Search results for: nutrition therapy guide
2232 The State in Africa and the twenty-First Century Global Economic Relations
Authors: Sunday Ofum Ogon
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The 1648 Westphalia Conference in Europe ushered in the state as the only legal entity with powers to engage in interstate relations on matters that bothers on the development need of her citizens. This epochal entry of the state reshaped global relations with the curtailment of the powers of individual and groups in external relations as the state became the only entity that acted on behalf of any individual or non-state actors like NGOs residing within the parameters of such a country. Thus, the paper interrogated the extent at which the state determines her Politico-Economic relations with regards to development and growth within the state. To achieve these objectives, the paper relied on documentary evidences wherein the qualitative descriptive method was used for data collection and analysis. The paper exploited the facilities of the Rentier State theory as a guide to the study. It was revealed at the end of the study that the 21st century global economic relations is largely determine by international organizations as exemplified by the World Bank and the International Monitory Fund (IMF) where their activities in the continent has undermined state sovereignty. Hence the paper recommended amongst others that states should look inward for development strategies rather than relying on handout from supra-national organizations which has infringe on their sovereignty.Keywords: State , Global , Rentier state, Twenty-First Century
Procedia PDF Downloads 2662231 Factors Affecting Treatment Resilience in Patients with Oesophago-Gastric Cancers Undergoing Palliative Chemotherapy: A Literature Review
Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne
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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience
Procedia PDF Downloads 712230 A Prospective Study of a Clinically Significant Anatomical Change in Head and Neck Intensity-Modulated Radiation Therapy Using Transit Electronic Portal Imaging Device Images
Authors: Wilai Masanga, Chirapha Tannanonta, Sangutid Thongsawad, Sasikarn Chamchod, Todsaporn Fuangrod
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The major factors of radiotherapy for head and neck (HN) cancers include patient’s anatomical changes and tumour shrinkage. These changes can significantly affect the planned dose distribution that causes the treatment plan deterioration. A measured transit EPID images compared to a predicted EPID images using gamma analysis has been clinically implemented to verify the dose accuracy as part of adaptive radiotherapy protocol. However, a global gamma analysis dose not sensitive to some critical organ changes as the entire treatment field is compared. The objective of this feasibility study is to evaluate the dosimetric response to patient anatomical changes during the treatment course in HN IMRT (Head and Neck Intensity-Modulated Radiation Therapy) using a novel comparison method; organ-of-interest gamma analysis. This method provides more sensitive to specific organ change detection. Random replanned 5 HN IMRT patients with causes of tumour shrinkage and patient weight loss that critically affect to the parotid size changes were selected and evaluated its transit dosimetry. A comprehensive physics-based model was used to generate a series of predicted transit EPID images for each gantry angle from original computed tomography (CT) and replan CT datasets. The patient structures; including left and right parotid, spinal cord, and planning target volume (PTV56) were projected to EPID level. The agreement between the transit images generated from original CT and replanned CT was quantified using gamma analysis with 3%, 3mm criteria. Moreover, only gamma pass-rate is calculated within each projected structure. The gamma pass-rate in right parotid and PTV56 between predicted transit of original CT and replan CT were 42.8%( ± 17.2%) and 54.7%( ± 21.5%). The gamma pass-rate for other projected organs were greater than 80%. Additionally, the results of organ-of-interest gamma analysis were compared with 3-dimensional cone-beam computed tomography (3D-CBCT) and the rational of replan by radiation oncologists. It showed that using only registration of 3D-CBCT to original CT does not provide the dosimetric impact of anatomical changes. Using transit EPID images with organ-of-interest gamma analysis can provide additional information for treatment plan suitability assessment.Keywords: re-plan, anatomical change, transit electronic portal imaging device, EPID, head, and neck
Procedia PDF Downloads 2092229 A Framework for Blockchain Vulnerability Detection and Cybersecurity Education
Authors: Hongmei Chi
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The Blockchain has become a necessity for many different societal industries and ordinary lives including cryptocurrency technology, supply chain, health care, public safety, education, etc. Therefore, training our future blockchain developers to know blockchain programming vulnerability and I.T. students' cyber security is in high demand. In this work, we propose a framework including learning modules and hands-on labs to guide future I.T. professionals towards developing secure blockchain programming habits and mitigating source code vulnerabilities at the early stages of the software development lifecycle following the concept of Secure Software Development Life Cycle (SSDLC). In this research, our goal is to make blockchain programmers and I.T. students aware of the vulnerabilities of blockchains. In summary, we develop a framework that will (1) improve students' skills and awareness of blockchain source code vulnerabilities, detection tools, and mitigation techniques (2) integrate concepts of blockchain vulnerabilities for IT students, (3) improve future IT workers’ ability to master the concepts of blockchain attacks.Keywords: software vulnerability detection, hands-on lab, static analysis tools, vulnerabilities, blockchain, active learning
Procedia PDF Downloads 892228 Biodiversity of the National Production through Companion Plants Analysis
Authors: Astrid Rivera, Diego Villatoro
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The world population increases at an accelerated pace, and it is essential to find solutions to feed the population. Nevertheless, crop diversity has significantly decreased in the last years, and the increase in food production is not the optimal solution. It is essential to consider the origin of the food, the nutriment contributions, among other dimensions. In this regard, biodiversity plays an indispensable role when designing an effective strategy to face the actual food security problems. Consequently, the purpose of this work is to analyze biodiversity in the Mexican national food production and suggest a proper crop selection based on companion plants, for which empirical and experimental knowledge shows a better scenery than current efforts. As a result, we get a set of crop recommendations to increase production in sustainable and nutritive planning. It is essential to explore more feasible options to advance sustainable development goals beyond an economic aspect.Keywords: biodiversity, food security, companion plats, nutrition
Procedia PDF Downloads 1932227 Correlation Studies and Heritability Estimates among Onion (Allium Cepa L.) Cultivars of North Western Nigeria
Authors: L. Abubakar, B. M. Sokoto, I. U. Mohammed, M. S. Na’allah, A. Mohammad, A. N. Garba, T. S. Bubuche
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Onion (Allium cepa var. cepa L.), is the most important species of the Allium group belonging to family Alliaceae and genus Allium. It can be regarded as the single important vegetable species in the world after tomatoes. Despite the similarities, which bring the species together, the genus is a strikingly diverse one, with more than five hundred species, which are perennial and mostly bulbous plants. Out of these, only seven species are in cultivation, and five are the most important species of the cultivated Allium. However, Allium cepa (onion) and Allium sativum (Garlic) are the two major cultivated species grown all over the world of which the onion crop is the most important. Heritability defined as the proportion of the observed total variability that is genetic, and its estimates from variance components give more useful information of genotypic variation from the total phenotypic differences and environmental effects on the individuals or families. It therefore guide the breeder with respect to the ease with which selection of traits can be carried out. Heritability estimates guide the breeder with respect to ease of selection of traits while correlations suggest how selection among characters can be practiced. Correlations explain relationship between characters and suggest how selection among characters can be practiced in breeding programmes. Highly significant correlations have been reported, between yield, maturity, rings/bulb and storage loss in onions. Similarly significant positive correlation exists between total bulb yield and plant height, leaf number/plant, bulb diameter and bulb yield/plant. Moderate positive correlations have been observed between maturity date and yield, dry matter content was highly correlated with soluble solids, and higher correlations were also observed between storage loss and soluble solids. The objective of the study is to determine heritability estimates and correlations for characters among onion cultivars of North Western Nigeria. This is envisaged will assist in the breeding of superior onion cultivars within the zone. Thirteen onion cultivars were collected during an expedition covering north western Nigeria and Southern part of Niger Republic during 2013, which are areas noted for onion production. The cultivars were evaluated at two locations; Sokoto, in Sokoto State and Jega in Kebbi State all in Nigeria during the 2013/14 onion season (dry season) under irrigation. Combined analysis of the results revealed fresh bulb yield is highly significantly positively correlated with bulb height and cured bulb yield, and significant positive correlation with plant height and bulb diameter. It also recorded significant negative correlation with mean No. of leaves/plant and non significant negative correlation with bolting %. Cured bulb yield (marketable yield) had highly significant positive correlation with mean bulb weight and fresh bulb yield/ha, with significant positive correlation with bulb height. It also recorded highly significant negative correlation with No. of leaves/plant and significant negative correlation with bolting % and non significant positive correlation with plant height and non significant negative correlation with bulb diameter. High broad sense heritability estimates were recorded for plant height, fresh bulb yield, number of leaves/plant, bolting % and cured bulb yield. Medium to low broad sense heritabilities were also observed for mean bulb weight, plant height and bulb diameter.Keywords: correlation, heritability, onions, North Western Nigeria
Procedia PDF Downloads 3942226 A Case of Postpartum Pulmonary Edema Induced by Oxytocin
Authors: May Zaw, Amber Latif, William Lim
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Postpartum dyspnea can be due to many causes, such as pulmonary embolism, amniotic fluid embolism, and peripartum cardiomyopathy, but less frequently due to acute pulmonary edema. The incidence of acute pulmonary edema during pregnancy and in the postpartum period has been estimated to be around 0.08%. About half of the cases are attributed to tocolytic therapy. Herein, we present a case of a young woman presenting with acute hypoxia after induction of labor with oxytocin and found to have acute pulmonary edema. This case aims to illustrate and add to a growing body of literature regarding oxytocin-induced acute pulmonary edema and highlights the importance of recognizing the rare complication of oxytocin and necessary interventions to avoid complications. Oxytocin-induced pulmonary edema is a relatively uncommon condition, but physicians should have a high index of suspicion to initiate timely intervention and avoid fetal complications.Keywords: pulmonary, pregnancy, oxytocin, postpartum
Procedia PDF Downloads 862225 Magnet Position Variation of the Electromagnetic Actuation System in a Torsional Scanner
Authors: Loke Kean Koay, Mani Maran Ratnam
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A mechanically-resonant torsional spring scanner was developed in a recent study. Various methods were developed to improve the angular displacement of the scanner while maintaining the scanner frequency. However, the effects of rotor magnet radial position on scanner characteristics were not well investigated. In this study, the relationships between the magnet position and the scanner characteristics such as natural frequency, angular displacement and stress level were studied. A finite element model was created and an average deviation of 3.18% was found between the simulation and experimental results, qualifying the simulation results as a guide for further investigations. Three magnet positions on the transverse oscillating suspended plate were investigated by finite element analysis (FEA) and one of the positions were selected as the design position. The magnet position with the longest distance from the twist axis of the mirror was selected since it attains minimum stress level while exceeding the minimum critical flicker frequency and delivering the targeted angular displacement to the scanner.Keywords: torsional scanner, design optimization, computer-aided design, magnet position variation
Procedia PDF Downloads 3602224 Mentoring in Translation: A Tool for Future Translators
Authors: Ana Sofia Saldanha
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The globalization is changing the translation world day after day, year after year. The need to know more about new technologies, clients, companies and social networks is becoming more and more demanding and competitive. The recently graduated translators usually do not know where to go, what to do or even who to contact to start their careers in translation. It is well known that there are innumerous webinars, books, blogs, webpages and even Facebook pages indicating what to do, what not to do, rates, how your CV should look like, etc. but are these pieces of advice of real translators? Translators, who work daily with clients, who understand their demands, requests, questions? As far as today`s trends, the answer is NO. Most of these pieces of advice are just theoretical and far away from the real translation world. Therefore, mentoring is becoming a very important tool to help and guide new translators starting their career. An effective and well-oriented mentoring is a powerful way to orient these translators on how to create their CVs, where to send CVs, how to approach clients, how to answer emails and how to negotiate rates in an efficient way. Mentoring is crucial when properly delivered by professional and experienced translators, to help developing careers. The advice and orientation sessions are almost a 'weapon' to destroy the barriers created by opinions, by influences or even by universities. This new trend is the future path of new translators and is the future of the translation industry and professionals, however minds and spirits need to be opened and engaged in this new way of developing skills.Keywords: mentoring, translation, translators, orientation, professional path
Procedia PDF Downloads 1712223 How to Ensure Environmental Sustainability and Food Security through the Use of Payments for Environmental Services in Developing Countries
Authors: Carlos Alves
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This research paper demonstrates how payments for environmental services (PES) can be an effective mechanism to combat food insecurity and reduce environmental degradation in developing countries. The paper begins by discussing how environmental services affect each one of the pillars of food security: availability, access, and utilization of food. However, due to numerous global environmental challenges, a new pillar of food security based on environmental sustainability is proposed and discussed. An argument is then made that PES can usefully combat food insecurity. It can provide an extra income to those who take on environmental service and help them to have a better access to food. In order to be successful in addressing food insecurity, PES schemes should target on the poor and redress issues that can prevent their effectiveness. Finally, the research presents a case study that discusses how several developing countries addressed problems and successfully developed PES programs.Keywords: environmental sustainability, food security, nutrition, payments for environmental services
Procedia PDF Downloads 3862222 Video-Based System for Support of Robot-Enhanced Gait Rehabilitation of Stroke Patients
Authors: Matjaž Divjak, Simon Zelič, Aleš Holobar
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We present a dedicated video-based monitoring system for quantification of patient’s attention to visual feedback during robot assisted gait rehabilitation. Two different approaches for eye gaze and head pose tracking are tested and compared. Several metrics for assessment of patient’s attention are also presented. Experimental results with healthy volunteers demonstrate that unobtrusive video-based gaze tracking during the robot-assisted gait rehabilitation is possible and is sufficiently robust for quantification of patient’s attention and assessment of compliance with the rehabilitation therapy.Keywords: video-based attention monitoring, gaze estimation, stroke rehabilitation, user compliance
Procedia PDF Downloads 4202221 The Physiological Effect of Cold Atmospheric Pressure Plasma on Cancer Cells, Cancer Stem Cells, and Adult Stem Cells
Authors: Jeongyeon Park, Yeo Jun Yoon, Jiyoung Seo, In Seok Moon, Hae Jun Lee, Kiwon Song
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Cold Atmospheric Pressure Plasma (CAPP) is defined as a partially ionized gas with electrically charged particles at room temperature and atmospheric pressure. CAPP generates reactive oxygen species (ROS) and reactive nitrogen species (RNS), and has potential as a new apoptosis-promoting cancer therapy. With an annular type dielectric barrier discharge (DBD) CAPP-generating device combined with a helium (He) gas feeding system, we showed that CAPP selectively induced apoptosis in various cancer cells while it promoted proliferation of the adipose tissue-derived stem cell (ASC). The apoptotic effect of CAPP was highly selective toward p53-mutated cancer cells. The intracellular ROS was mainly responsible for apoptotic cell death in CAPP-treated cancer cells. CAPP induced apoptosis even in doxorubicin-resistant cancer cell lines, demonstrating the feasibility of CAPP as a potent cancer therapy. With the same device and exposure conditions to cancer cells, CAPP stimulated proliferation of the ASC, a kind of mesenchymal stem cell that is capable of self-renewing and differentiating into adipocytes, chondrocytes, osteoblasts and neurons. CAPP-treated ASCs expressed the stem cell markers and differentiated into adipocytes as untreated ASCs. The increase of proliferation by CAPP in ASCs was offset by a NO scavenger but was not affected by ROS scavengers, suggesting that NO generated by CAPP is responsible for the activated proliferation in ASCs. Usually, cancer stem cells are reported to be resistant to known cancer therapies. When we applied CAPP of the same device and exposure conditions to cancer cells to liver cancer stem cells (CSCs) that express CD133 and epithelial cell adhesion molecule (EpCAM) cancer stem cell markers, apoptotic cell death was not examined. Apoptotic cell death of liver CSCs was induced by the CAPP generated from a device with an air-based flatten type DBD. An exposure of liver CSCs to CAPP decreased the viability of liver CSCs to a great extent, suggesting plasma be used as a promising anti-cancer treatment. To validate whether CAPP can be a promising anti-cancer treatment or an adjuvant modality to eliminate remnant tumor in cancer surgery of vestibular schwannoma, we applied CAPP to mouse schwannoma cell line SC4 Nf2 ‑/‑ and human schwannoma cell line HEI-193. A CAPP treatment leads to anti-proliferative effect in both cell lines. We are currently studying the molecular mechanisms of differential physiological effect of CAPP; the proliferation of ASCs and apoptosis of various cancer cells and CSCs.Keywords: cold atmospheric pressure plasma, apoptosis, proliferation, cancer cells, adult stem cells
Procedia PDF Downloads 2752220 A Systematic Review on the Whole-Body Cryotherapy versus Control Interventions for Recovery of Muscle Function and Perceptions of Muscle Soreness Following Exercise-Induced Muscle Damage in Runners
Authors: Michael Nolte, Iwona Kasior, Kala Flagg, Spiro Karavatas
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Background: Cryotherapy has been used as a post-exercise recovery modality for decades. Whole-body cryotherapy (WBC) is an intervention which involves brief exposures to extremely cold air in order to induce therapeutic effects. It is currently being investigated for its effectiveness in treating certain exercise-induced impairments. Purpose: The purpose of this systematic review was to determine whether WBC as a recovery intervention is more, less, or equally as effective as other interventions at reducing perceived levels of muscle soreness and promoting recovery of muscle function after exercise-induced muscle damage (EIMD) from running. Methods: A systematic review of the current literature was performed utilizing the following MeSH terms: cryotherapy, whole-body cryotherapy, exercise-induced muscle damage, muscle soreness, muscle recovery, and running. The databases utilized were PubMed, CINAHL, EBSCO Host, and Google Scholar. Articles were included if they were published within the last ten years, had a CEBM level of evidence of IIb or higher, had a PEDro scale score of 5 or higher, studied runners as primary subjects, and utilized both perceived levels of muscle soreness and recovery of muscle function as dependent variables. Articles were excluded if subjects did not include runners, if the interventions included PBC instead of WBC, and if both muscle performance and perceived muscle soreness were not assessed within the study. Results: Two of the four articles revealed that WBC was significantly more effective than treatment interventions such as far-infrared radiation and passive recovery at reducing perceived levels of muscle soreness and restoring muscle power and endurance following simulated trail runs and high-intensity interval running, respectively. One of the four articles revealed no significant difference between WBC and passive recovery in terms of reducing perceived muscle soreness and restoring muscle power following sprint intervals. One of the four articles revealed that WBC had a harmful effect compared to CWI and passive recovery on both perceived muscle soreness and recovery of muscle strength and power following a marathon. Discussion/Conclusion: Though there was no consensus in terms of WBC’s effectiveness at treating exercise-induced muscle damage following running compared to other interventions, it seems as though WBC may at least have a time-dependent positive effect on muscle soreness and recovery following high-intensity interval runs and endurance running, marathons excluded. More research needs to be conducted in order to determine the most effective way to implement WBC as a recovery method for exercise-induced muscle damage, including the optimal temperature, timing, duration, and frequency of treatment.Keywords: cryotherapy, physical therapy intervention, physical therapy, whole body cryotherapy
Procedia PDF Downloads 2282219 Evaluation of Cooperative Hand Movement Capacity in Stroke Patients Using the Cooperative Activity Stroke Assessment
Authors: F. A. Thomas, M. Schrafl-Altermatt, R. Treier, S. Kaufmann
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Stroke is the main cause of adult disability. Especially upper limb function is affected in most patients. Recently, cooperative hand movements have been shown to be a promising type of upper limb training in stroke rehabilitation. In these movements, which are frequently found in activities of daily living (e.g. opening a bottle, winding up a blind), the force of one upper limb has to be equally counteracted by the other limb to successfully accomplish a task. The use of standardized and reliable clinical assessments is essential to evaluate the efficacy of therapy and the functional outcome of a patient. Many assessments for upper limb function or impairment are available. However, the evaluation of cooperative hand movement tasks are rarely included in those. Thus, the aim of this study was (i) to develop a novel clinical assessment (CASA - Cooperative Activity Stroke Assessment) for the evaluation of patients’ capacity to perform cooperative hand movements and (ii) to test its inter- and interrater reliability. Furthermore, CASA scores were compared to current gold standard assessments for upper extremity in stroke patients (i.e. Fugl-Meyer Assessment, Box & Blocks Test). The CASA consists of five cooperative activities of daily living including (1) opening a jar, (2) opening a bottle, (3) open and closing of a zip, (4) unscrew a nut and (5) opening a clipbox. Here, the goal is to accomplish the tasks as fast as possible. In addition to the quantitative rating (i.e. time) which is converted to a 7-point scale, also the quality of the movement is rated in a 4-point scale. To test the reliability of CASA, fifteen stroke subjects were tested within a week twice by the same two raters. Intra-and interrater reliability was calculated using the intraclass correlation coefficient (ICC) for total CASA score and single items. Furthermore, Pearson-correlation was used to compare the CASA scores to the scores of Fugl-Meyer upper limb assessment and the box and blocks test, which were assessed in every patient additionally to the CASA. ICC scores of the total CASA score indicated an excellent- and single items established a good to excellent inter- and interrater reliability. Furthermore, the CASA score was significantly correlated to the Fugl-Meyer and Box & Blocks score. The CASA provides a reliable assessment for cooperative hand movements which are crucial for many activities of daily living. Due to its non-costly setup, easy and fast implementation, we suggest it to be well suitable for clinical application. In conclusion, the CASA is a useful tool in assessing the functional status and therapy related recovery in cooperative hand movement capacity in stroke patients.Keywords: activitites of daily living, clinical assessment, cooperative hand movements, reliability, stroke
Procedia PDF Downloads 3152218 Management Problems in a Patient With Long-term Undiagnosed Permanent Hypoparathyroidism
Authors: Babarina Maria, Andropova Margarita
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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria
Procedia PDF Downloads 992217 Evaluation of Functional Properties of Protein Hydrolysate from the Fresh Water Mussel Lamellidens marginalis for Nutraceutical Therapy
Authors: Jana Chakrabarti, Madhushrita Das, Ankhi Haldar, Roshni Chatterjee, Tanmoy Dey, Pubali Dhar
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High incidences of Protein Energy Malnutrition as a consequence of low protein intake are quite prevalent among the children in developing countries. Thus prevention of under-nutrition has emerged as a critical challenge to India’s developmental Planners in recent times. Increase in population over the last decade has led to greater pressure on the existing animal protein sources. But these resources are currently declining due to persistent drought, diseases, natural disasters, high-cost of feed, and low productivity of local breeds and this decline in productivity is most evident in some developing countries. So the need of the hour is to search for efficient utilization of unconventional low-cost animal protein resources. Molluscs, as a group is regarded as under-exploited source of health-benefit molecules. Bivalve is the second largest class of phylum Mollusca. Annual harvests of bivalves for human consumption represent about 5% by weight of the total world harvest of aquatic resources. The freshwater mussel Lamellidens marginalis is widely distributed in ponds and large bodies of perennial waters in the Indian sub-continent and well accepted as food all over India. Moreover, ethno-medicinal uses of the flesh of Lamellidens among the rural people to treat hypertension have been documented. Present investigation thus attempts to evaluate the potential of Lamellidens marginalis as functional food. Mussels were collected from freshwater ponds and brought to the laboratory two days before experimentation for acclimatization in laboratory conditions. Shells were removed and fleshes were preserved at- 20oC until analysis. Tissue homogenate was prepared for proximate studies. Fatty acids and amino acids composition were analyzed. Vitamins, Minerals and Heavy metal contents were also studied. Mussel Protein hydrolysate was prepared using Alcalase 2.4 L and degree of hydrolysis was evaluated to analyze its Functional properties. Ferric Reducing Antioxidant Power (FRAP) and DPPH Antioxidant assays were performed. Anti-hypertensive property was evaluated by measuring Angiotensin Converting Enzyme (ACE) inhibition assay. Proximate analysis indicates that mussel meat contains moderate amount of protein (8.30±0.67%), carbohydrate (8.01±0.38%) and reducing sugar (4.75±0.07%), but less amount of fat (1.02±0.20%). Moisture content is quite high but ash content is very low. Phospholipid content is significantly high (19.43 %). Lipid constitutes, substantial amount of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which have proven prophylactic values. Trace elements are found present in substantial amount. Comparative study of proximate nutrients between Labeo rohita, Lamellidens and cow’s milk indicates that mussel meat can be used as complementary food source. Functionality analyses of protein hydrolysate show increase in Fat absorption, Emulsification, Foaming capacity and Protein solubility. Progressive anti-oxidant and anti-hypertensive properties have also been documented. Lamellidens marginalis can thus be regarded as a functional food source as this may combine effectively with other food components for providing essential elements to the body. Moreover, mussel protein hydrolysate provides opportunities for utilizing it in various food formulations and pharmaceuticals. The observations presented herein should be viewed as a prelude to what future holds.Keywords: functional food, functional properties, Lamellidens marginalis, protein hydrolysate
Procedia PDF Downloads 4152216 Development a Home-Hotel-Hospital-School Community-Based Palliative Care Model for Patients with Cancer in Suratthani, Thailand
Authors: Patcharaporn Sakulpong, Wiriya Phokhwang
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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliativeKeywords: community-based palliative care, model, participatory action research, patients with cancer
Procedia PDF Downloads 2632215 Stimulating the Social Interaction Development of Children through Computer Play Activities: The Role of Teachers
Authors: Mahani Razali, Abd Halim Masnan, Nordin Mamat, Seah Siok Peh
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This research is based on three main objectives which are to identify children`s social interaction behaviour during computer play activities, teacher’s role and to explore teacher’s beliefs, views and knowledge about computers use in four Malaysian pre-schools.This qualitative study was carried out among 25 pre-school children and three teachers as the research sample. The data collection procedures involved structured observation which was to identify social interaction behavior among pre-school children through computer play activities; as for semi-structured interviews, it was done to study the perception of the teachers on the acquired of social interaction behavior development among the children. A variety of patterns can be seen within the peer interactions indicating that children exhibit a vast range of social interactions at the computer, and they varied each day. The findings of this study guide us to certain conclusions, which have implications in understanding the phenomena of how computers were used and how its relationship to the children’s social interactions emerge in the four Malaysian preschools. This study provides evidence that the children’s social interactions with peers and adults were mediated by the engagement of the children in the computer environments.Keywords: computer, play, preschool, social interaction
Procedia PDF Downloads 2872214 Novel EGFR Ectodomain Mutations and Resistance to Anti-EGFR and Radiation Therapy in H&N Cancer
Authors: Markus Bredel, Sindhu Nair, Hoa Q. Trummell, Rajani Rajbhandari, Christopher D. Willey, Lewis Z. Shi, Zhuo Zhang, William J. Placzek, James A. Bonner
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Purpose: EGFR-targeted monoclonal antibodies (mAbs) provide clinical benefit in some patients with H&N squamous cell carcinoma (HNSCC), but others progress with minimal response. Missense mutations in the EGFR ectodomain (ECD) can be acquired under mAb therapy by mimicking the effect of large deletions on receptor untethering and activation. Little is known about the contribution of EGFR ECD mutations to EGFR activation and anti-EGFR response in HNSCC. Methods: We selected patient-derived HNSCC cells (UM-SCC-1) for resistance to mAb Cetuximab (CTX) by repeated, stepwise exposure to mimic what may occur clinically and identified two concurrent EGFR ECD mutations (UM-SCC-1R). We examined the competence of the mutants to bind EGF ligand or CTX. We assessed the potential impact of the mutations through visual analysis of space-filling models of the native sidechains in the original structures vs. their respective side-chain mutations. We performed CRISPR in combination with site-directed mutagenesis to test for the effect of the mutants on ligand-independent EGFR activation and sorting. We determined the effects on receptor internalization, endocytosis, downstream signaling, and radiation sensitivity. Results: UM-SCC-1R cells carried two non-synonymous missense mutations (G33S and N56K) mapping to domain I in or near the EGF binding pocket of the EGFR ECD. Structural modeling predicted that these mutants restrict the adoption of a tethered, inactive EGFR conformation while not permitting association of EGFR with the EGF ligand or CTX. Binding studies confirmed that the mutant, untethered receptor displayed a reduced affinity for both EGF and CTX but demonstrated sustained activation and presence at the cell surface with diminished internalization and sorting for endosomal degradation. Single and double-mutant models demonstrated that the G33S mutant is dominant over the N56K mutant in its effect on EGFR activation and EGF binding. CTX-resistant UM-SCC-1R cells demonstrated cross-resistance to mAb Panitumuab but, paradoxically, remained sensitive to the reversible receptor tyrosine kinase inhibitor Erlotinib. Conclusions: HNSCC cells can select for EGFR ECD mutations under EGFR mAb exposure that converge to trap the receptor in an open, constitutively activated state. These mutants impede the receptor’s competence to bind mAbs and EGF ligand and alter its endosomal trafficking, possibly explaining certain cases of clinical mAb and radiation resistance.Keywords: head and neck cancer, EGFR mutation, resistance, cetuximab
Procedia PDF Downloads 852213 The Prevalence of Overweight and Obesity among Adolescents in Public and Private Schools in Two Senatorial Districts of Osun State, Nigeria
Authors: O. Akinola, R. Mustapha
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Obesity is the most serious long-term health problem currently facing adolescents and its prevalence increasing worldwide including developing countries. A cross-sectional study was carried out among age 11-19 years in both public and private school in the urban area of the state. The data was collected using pretest self-administered questionnaire; Anthropometric measurement was also used to examine their nutritional status. Obesity status were determined using BMI cut off point, the overweight was found to be 3.06% among female and 0.6% among male whereas the prevalence of obesity was 0.46% in female and non among male. 62.6% snack daily, fruit consumption pattern was low 0.6%, and 43.7% spend between 4-5 hours watching television daily after school. A positive association exists between the lifestyle and nutritional status of the respondents. Education effort to improve nutrition knowledge can be incorporated into course curriculum and focus on various components within the system when implementing preventive measure on obesity.Keywords: adolescent, obesity, overweight, prevalence
Procedia PDF Downloads 3172212 A Guide to the Implementation of Ambisonics Super Stereo
Authors: Alessio Mastrorillo, Giuseppe Silvi, Francesco Scagliola
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In this work, we introduce an Ambisonics decoder with an implementation of the C-format, also called Super Stereo. This format is an alternative to conventional stereo and binaural decoding. Unlike those, this format conveys audio information from the horizontal plane and works with stereo speakers and headphones. The two C-format channels can also return a reconstructed planar B-format. This work provides an open-source implementation for this format. We implement an all-pass filter for signal quadrature, as required by the decoding equations. This filter works with six Biquads in a cascade configuration, with values for control frequency and quality factor discovered experimentally. The phase response of the filter delivers a small error in the 20-14.000Hz range. The decoder has been tested with audio sources up to 192kHz sample rate, returning pristine sound quality and detailed stereo image. It has been included in the Envelop for Live suite and is available as an open-source repository. This decoder has applications in Virtual Reality and 360° audio productions, music composition, and online streaming.Keywords: ambisonics, UHJ, quadrature filter, virtual reality, Gerzon, decoder, stereo, binaural, biquad
Procedia PDF Downloads 852211 Author Self-Archiving in Open Access Institutional Repositories for Awareness Creation in Universities
Authors: Kwame Kodua-Ntim
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The study explored the authors self-archiving to create awareness of open-access institutional repositories in universities. The qualitative approach of the study was informed by the interpretive paradigm as well as the case research design. The target population for the study was all twelve (12) open-access institutional repositories managers and administrators purposively selected from the five (5) universities in Ghana. The universities were chosen since they were the only ones listed in the Directory of Open Access Repositories. Interviews were conducted using a semi-structured interview guide and data were analyzed using thematic analysis. The study revealed that academics had some information about self-archiving in open-access institutional repositories and university libraries with open-access institutional repositories were using DSpace software. Managers and administrators of open-access institutional repositories mediated content uploaded and believed that author self-archiving could improve awareness of open-access institutional repositories. The study recommended that universities should fully implement the author’s self-archiving protocol, and academics should be trained to be able to upload research works onto open-access institutional repositories. Furthermore, the university and university library should provide rigorous policies on author self-archiving and incentives for author self-archiving in the open access institutional repositories.Keywords: author, awareness, institutional repositories, open access, open archive, self-archiving
Procedia PDF Downloads 752210 Modeling and Control of a 4DoF Robotic Assistive Device for Hand Rehabilitation
Authors: Christopher Spiewak, M. R. Islam, Mohammad Arifur Rahaman, Mohammad H. Rahman, Roger Smith, Maarouf Saad
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For those who have lost the ability to move their hand, going through repetitious motions with the assistance of a therapist is the main method of recovery. We have been developed a robotic assistive device to rehabilitate the hand motions in place of the traditional therapy. The developed assistive device (RAD-HR) is comprised of four degrees of freedom enabling basic movements, hand function, and assists in supporting the hand during rehabilitation. We used a nonlinear computed torque control technique to control the RAD-HR. The accuracy of the controller was evaluated in simulations (MATLAB/Simulink environment). To see the robustness of the controller external disturbance as modelling uncertainty (±10% of joint torques) were added in each joints.Keywords: biorobotics, rehabilitation, robotic assistive device, exoskeleton, nonlinear control
Procedia PDF Downloads 4652209 Finite Element Analysis of Ball-Joint Boots under Environmental and Endurance Tests
Authors: Young-Doo Kwon, Seong-Hwa Jun, Dong-Jin Lee, Hyung-Seok Lee
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Ball joints support and guide certain automotive parts that move relative to the frame of the vehicle. Such ball joints are covered and protected from dust, mud, and other interfering materials by ball-joint boots made of rubber—a flexible and near-incompressible material. The boots may experience twisting and bending deformations because of the motion of the joint arm. Thus, environmental and endurance tests of ball-joint boots apply both bending and twisting deformations. In this study, environmental and endurance testing was simulated via the finite element method performed by using a commercial software package. The ranges of principal stress and principal strain values that are known to directly affect the fatigue lives of the parts were sought. By defining these ranges, the number of iterative tests and modifications of the materials and dimensions of the boot can be decreased. Therefore, instead of performing actual part tests, manufacturers can perform standard fatigue tests in trials of different materials by applying only the defined range of stress or strain values.Keywords: boot, endurance tests, rubber, FEA
Procedia PDF Downloads 2572208 Erythema Multiforme Exudativum Major Caused by Isoniazid Hypersensitivity in a Child
Authors: Azwin Lubis, Rika Hapsari, Zahrah Hikmah, Anang Endaryanto, Ariyanto Harsono
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Erythema Multiforme Exudativum Major (EMEM) is one of the drug allergy diseases. Drug allergies caused by isoniazid rarely causes EMEM. Cutaneous reactions caused by isoniazid were obtained in 0.98% of patients, but the precise occurrence of Steven Johnson’s Syndrome (SJS) and Toxic Epidermolisis Necrolisis (TEN) due to isoniazid is not known for certain. We present this case to show hypersensitivity of isoniazid in a child. Based on the history of drug intake, physical diagnostic tests, drug elimination and provocation; we established the diagnosis of isoniazid hypersensitivity. The child showed improvement on skin manifestation after stopped isoniazid therapy.Keywords: erythema multiforme exudativum major, hypersensitivity, elimination test, provocation test
Procedia PDF Downloads 2462207 Low Density Lipoprotein: The Culprit in the Development of Obesity
Authors: Ojiegbe Ikenna Nathan
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Obesity is a medical condition in which excess body fat has accumulated to the extent that it leads to reduced life expectancy and or increased health problems. Obesity as a worldwide problem is seen clustered in the families and it moves from generation to generation. It causes some disabilities, mortality and morbidity if left unattended to. The predisposing factors to obesity are either genetic or environment in origin. Nevertheless, the main predisposing factor to obesity is the excessive consumption of food rich in low-density lipoprotein (LDL) such as organ meats, saturated fats etc. This low-density lipoprotein causes an increase in adipose tissue and complicates to obesity. There are varieties of obesity which one needs to take appropriate measures to avoid; such as android, gynoid and morbid obesity. Nonetheless, studies have shown that there is hope for the obese individuals, despite the cause, type and degree of their obesity. This is through the use of the different available treatment measures which increase in physical activities, caloric restrictions, drug therapy and surgical intervention.Keywords: low-density, lipoprotein, culprit, obesity
Procedia PDF Downloads 3912206 The Relationship between Wasting and Stunting in Young Children: A Systematic Review
Authors: Susan Thurstans, Natalie Sessions, Carmel Dolan, Kate Sadler, Bernardette Cichon, Shelia Isanaka, Dominique Roberfroid, Heather Stobagh, Patrick Webb, Tanya Khara
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For many years, wasting and stunting have been viewed as separate conditions without clear evidence supporting this distinction. In 2014, the Emergency Nutrition Network (ENN) examined the relationship between wasting and stunting and published a report highlighting the evidence for linkages between the two forms of undernutrition. This systematic review aimed to update the evidence generated since this 2014 report to better understand the implications for improving child nutrition, health and survival. Following PRISMA guidelines, this review was conducted using search terms to describe the relationship between wasting and stunting. Studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting, as well as the association between the two, were included. Risk of bias was assessed in all included studies using SIGN checklists. 45 studies met the inclusion criteria- 39 peer reviewed studies, 1 manual chapter, 3 pre-print publications and 2 published reports. The review found that there is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Possible interconnected physiological processes and common risk factors drive an accumulation of vulnerabilities. Peak incidence of both wasting and stunting was found to be between birth and three months. A significant proportion of children experience concurrent wasting and stunting- Country level data suggests that up to 8% of children under 5 may be both wasted and stunted at the same time, global estimates translate to around 16 million children. Children with concurrent wasting and stunting have an elevated risk of mortality when compared to children with one deficit alone. These children should therefore be considered a high-risk group in the targeting of treatment. Wasting, stunting and concurrent wasting and stunting appear to be more prevalent in boys than girls and it appears that concurrent wasting and stunting peaks between 12- 30 months of age with younger children being the most affected. Seasonal patterns in prevalence of both wasting and stunting are seen in longitudinal and cross sectional data and in particular season of birth has been shown to have an impact on a child’s subsequent experience of wasting and stunting. Evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z-score might effectively identify children most at risk of near-term mortality, including those concurrently wasted and stunted. Wasting and stunting frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence suggests there is a process of accumulation of nutritional deficits and therefore risk over the life course of a child demonstrates the need for a more integrated approach to prevention and treatment strategies to interrupt this process. To achieve this, undernutrition policies, programmes, financing and research must become more unified.Keywords: Concurrent wasting and stunting, Review, Risk factors, Undernutrition
Procedia PDF Downloads 1152205 Aiding Water Flow in Irrigation Technology with a Pedal Operated Manual Pump
Authors: Isaac Ali Kwasu, Aje Tokan
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The research was set to design a manually pedal operated water pump to aid water flow technology for irrigation activities for rural farmers. The development was carried out first by a prototype design to guide the fabrication. All items needed for the fabrication were used for the final product. The machine is operated manually by pedaling. This engages all the parts of the machine into active motion. Energy is generated and transfer finally to the pumping unit which is wired with plastic pipes. The pumping unit which is wired with PVC pipes, both linked to the water source and the reservoir respectively. The (rpm) revolution per minute of the machine is approximated at 3130 depending on the pedaling speed of the user. The machine does not have gear arrangement yet can give high (rpm) for effective performance. The pumping performance of the machine is 125 liters in one minute and can sustain small scale irrigation farming activities and to supplement water management system to sustain crop growth.Keywords: pump, development, manual, flywheel, sprocket, pulley, machine, v belt, chain, hub, pipe, steel, mechanism, irrigation, prototype, fabrication
Procedia PDF Downloads 1992204 Evaluating Distance and Blended Learning during COVID-19: Experiences and Innovations from High School and Secondary Educators
Authors: Azzeddine Atibi, Khadija El Kababi, Salim Ahmed, Mohamed Radid
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The primary aim of the present study is to undertake an extensive comparative examination of distance learning and blended learning modalities, with a particular focus on assessing their efficacy during the period of confinement imposed by the COVID-19 pandemic. This investigation is grounded in the firsthand experiences of educators at the high school and secondary levels across both private and public educational institutions. To gather the necessary data, we designed and distributed a meticulously crafted survey to these educators, soliciting detailed accounts of their professional experiences throughout this challenging period. The survey's objectives include elucidating the specific difficulties faced by teachers, as well as highlighting the innovative pedagogical strategies they developed in response to these challenges. By synthesizing the insights gained from this survey, we aim to foster an exchange of experiences among educators and to generate informed recommendations that will guide future educational reforms. Ultimately, this study aspires to contribute to the ongoing discourse on optimizing educational practices in the face of unprecedented disruptions.Keywords: distance learning, blended learning, covid 19, secondary/ high school, teachingperformance, evaluation
Procedia PDF Downloads 242203 A Process to Support Multidisciplinary Teams to Design Serious Games
Authors: Naza Djafarova, Tony Bates, Margaret Verkuyl, Leonora Zefi, Ozgur Turetken, Alex Ferworn, Mastrilli Paula, Daria Romaniuk, Kosha Bramesfeld, Anastasia Dimitriadou, Cheryl To
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Designing serious games for education is a challenging and resource-intensive effort. If a well-designed process that balances pedagogical principles with game mechanics is in place, it can help to simplify the design process of serious games and increase efficiency. Multidisciplinary teams involved in designing serious games can benefit tremendously from such a process in their endeavours to develop and implement these games at undergraduate and graduate levels. This paper presentation will outline research results on identified gaps within existing processes and frameworks and present an adapted process that emerged from the research. The research methodology was based on a survey, semi-structured interviews and workshops for testing the adapted process for game design. Based on the findings, the authors propose a simple process for the pre-production stage of serious game design that may help guide multidisciplinary teams in their work. This process was used to facilitate team brainstorming, and is currently being tested to assess if multidisciplinary teams find value in using it in their process of designing serious games.Keywords: serious game-design, multidisciplinary team, game design framework, learning games, multidisciplinary game design process
Procedia PDF Downloads 420