting high-performance, eco-efficient, economical and environmentally friendly design decisions on stormwater, roads, water and sanitation related to township infrastructure projects. These green solutions would bring a whole new class of eco-friendly solutions to current infrastructure problems, while at the same time adding a fresh perspective to the traditional infrastructure design process. A variety of projects were evaluated using the green infrastructure toolkit and their results are compared to each other, to assess the results of using greener infrastructure verses the traditional method of designing infrastructure. The application of ‘green technology’ would ensure a sustainable design of township infrastructure services assisting the design to consider alternative resources, the environmental impacts of design decisions, ecological sensitivity issues, innovation, maintenance and materials, at the design stage of a project.

Keywords: eco-efficiency, green infrastructure, infrastructure design, sustainable development

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8452 The Effect of Parents and Coaches on Preschool Children's Self-Control in Preschool Centers in District 5 of Tehran

Authors: Alieh Arasteh

Abstract:

The main purpose of this study was to investigate the effect of parents and educators on the self-control of children in pre-primary schools in District 5 of Tehran. The method of this survey was a survey and post-correlation type. The statistical population of this study included all teachers and parents of children in preschool centers in the region. The 5th city of Tehran in 1397 was the number of kindergartens in 117 centers and the number of parents was 1872, the sample size of the parents was 320 and the sample size of the trainers was 76. The method of sampling in this study was randomized and clustered. The data gathering tool was Rosenbaum and Ronen (1992) self-control skills, a five-factor questionnaire NEO personality Costa and McCrae (1985) and a questionnaire on demographic characteristics, reliability using Cronbach's alpha, the data analysis was performed using the software spss24. The results of the research showed that the personality characteristics of parents, parents' socioeconomic status and personality traits of educators affect the self-control dimensions of pre-primary school children (P <0.05).

Keywords: self-control, pre-primary school, the effect of parents, couches

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8451 A Single Stage Rocket Using Solid Fuels in Conventional Propulsion Systems

Authors: John R Evans, Sook-Ying Ho, Rey Chin

Abstract:

This paper describes the research investigations orientated to the starting and propelling of a solid fuel rocket engine which operates as combined cycle propulsion system using three thrust pulses. The vehicle has been designed to minimise the cost of launching small number of Nano/Cube satellites into low earth orbits (LEO). A technology described in this paper is a ground-based launch propulsion system which starts the rocket vertical motion immediately causing air flow to enter the ramjet’s intake. Current technology has a ramjet operation predicted to be able to start high subsonic speed of 280 m/s using a liquid fuel ramjet (LFRJ). The combined cycle engine configuration is in many ways fundamentally different from the LFRJ. A much lower subsonic start speed is highly desirable since the use of a mortar to obtain the latter speed for rocket means a shorter launcher length can be utilized. This paper examines the means and has some performance calculations, including Computational Fluid Dynamics analysis of air-intake at suitable operational conditions, 3-DOF point mass trajectory analysis of multi-pulse propulsion system (where pulse ignition time and thrust magnitude can be controlled), etc. of getting a combined cycle rocket engine use in a single stage vehicle.

Keywords: combine cycle propulsion system, low earth orbit launch vehicle, computational fluid dynamics analysis, 3dof trajectory analysis

Procedia PDF Downloads 183
8450 The FINDRISC Score for Prediabetes and Diabetes Screening in Adult Libyan Males

Authors: Issam M Hajjaji, Adel Tajoury, Salah R Benhamid

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The MENA region has the highest prevalence of diabetes in the world. Various risk scores were developed, not all appropriate locally. The objective of this study is to apply the FINDRISC Score to adult Libyan males to determine its significance, sensitivity, specificity and Positive Predictive Values as an initial screening tool for type 2 diabetes, and suggest a cut-off point. Methods: 600 subjects answered the questionnaire at their place of work, and their waist, weight, height & BP were measured. Thereafter, after excluding those with known diabetes, an Oral Glucose Tolerance Test was done. Results: 414 subjects aged 19-78 completed the questionnaire and tests. 35 (8.4%) had impaired glucose tolerance (IGT) and 13 (3.1%) had diabetes (DM). The AUC-ROC for IGT was 0.614 (95% CI: 0.527-0.701), for DM 0.810 (95% CI: 0.709-0.911) and for both 0.689 (95% CI: 0.609-0.769). The Positive Predictive Value for a cut-off score of 5 were 15.5%, 11.7% & 5.7% for both conditions combined, prediabetes & diabetes respectively. The equivalent values for a cut-off score of 8 were 16.1%, 9.0% & 7.7%. The Negative Predictive Values were uniformly above 90%. Conclusions & Recommendations: The FINDRISC Score had a low predictive value for dysglycaemia in this sample and performed at a level of significance for IGT that is similar to other MENA countries, but did better for DM. A larger sample that included women is suggested, with a view of adjusting the Score to suit the local population.

Keywords: diabetes, FINDRISK, Libya, prediabetes

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8449 Health Tourists in Iran and Cultural Prejudices

Authors: Naeemeh Silvari

Abstract:

The tourism industry is important for different nations in two ways. Apart from economic benefits, it provides a basis for getting acquainted with the culture of different regions of the world. Depending on the capacities and contexts of their geography, countries try to attract more people to their country in different ways. Health tourism has been an important branch of the tourism industry in recent years, and many countries around the world are trying to make progress in this field and attract many tourists from around the world. Iran, like many developing countries in the Middle East and East Asia, is trying to improve and develop tourist attractions in the field of health. Due to the cheapness of providing medical services to tourists, many people have traveled to Iran for medical and health care. However, there is a long way to go before recognizing and reaching the desired position in this field. Due to the direct relationship between tourism and culture, the negative attitude towards the context of Iran has caused foreign travelers not to choose this country as their tourist destination. In this article, we tried to study the change in their attitude towards Iran by using semi-structured interviews of foreign travelers who traveled to Iran for treatment and medical services. The text of the interviews was coded and analyzed by MAX QDA software. Many of the people in the sample were from Middle Eastern and Arabic-speaking countries. Influenced by the media, they felt rejected by the Iranians before the trip. During their stay in Iran and in connection with the health care staff, in the first stage, they pointed out that many of their anxieties about the kind of treatment of Iranians have been allayed. In addition to the satisfaction with the medical services provided, they considered the atmosphere of Iranians' interaction with foreign travelers to be relatively appropriate, and some stated that Iran would be the destination of their leisure trip in the future. At the end of the research, policymakers were suggested that in order to resolve cultural contradictions rooted in values, they should first be recognized and seek to use other opportunities to resolve contradictions and form interactions with other cultures.

Keywords: cultural conflict, health tourism, cultural prejudice, advertising and media

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8448 Organizational Resilience in the Perspective of Supply Chain Risk Management: A Scholarly Network Analysis

Authors: William Ho, Agus Wicaksana

Abstract:

Anecdotal evidence in the last decade shows that the occurrence of disruptive events and uncertainties in the supply chain is increasing. The coupling of these events with the nature of an increasingly complex and interdependent business environment leads to devastating impacts that quickly propagate within and across organizations. For example, the recent COVID-19 pandemic increased the global supply chain disruption frequency by at least 20% in 2020 and is projected to have an accumulative cost of $13.8 trillion by 2024. This crisis raises attention to organizational resilience to weather business uncertainty. However, the concept has been criticized for being vague and lacking a consistent definition, thus reducing the significance of the concept for practice and research. This study is intended to solve that issue by providing a comprehensive review of the conceptualization, measurement, and antecedents of operational resilience that have been discussed in the supply chain risk management literature (SCRM). We performed a Scholarly Network Analysis, combining citation-based and text-based approaches, on 252 articles published from 2000 to 2021 in top-tier journals based on three parameters: AJG ranking and ABS ranking, UT Dallas and FT50 list, and editorial board review. We utilized a hybrid scholarly network analysis by combining citation-based and text-based approaches to understand the conceptualization, measurement, and antecedents of operational resilience in the SCRM literature. Specifically, we employed a Bibliographic Coupling Analysis in the research cluster formation stage and a Co-words Analysis in the research cluster interpretation and analysis stage. Our analysis reveals three major research clusters of resilience research in the SCRM literature, namely (1) supply chain network design and optimization, (2) organizational capabilities, and (3) digital technologies. We portray the research process in the last two decades in terms of the exemplar studies, problems studied, commonly used approaches and theories, and solutions provided in each cluster. We then provide a conceptual framework on the conceptualization and antecedents of resilience based on studies in these clusters and highlight potential areas that need to be studied further. Finally, we leverage the concept of abnormal operating performance to propose a new measurement strategy for resilience. This measurement overcomes the limitation of most current measurements that are event-dependent and focus on the resistance or recovery stage - without capturing the growth stage. In conclusion, this study provides a robust literature review through a scholarly network analysis that increases the completeness and accuracy of research cluster identification and analysis to understand conceptualization, antecedents, and measurement of resilience. It also enables us to perform a comprehensive review of resilience research in SCRM literature by including research articles published during the pandemic and connects this development with a plethora of articles published in the last two decades. From the managerial perspective, this study provides practitioners with clarity on the conceptualization and critical success factors of firm resilience from the SCRM perspective.

Keywords: supply chain risk management, organizational resilience, scholarly network analysis, systematic literature review

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8447 Evaluation of Liquid Fermentation Strategies to Obtain a Biofertilizer Based on Rhizobium sp.

Authors: Andres Diaz Garcia, Ana Maria Ceballos Rojas, Duvan Albeiro Millan Montano

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This paper describes the initial technological development stages in the area of liquid fermentation required to reach the quantities of biomass of the biofertilizer microorganism Rhizobium sp. strain B02, for the application of the unitary stages downstream at laboratory scale. In the first stage, the adjustment and standardization of the fermentation process in conventional batch mode were carried out. In the second stage, various fed-batch and continuous fermentation strategies were evaluated in 10L-bioreactor in order to optimize the yields in concentration (Colony Forming Units/ml•h) and biomass (g/l•h), to make feasible the application of unit operations downstream of process. The growth kinetics, the evolution of dissolved oxygen and the pH profile generated in each of the strategies were monitored and used to make sequential adjustments. Once the fermentation was finished, the final concentration and viability of the obtained biomass were determined and performance parameters were calculated with the purpose of select the optimal operating conditions that significantly improved the baseline results. Under the conditions adjusted and standardized in batch mode, concentrations of 6.67E9 CFU/ml were reached after 27 hours of fermentation and a subsequent noticeable decrease was observed associated with a basification of the culture medium. By applying fed-batch and continuous strategies, significant increases in yields were achieved, but with similar concentration levels, which involved the design of several production scenarios based on the availability of equipment usage time and volume of required batch.

Keywords: biofertilizer, liquid fermentation, Rhizobium sp., standardization of processes

Procedia PDF Downloads 169
8446 An Innovation Decision Process View in an Adoption of Total Laboratory Automation

Authors: Chia-Jung Chen, Yu-Chi Hsu, June-Dong Lin, Kun-Chen Chan, Chieh-Tien Wang, Li-Ching Wu, Chung-Feng Liu

Abstract:

With fast advances in healthcare technology, various total laboratory automation (TLA) processes have been proposed. However, adopting TLA needs quite high funding. This study explores an early adoption experience by Taiwan’s large-scale hospital group, the Chimei Hospital Group (CMG), which owns three branch hospitals (Yongkang, Liouying and Chiali, in order by service scale), based on the five stages of Everett Rogers’ Diffusion Decision Process. 1.Knowledge stage: Over the years, two weaknesses exists in laboratory department of CMG: 1) only a few examination categories (e.g., sugar testing and HbA1c) can now be completed and reported within a day during an outpatient clinical visit; 2) the Yongkang Hospital laboratory space is dispersed across three buildings, resulting in duplicated investment in analysis instruments and inconvenient artificial specimen transportation. Thus, the senior management of the department raised a crucial question, was it time to process the redesign of the laboratory department? 2.Persuasion stage: At the end of 2013, Yongkang Hospital’s new building and restructuring project created a great opportunity for the redesign of the laboratory department. However, not all laboratory colleagues had the consensus for change. Thus, the top managers arranged a series of benchmark visits to stimulate colleagues into being aware of and accepting TLA. Later, the director of the department proposed a formal report to the top management of CMG with the results of the benchmark visits, preliminary feasibility analysis, potential benefits and so on. 3.Decision stage: This TLA suggestion was well-supported by the top management of CMG and, finally, they made a decision to carry out the project with an instrument-leasing strategy. After the announcement of a request for proposal and several vendor briefings, CMG confirmed their laboratory automation architecture and finally completed the contracts. At the same time, a cross-department project team was formed and the laboratory department assigned a section leader to the National Taiwan University Hospital for one month of relevant training. 4.Implementation stage: During the implementation, the project team called for regular meetings to review the results of the operations and to offer an immediate response to the adjustment. The main project tasks included: 1) completion of the preparatory work for beginning the automation procedures; 2) ensuring information security and privacy protection; 3) formulating automated examination process protocols; 4) evaluating the performance of new instruments and the instrument connectivity; 5)ensuring good integration with hospital information systems (HIS)/laboratory information systems (LIS); and 6) ensuring continued compliance with ISO 15189 certification. 5.Confirmation stage: In short, the core process changes include: 1) cancellation of signature seals on the specimen tubes; 2) transfer of daily examination reports to a data warehouse; 3) routine pre-admission blood drawing and formal inpatient morning blood drawing can be incorporated into an automatically-prepared tube mechanism. The study summarizes below the continuous improvement orientations: (1) Flexible reference range set-up for new instruments in LIS. (2) Restructure of the specimen category. (3) Continuous review and improvements to the examination process. (4) Whether installing the tube (specimen) delivery tracks need further evaluation.

Keywords: innovation decision process, total laboratory automation, health care

Procedia PDF Downloads 409