Search results for: digital healthcare

Authors: Yaser E. Greish, Emad F. Hindawy, Maryam S. Al Nehayan

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Introductory courses such as General Chemistry I, General Physics I and General Biology need special attention as students taking these courses are usually at their first year of the university. In addition to the language barrier for most of them, they also face other difficulties if these elementary courses are taught in the traditional way. Changing the routine method of teaching of these courses is therefore mandated. In this regard, podcasting of chemistry lectures was used as an add-on to the traditional and non-traditional methods of teaching chemistry to science and non-science students. Podcasts refer to video files that are distributed in a digital format through the Internet using personal computers or mobile devices. Pedagogical strategy is another way of identifying podcasts. Three distinct teaching approaches are evident in the current literature and include receptive viewing, problem-solving, and created video podcasts. The digital format and dispensing of video podcasts have stabilized over the past eight years, the type of podcasts vary considerably according to their purpose, degree of segmentation, pedagogical strategy, and academic focus. In this regard, the whole syllabus of 'General Chemistry I' course was developed as podcasts and were delivered to students throughout the semester. Students used the podcasted files extensively during their studies, especially as part of their preparations for exams. Feedback of students strongly supported the idea of using podcasting as it reflected its effect on the overall understanding of the subject, and a consequent improvement of their grades.

Keywords: podcasting, introductory course, interactivity, flipped classroom

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Authors: Ayush Shrivastava, Arpit Chaudhary, Devang Kulshreshtha, Vibhav Prakash Singh, Rajeev Srivastava

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Early diagnosis of breast cancer can improve the survival rate by detecting cancer at an early stage. Breast region segmentation is an essential step in the analysis of digital mammograms. Accurate image segmentation leads to better detection of cancer. It aims at separating out Region of Interest (ROI) from rest of the image. The procedure begins with removal of labels, annotations and tags from the mammographic image using morphological opening method. Pectoral Muscle Sliding Window Algorithm (PMSWA) is used for removal of pectoral muscle from mammograms which is necessary as the intensity values of pectoral muscles are similar to that of ROI which makes it difficult to separate out. After removing the pectoral muscle, Dispersed Region Growing Algorithm (DRGA) is used for segmentation of mammogram which disperses seeds in different regions instead of a single bright region. To demonstrate the validity of our segmentation method, 322 mammographic images from Mammographic Image Analysis Society (MIAS) database are used. The dataset contains medio-lateral oblique (MLO) view of mammograms. Experimental results on MIAS dataset show the effectiveness of our proposed method.

Keywords: CAD, dispersed region growing algorithm (DRGA), image segmentation, mammography, pectoral muscle sliding window algorithm (PMSWA)

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Authors: Shannon Hearney, Jeffrey Hoch

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Pancreatic cancer is a notoriously costly and deadly form of cancer. Many types of treatment centers exist for patients to seek care from, including high-volume centers which have shown promise to provide the highest quality of care. While it may be true that this type of center provides the best care it is unclear if that care is cost-effective. Studies in the US have confirmed that high-volume hospitals do provide higher quality of care but have shown inconsistencies in the cost-effectiveness of that care. Other studies, like those from Finland have shown that high-volume centers had lower mortality and lower costs than low-volume centers. This paper thus seeks to review the current scientific literature to better understand if high-volume centers are cost-effective in delivering care in both a European setting and in the US. A review of major reference databases such as Medline, Embase and PubMed will be conducted for cost-effectiveness studies on the surgical treatment of pancreatic cancer at high-volume centers. Possible MeSH terms to be included, but not limited to, are: “pancreatic cancer”, “cost analysis”, “cost-effectiveness”, “economic evaluation”, “pancreatic neoplasms”, “surgical”, and “high-volume”. Studies must also have been available in the English language. This review will encompass European scientific literature, as well as those in the US. Based on our preliminary findings, we anticipate high-volume hospitals to provide better care at greater costs. We anticipate that high-volume hospitals may be cost-effective in different contexts depending on the national structure of a healthcare system. Countries with more centralized and socialized healthcare may yield results that are more cost-effective. High-volume centers may differ in their cost-effectiveness of the surgical care of pancreatic cancer internationally especially when comparing those in the United States to others throughout Europe.

Keywords: cost-effectiveness analysis, economic evaluation, pancreatic cancer, scientific literature review

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: Kwanele Shishane

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Numerous countries are faced with challenges such as disease, poverty and other social ills and inadequate government support to meet the needs of the entire population. In developing countries, the concept of child-headed households has become a ubiquitous phenomenon and lived experience. As such, migration of children is common in these countries. This study aims to explore the lived experiences of unaccompanied adolescent migrant, with regards to the utilization of health care in South Africa. The objectives of the study are to examine the lived experiences of health care utilization by unaccompanied adolescent migrants; examine the predisposing, enabling and need factors influencing utilization of health care among unaccompanied adolescent migrants; examine the social and cultural influences on health care utilization among unaccompanied adolescent migrants; and identify the health system barriers to utilization of health care by unaccompanied adolescent migrants. Andersen and Newman’s Model of Health Care Utilization (1995) which explains factors determining the utilization of healthcare will provide the theoretical framework for the empirical investigation of this study. The target population for this study is unaccompanied adolescent migrants, seeking to access services from migrant service organizations in four provinces in South Africa (Limpopo, KwaZulu-Natal, Free State, and Gauteng). Participants will be selected using a purposive sampling procedure. A qualitative research approach utilizing a descriptive phenomenological epistemology will be utilized in this study. Data will be collected through conducting in-depth interviews and focus group discussions with unaccompanied migrant adolescents, to explore their lived experiences related to access and utilization of health care, as an unaccompanied migrant in SA. The qualitative data will be analysed using Tech’s (1990) thematic analytical approach.

Keywords: health care utilisation, unaccompanied migrant youth, South Africa, lived experiences

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Authors: Isabell Koinig, Sandra Diehl

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In recent years, the health-care context has not been left unaffected by technological developments. In recent years, the Internet of Medical Things (IoMT)has not only led to a collaboration between disease management and advanced care coordination but also to more personalized health care and patient empowerment. With more than 40 % of all health technology being IoMT-related by 2020, questions regarding privacy become more prevalent, even more so during COVID-19when apps allowing for an intensive tracking of people’s whereabouts and their personal contacts cause privacy advocates to protest and revolt. There is a widespread tendency that even though users may express concerns and fears about their privacy, they behave in a manner that appears to contradict their statements by disclosing personal data. In literature, this phenomenon is discussed as a privacy paradox. While there are some studies investigating the privacy paradox in general, there is only scarce research related to the privacy paradox in the health sector and, to the authors’ knowledge, no empirical study investigating young people’s attitudes toward data security when using wearables and health apps. The empirical study presented in this paper tries to reduce this research gap by focusing on the area of digital and mobile health. It sets out to investigate the degree of importance individuals attribute to protecting their privacy and individual privacy protection strategies. Moreover, the question to which degree individuals between the ages of 20 and 30 years are willing to grant commercial parties access to their private data to use digital health services and apps are put to the test. To answer this research question, results from 6 focus groups with 40 participants will be presented. The focus was put on this age segment that has grown up in a digitally immersed environment. Moreover, it is particularly the young generation who is not only interested in health and fitness but also already uses health-supporting apps or gadgets. Approximately one-third of the study participants were students. Subjects were recruited in August and September 2019 by two trained researchers via email and were offered an incentive for their participation. Overall, results indicate that the young generation is well informed about the growing data collection and is quite critical of it; moreover, they possess knowledge of the potential side effects associated with this data collection. Most respondents indicated to cautiously handle their data and consider privacy as highly relevant, utilizing a number of protective strategies to ensure the confidentiality of their information. Their willingness to share information in exchange for services was only moderately pronounced, particularly in the health context, since health data was seen as valuable and sensitive. The majority of respondents indicated to rather miss out on using digital and mobile health offerings in order to maintain their privacy. While this behavior might be an unintended consequence, it is an important piece of information for app developers and medical providers, who have to find a way to find a user base for their products against the background of rising user privacy concerns.

Keywords: digital health, privacy, privacy paradox, IoMT

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Authors: Robyn Moloney, HuiLing Xu

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Many countries wish to produce Asia-literate citizens, through language education. International contexts of Chinese language education are seeking pedagogical innovation to meet local contextual factors frequently holding back learner success. In multicultural Australia, innovative pedagogy is urgently needed to support motivation in sustained study, with greater strategic integration of technology. This research took a qualitative approach to identify need and solutions. The paper analyses strategies that three secondary school teachers are adopting to meet specific challenges in the Australian context. The data include teacher interviews, classroom observations and student interviews. We highlight the use of task-based learning and differentiated teaching for multilevel classes, and the role which digital technologies play in facilitating both areas. The strategy examples are analysed in reference both to a research-based framework for describing quality teaching, and to current understandings of motivation in language learning. The analysis of data identifies learning featuring deep knowledge, higher-order thinking, engagement, social support, utilisation of background knowledge, and connectedness, all of which work towards the learners having a sense of autonomy and an imagination of becoming an adult Chinese language user.

Keywords: Chinese pedagogy, digital technologies, motivation, secondary school

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Authors: Martha Wilson

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With the peak of Computer-Assisted Language Learning slowly coming to pass and Mobile-Assisted Language Learning, at times, a bit lacking in the communicative department, we are now faced with a challenging question: How can we engage the interest of our digital native students and, most importantly, sustain it? As previously mentioned, our classrooms are now experiencing an influx of “digital natives” – people who have grown up using and having unlimited access to technology. While modernizing our curriculum and digitalizing our classrooms are necessary in order to accommodate this new learning style, it is a huge financial burden and a massive undertaking for language institutes. Instead, opting for a more compact, simple, yet multidimensional pedagogical tool may be the solution to the issue at hand. This paper aims to give a brief overview into an existing device referred to as Student Response Systems (SRS) and to expand on this notion to include a new prototype of response system that will be designed as a mobile application to eliminate the need for costly hardware and software. Additionally, an analysis into recent attempts by other institutes to develop the Mobile Response System (MRS) and customer reviews of the existing MRSs will be provided, as well as the lessons learned from those projects. Finally, while the new model of MRS is still in its infancy stage, this paper will discuss the implications of incorporating such an application as a tool to support and to enrich traditional techniques and also offer practical classroom applications with the existing response systems that are immediately available on the market.

Keywords: app, clickers, mobile app, mobile response system, student response system

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Authors: Justin Woulfe

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Siloed logistics and supply chain management systems throughout the Department of Defense (DOD) has led to disparate approaches to modeling and simulation (M&S), a lack of understanding of how one system impacts the whole, and issues with “optimal” solutions that are good for one organization but have dramatic negative impacts on another. Many different systems have evolved to try to understand and account for uncertainty and try to reduce the consequences of the unknown. As the DoD undertakes expansive digital transformation initiatives, there is an opportunity to fuse and leverage traditionally disparate data into a centrally hosted source of truth. With a streamlined process incorporating machine learning (ML) and artificial intelligence (AI), advanced M&S will enable informed decisions guiding program success via optimized operational readiness and improved mission success. One of the current challenges is to leverage the terabytes of data generated by monitored systems to provide actionable information for all levels of users. The implementation of a cloud-based application analyzing data transactions, learning and predicting future states from current and past states in real-time, and communicating those anticipated states is an appropriate solution for the purposes of reduced latency and improved confidence in decisions. Decisions made from an ML and AI application combined with advanced optimization algorithms will improve the mission success and performance of systems, which will improve the overall cost and effectiveness of any program. The Systecon team constructs and employs model-based simulations, cutting across traditional silos of data, aggregating maintenance, and supply data, incorporating sensor information, and applying optimization and simulation methods to an as-maintained digital twin with the ability to aggregate results across a system’s lifecycle and across logical and operational groupings of systems. This coupling of data throughout the enterprise enables tactical, operational, and strategic decision support, detachable and deployable logistics services, and configuration-based automated distribution of digital technical and product data to enhance supply and logistics operations. As a complete solution, this approach significantly reduces program risk by allowing flexible configuration of data, data relationships, business process workflows, and early test and evaluation, especially budget trade-off analyses. A true capability to tie resources (dollars) to weapon system readiness in alignment with the real-world scenarios a warfighter may experience has been an objective yet to be realized to date. By developing and solidifying an organic capability to directly relate dollars to readiness and to inform the digital twin, the decision-maker is now empowered through valuable insight and traceability. This type of educated decision-making provides an advantage over the adversaries who struggle with maintaining system readiness at an affordable cost. The M&S capability developed allows program managers to independently evaluate system design and support decisions by quantifying their impact on operational availability and operations and support cost resulting in the ability to simultaneously optimize readiness and cost. This will allow the stakeholders to make data-driven decisions when trading cost and readiness throughout the life of the program. Finally, sponsors are available to validate product deliverables with efficiency and much higher accuracy than in previous years.

Keywords: artificial intelligence, digital transformation, machine learning, predictive analytics

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Authors: Rahy Farooq, Maria Ahmad Khan, Ayesha Isani Majeed

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Objective: The main aim of this research is to assess the knowledge, attitude and practices of female nursing staff and nursing students regarding breast cancer, to provide a baseline for monitoring trends of breast cancer awareness in them. Background: Healthcare professionals are a direct source of information for the patients and the general public as a whole. It is, therefore, essential that the information they convey be accurate and helps in building additional awareness. However, clinical experience does not influence the knowledge, attitude and practices regarding breast cancer. Nurses, being the prime part of the healthcare professionals, play a significant role and hence, their awareness regarding this pressing issue is pertinent. Lack of awareness regarding common presenting symptoms or breast cancer risk factors translates to poor breast cancer screening practices and late diagnosis. Methodology: A cross-sectional study of 280 female nurses was conducted at a tertiary care hospital in Islamabad, Pakistan. A pre-tested structured questionnaire with additional variables like cultural barriers to seeking medical help was used. The scores for outcome variables including knowledge, attitude and practices were pre-defined. Data was analyzed using SPSSv23. Results: Of the 280 participants with a mean age of 28.99±9.98 years, 142 (50.7%) were married, and 138 (49.3%) were unmarried. Mean scores were computed to be 6.14±2.93 (out of 12), 0.30±0.7 (out of 3) and 9.53±1.92 (out of 16) for knowledge, attitude and practice respectively. Using independent sample T-test, a statistically significant correlation was found when means for the score of Attitude was compared with age. With a p-value of 0.018, 117 nurses of age more than 30 years, faced more practical, financial, emotional and service barriers as compared to 163 women younger than 30 years of age. Knowledge of age-related lifetime risks was also significantly poor more in single women; with a p-value of 0.006 for identification of correct age as a risk factor and a p-value of 0.005 for correct identification of risk for development of breast cancer in the lifetime of women. By application of Chi-square test, there was a significant correlation between marital status and cultural barriers to seeking medical help, showing that single women (58.7%) shy away from talking about breast cancer considering it a taboo (p-value 0.028) whereas, more married nurses (59.2%) were apprehensive that they might be considered at fault by the society, as compared to 40.8% of single nurses. (p-value 0.038). Conclusion: Owing to the scarcity of awareness among nurses, this study recognizes the need for delivering effective information to the female nurses regarding breast cancer. Educating patients is likely to be effective if the female nurses play their part and have correct attitudes towards breast cancer practices. A better understanding of the knowledge and practices regarding breast cancer among the nursing population will enable high-risk patients to be recognized early. Therefore, we recommend arrangement of special courses and seminars for all healthcare professionals including the nursing staff.

Keywords: breast cancer, cultural barriers, kap, nurses

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Authors: Karish Thavabalan, Alistair Ovenell, Aman Sutaria, Annabelle Parkhouse, Numan Baydemir, Theodore Lally

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Background: Open discussions surrounding menopause are often associated with stigma, with many women feeling uncomfortable to engage in them with friends, colleagues, and healthcare professionals. Though the barriers regarding safe discussions of symptom management experienced by menopausal women are well documented, existing research offers little insight into whether these were shared by pre-menopausal women. This study aimed to explore the barriers regarding safe discussions about menopausal symptom management as perceived or experienced by pre-menopausal and menopausal women. Methods: This qualitative study was conducted over a 2-month period (March 2022 - April 2022) under the auspices of Imperial College Business School, London, UK. Snowball sampling was used to recruit both menopausal (age 45-70) and pre-menopausal participants (age <45), and sampling continued until data saturation was achieved. 16 semi-structured online interviews were conducted, and transcripts were thematically analyzed following Braun and Clarke’s six-step methodology. Results: A total of 7 higher themes regarding safe discussion of menopausal symptom management were identified by both pre-menopausal and menopausal women, including: “ineffective coping mechanisms”, “perceived onus to self-endure”, “lack of workplace support”, “poor knowledge of management approaches”, “poor healthcare infrastructure”, “poor support from friends and family”, “lack of knowledge and interest from a young age”. Conclusion: Identifying the barriers regarding safe discussion helped to highlight which areas require most significant intervention. Alongside tackling the barriers, menopausal women face, ultimately, there is a pertinent need to and address the lack of insight into menopause from a younger age and to encourage earlier discussions so as to not propagate the cycle of stigma.

Keywords: menopause, stigma, safe discussions, symptom management

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Authors: André Felipe Gimenez, Flávia Alessandra Ribeiro da Silva, Roberto Saverio Souza Costa

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Currently, the rural producer has been facing problems regarding environmental regularization, which is precisely why the CAR (Rural Environmental Registry) was created. CAR is an electronic registry for rural properties with the purpose of assimilating notions about legal reserve areas, permanent preservation areas, areas of limited use, stable areas, forests and remnants of native vegetation, and all rural properties in Brazil. . The objective of this work was to evaluate and compare altimetry and slope data from google Earth with a digital terrain model (MDT) generated by aerophotogrammetry, in three plots of a steep slope, for the purpose of declaration in the CAR (Rural Environmental Registry). The realization of this work is justified in these areas, in which rural landowners have doubts about the reliability of the use of the free software Google Earth to diagnose inclinations greater than 25 degrees, as recommended by federal law 12651/2012. Added to the fact that in the literature, there is a deficiency of this type of study for the purpose of declaration of the CAR. The results showed that when comparing the drone altimetry data with the Google Earth image data, in areas of high slope (above 40% slope), Google underestimated the real values of terrain slope. Thus, it is concluded that Google Earth is not reliable for diagnosing areas with an inclination greater than 25 degrees (46% declivity) for the purpose of declaration in the CAR, being essential to carry out the local topographic survey.

Keywords: MDT, drone, RPA, SiCar, photogrammetry

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Authors: N. Liu, K.Miao

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This research investigates novel methods to enhance people’s experience in religious culture through technology and digitization. This stage focuses on promoting Taiwanese culture regarding traditional religion. There are three primary research areas in this research field, namely the cultural and creative industry, digitalization, and digital games and cultural cognition. The research is designed based on mixed methodologies, which consist of two experiments. In Experiment I, experts who have religious and cultural background are being interviewed for qualitative data. The suggestions and opinions obtained from this experiment provide a deeper understanding of Taiwanese religious culture. In Experience II, quantitative approach is being adopted. This includes a survey among the younger generation in Taiwan to give a broader look at peoples’ thought about experiencing religious cultures with digitalization. This research allows us to determine the people’s interest in the digitalization of culture. It will help us to combine technology, culture, creativity, industrial, and cultural promotion. Including the design of applications, serious games, and immersive technology. This study shows that technology and digitalization can be used to help people to understand a traditional culture better. The outcome of this research can help designers and developers related to the cultural creativity industries by providing results on people’s interest regarding culture across three vital aspects: 1. Their attitude regarding the education of culture. 2. Their attitude regarding the promotion of culture. 3. Their attitude regarding the information on culture. In addition, this research will help designers who wish to implement cultural elements into their works. It also has great benefits for associations, governments, or individuals who try an innovative way of cultural perversion.

Keywords: culture heritage, digital games, digitalization, traditional religious culture

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Authors: Nancy Ayman Kamal Mohamed Mehrz

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As the economies of other countries in the Mediterranean Basin, the tourism sector in our country has a high denominator in economics. Tourism businesses, which are building blocks of tourism, sector faces with a variety of problems during their activities. These problems faced make business efficiency and competition conditions of the businesses difficult. Most of the problems faced by the tourism businesses and the information of consumers about consumers’ rights were used in this study, which is conducted to determine the problems of tourism businesses in the Central Anatolia Region. It is aimed to contribute the awareness of staff and executives working at tourism sector and to attract attention of businesses active concurrently with tourism sector and legislators. E-tourism is among the issues that have recently been entered into the field of tourism. In order to achieve this type of tourism, Information and Communications Technology (or ICT) infrastructures as well as Co-governmental organizations and tourism resources are important. In this study, the opinions of managers and tourism officials about the e-tourism in Leman city were measured; it also surveyed the impact of level of digital literacy of managers and tourism officials on attracting tourists. This study was conducted. One of the environs of the Esfahan province. This study is a documentary – survey and the sources include library resources and also questionnaires. The results obtained indicate that if managers use ICT, it may help e-tourism to be developed in the region, and increasing managers’ beliefs on e-tourism and upgrading their level of digital literacy may affect e-tourism development.

Keywords: financial problems, the problems of tourism businesses, tourism businesses, internet, marketing, tourism, tourism management economic competitiveness, enhancing competitiveness

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Authors: Max Butler

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Melanoma accounts for 80% of skin cancer-related deaths globally. The poor prognosis and increasing incidence of melanoma impose a significant burden on global healthcare systems. Early detection, precise diagnosis, and preventative strategies are critical to improving patient outcomes. Dermoscopy is the gold standard for specialist assessments of pigmented skin lesions, as it can differentiate between benign and malignant growths with greater accuracy than visual inspection. In the United Kingdom, guidelines from the National Institute of Clinical Excellence (NICE) state dermoscopy should be used in all specialist assessments of pigmented skin lesions. Compliance with this guideline is low, resulting in missed and delayed melanoma diagnoses. To address this problem, a quality improvement project was initiated at Buckinghamshire Healthcare Trust (BHT) within the plastic surgery department. The target group was a trainee and consultant plastic surgeons conducting outpatient skin cancer clinics. Analysis of clinic documentation over a one-month period found that only 62% (38/61) of patients referred with pigmented skin lesions were examined using dermoscopy. To increase dermoscopy rates, teaching was delivered to the department highlighting national guidelines and the evidence base for dermoscopic examination. In addition, clinic paperwork was redesigned to include a text box for dermoscopic examination. Reauditing after the intervention found a significant increase in dermoscopy rates (52/61, p = 0.014). In conclusion, implementing a quality improvement project with targeted teaching and documentation template templates successfully increased dermoscopy rates. This is a promising step toward improving early melanoma detection and patient outcomes.

Keywords: melanoma, dermoscopy, plastic surgery, quality improvement

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Authors: Raja Arslan Ahmad Khan

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Audience feedback and data play an increasingly crucial role, particularly in the digital age. The advent of digital media and the digitalization of news have given rise to novel forms of audience feedback, markedly different from traditional channels. The engagement of online audiences challenges the conventional role of journalists, introducing a dynamic where audiences can wield both direct and indirect influence. This struggle between the audience and journalists is evident in their contributions and interactions. Media professionals are grappling with challenges such as derogatory remarks, hate speech, online harassment, audience hostility, and attacks from online audiences. The influence of online audiences extends to shaping journalists' daily routines and work practices. Consequently, this study seeks to analyze the impact of online audience feedback on journalists at a routine level within the Malaysian context. Employing a Hierarchy of Influence model as a theoretical framework, the study will utilize a quantitative approach with a snowball survey method. The study's findings aim to enhance our understanding of how online audiences influence journalists and their work practices, encompassing aspects like journalists' autonomy and integrity, editorial decision-making, performance and accountability, daily routines, work practices, as well as the psychological and emotional costs they bear. It's important to note that the study has limitations due to the use of the snowball survey method and its focus within the specific context of Malaysia, making it relatively small in scale.

Keywords: online audiences, feedback, influence, journalists, Malaysia

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Authors: Ramazan Bakir, Gizem Kayar

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It is known that Alzheimer and Dementia are the two most common types of Neurodegenerative diseases and their visibility is getting accelerated for the last couple of years. As the population sees older ages all over the world, researchers expect to see the rate of this acceleration much higher. However, unfortunately, there is no known pharmacological cure for both, although some help to reduce the rate of cognitive decline speed. This is why we encounter with non-pharmacological treatment and tracking methods more for the last five years. Many researchers, including well-known associations and hospitals, lean towards using non-pharmacological methods to support cognitive function and improve the patient’s life quality. As the dementia symptoms related to mind, learning, memory, speaking, problem-solving, social abilities and daily activities gradually worsen over the years, many researchers know that cognitive support should start from the very beginning of the symptoms in order to slow down the decline. At this point, life of a patient and caregiver can be improved with some daily activities and applications. These activities include but not limited to basic word puzzles, daily cleaning activities, taking notes. Later, these activities and their results should be observed carefully and it is only possible during patient/caregiver and M.D. in-person meetings in hospitals. These meetings can be quite time-consuming, exhausting and financially ineffective for hospitals, medical doctors, caregivers and especially for patients. On the other hand, digital support systems are showing positive results for all stakeholders of healthcare systems. This can be observed in countries that started Telemedicine systems. The biggest potential of our system is setting the inter-user communication up in the best possible way. In our project, we propose Machine Learning based digitalization of validated traditional cognitive tests (e.g. MOCA, Afazi, left-right hemisphere), their analyses for high-quality follow-up and communication systems for all stakeholders. R. Bakir and G. Kayar are with Gefeasoft, Inc, R&D – Software Development and Health Technologies company. Emails: ramazan, gizem @ gefeasoft.com This platform has a high potential not only for patient tracking but also for making all stakeholders feel safe through all stages. As the registered hospitals assign corresponding medical doctors to the system, these MDs are able to register their own patients and assign special tasks for each patient. With our integrated machine learning support, MDs are able to track the failure and success rates of each patient and also see general averages among similarly progressed patients. In addition, our platform also supports multi-player technology which helps patients play with their caregivers so that they feel much safer at any point they are uncomfortable. By also gamifying the daily household activities, the patients will be able to repeat their social tasks and we will provide non-pharmacological reminiscence therapy (RT – life review therapy). All collected data will be mined by our data scientists and analyzed meaningfully. In addition, we will also add gamification modules for caregivers based on Naomi Feil’s Validation Therapy. Both are behaving positively to the patient and keeping yourself mentally healthy is important for caregivers. We aim to provide a therapy system based on gamification for them, too. When this project accomplishes all the above-written tasks, patients will have the chance to do many tasks at home remotely and MDs will be able to follow them up very effectively. We propose a complete platform and the whole project is both time and cost-effective for supporting all stakeholders.

Keywords: alzheimer’s, dementia, cognitive functionality, cognitive tests, serious games, machine learning, artificial intelligence, digitalization, non-pharmacological, data analysis, telemedicine, e-health, health-tech, gamification

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Authors: Qurratulain Faheem

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The human body often serves as a reference point to analyse the notions of self and society. Situating on Merleau-Ponty and Bourdieu theories of embodiments, this research explores the notions around the human body and its influence on the ethical considerations in regards to organ transplantation among the Muslim communities in Pakistan. The context of Pakistan makes an intriguing case study as cadaveric organ transplantation is not in practise. Whereas living organ transplantation is commonly is practised between family members only. These contradictory practices apparently rests on the ideologies around the human body and religious beliefs as well the personal judgements and authority of healthcare professionals. This research is a year-long ethnographic study carried out as part of doctoral studies. An anthropological approach towards organ transplantation in Pakistan brought forward various socio-cultural notions around the human body and selfhood that serve as a framework around biomedical ethical issues in various societies. Further, it surface the contradictions and issues associated with organ transplantation that makes it a dilemma situated in a nexus of various socio-cultural and political factors rather seeing it as an isolated health concern. This research is a novel study on the subject of organ transplantation in the context of Pakistan but also put forward ethnographic data that could serve as a reference in other religious societies. Further, the ethnographic data bring forward experiences and stories of organ receivers, organ donors, religious leaders, healthcare professionals, and the general public, which aspire to encourage biomedical ethicists and social-scientists to consider ethnography as a research methodology and rely upon people’s lived experiences while establishing policies and practices around biomedical ethical issues.

Keywords: Gender, organ transplantation, muslims, pakistan, organ donation, bioethics, culture and religion, gender

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Authors: Robson da C. Santos, Carlos Henrique de A. S. P. Coutinho, Lucas Moreira Dias, Gerson Gomes Cunha

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The article refers to the development of an augmented reality 3D display, through the control of servo motors and projection of image with aid of video projector on the model. Augmented Reality is a branch that explores multiple approaches to increase real-world view by viewing additional information along with the real scene. The article presents the broad use of electrical, electronic, mechanical and industrial automation for geospatial visualizations, applications in mathematical models with the visualization of functions and 3D surface graphics and volumetric rendering that are currently seen in 2D layers. Application as a 3D display for representation and visualization of Digital Terrain Model (DTM) and Digital Surface Models (DSM), where it can be applied in the identification of canyons in the marine area of the Campos Basin, Rio de Janeiro, Brazil. The same can execute visualization of regions subject to landslides, as in Serra do Mar - Agra dos Reis and Serranas cities both in the State of Rio de Janeiro. From the foregoing, loss of human life and leakage of oil from pipelines buried in these regions may be anticipated in advance. The physical design consists of a table consisting of a 9 x 16 matrix of servo motors, totalizing 144 servos, a mesh is used on the servo motors for visualization of the models projected by a retro projector. Each model for by an image pre-processing, is sent to a server to be converted and viewed from a software developed in C # Programming Language.

Keywords: visualization, 3D models, servo motors, C# programming language

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Authors: Sunil Kumar Singal, Manoj Sood, Upendra Bajpai

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Instream technology is the upcoming sustainable approach in the hydro sector for energy harnessing. With well-known cross-sections and regulated supply, open channels are the most prominent locations for the installation of hydrokinetic turbines. The fluctuation in generated torque varies with site condition (flow depth and flow velocity), as well as with the type of turbine. The present experimental study aims to investigate the torque/power fluctuations of crossflow hydrokinetic turbines operating at different flow velocities and water depths. The flow velocity is varied from 1.0 m/s to 2.0 m/s. The complete assembly includes an open channel having dimensions of 0.3 m (depth) x 0.71 m (width) x 4.5 m (length), along with a lifting mechanism for varying the channel slope, a digital transducer for monitoring the torque, power, and rpm, a digital handheld water velocity meter for measuring the flow velocity. Further, a time series of torque, power, and rpm is plotted for a duration of 30 minutes showing the continuous operation of the turbine. A comparison of Savonius, Darrieus, and their improved twisted and helical blades is also presented in the study. A correlation has also been developed for assessing the hydropower generation from the installed turbine. The developed correlations will be very useful in the decision-making process for development at a site.

Keywords: darrieus turbine, flow velocity, open channel, savoinus turbine, water depth, hydropower

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Authors: Karish Thavabalan, Aman Sutaria, Alistair Ovenell, Annabelle Parkhouse, Numan Baydemir, Theodore Lally

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Background: Open discussions surrounding menopause are often associated with stigma, with many women feeling uncomfortable engaging in them with friends, colleagues, and healthcare professionals. Though the barriers regarding safe discussions of symptom management experienced by menopausal women are well documented, existing research offers little insight into whether these were shared by pre-menopausal women. This study aimed to explore the barriers regarding safe discussions about menopausal symptom management as perceived or experienced by pre-menopausal and menopausal women. Methods: This qualitative study was conducted over a 2-month period (March 2022 - April 2022) under the auspices of Imperial College Business School, London, UK. Snowball sampling was used to recruit both menopausal (age 45-70) and pre-menopausal participants (age <45) and sampling continued until data saturation was achieved. Sixteen semi-structured online interviews were conducted, and transcripts were thematically analyzed following Braun and Clarke’s six-step methodology. Results: A total of 7 higher themes regarding safe discussion of menopausal symptom management were identified by both pre-menopausal and menopausal women, including: “ineffective coping mechanisms,” “perceived onus to self-endure,” “lack of workplace support,” “poor knowledge of management approaches,” “poor healthcare infrastructure,” “poor support from friends and family,” “lack of knowledge and interest from a young age.” Conclusion: Identifying the barriers regarding safe discussion helped to highlight which areas require the most significant intervention. Alongside tackling the barriers, menopausal women face, ultimately, there is a pertinent need to address the lack of insight into menopause from a younger age and to encourage earlier discussions so as to not propagate the cycle of stigma.

Keywords: menopause, safe discussion, symptom management, stigma

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Authors: Ghadeer Aly, Yasmeen Hanafy

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The way we research travel options and decide where to go has substantially changed in the digital age. Atypical search engines like social networking sites like TikTok have evolved, influencing the preferences of various generations. The influence of TikTok use as a search engine for choosing travel locations and its effect on a country's destination branding are both examined in this study. The study specifically focuses on the comparative preferences and actions of Generations Y and Z within the Egyptian community, shedding light on how these generations interact with travel related TikTok content and how it influences their perceptions of various destinations. It also investigates how TikTok Accounts use tourism branding techniques to promote a country's tourist destination. The investigation of how social media platforms are changing as unconventional search engines has theoretical relevance. This study can advance our knowledge of how digital platforms alter information-seeking behaviors and affect the way people make decisions. Furthermore, investigating the relationship between TikTok video and destination branding might shed light on the intricate interplay between social media, perceptions of locations, and travel preferences, enhancing theories about consumer behavior and communication in the digital age. Regarding the methodology of the research, the study is conducted in two stages: first, both generations are polled, and from the results, the top three destinations are chosen to be subjected to content analysis. As for the research's theoretical framework, it incorporates the tourism destination branding model as well as the conceptual model of nation branding. Through the use of the survey as a quantitative approach and the qualitative content analysis, the research will rely on both quantitative and qualitative methods. When it comes to the theoretical framework, both the Nation Branding Model and the Tourism Branding Model can offer useful frameworks for analyzing and comprehending the dynamics of using TikTok as a search engine to choose travel destinations, especially in the context of Generation Y and Generation Z in the Egyptian community. Additionally, the sample will be drawn specifically from both Gen-Y and Gen-Z. 100 members of Gen Z and 100 members of Gen Y will be chosen from TikTok users and followers of travel-related accounts, and the sample for the content analysis will be chosen based on the survey's results.

Keywords: tiktok, nation image, egyptian community, tourism branding

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Authors: Delband Yekta Moazami

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Background: For proper care and treatment of HIV patients and drug users, the medical staff and physicians must have a correct and positive attitude and knowledge towards such patients. We aimed to assess the attitudes in a sample of health care workers (HCW) working in different hospitals and clinics and medical students in Georgia towards HIV infected people and drug users in Tbilisi. Method: We conducted a cross-sectional study to assess attitudes of health care workers towards people living with HIV and drug users in hospitals and clinics in Tbilisi. The study was carried out from 1st of May 2020 till 30th of September 2020. Data were collected using a self-administered structured online questionnaire. With this tool we evaluated four facets of attitudes: Discrimination, Acceptance of HIV/AIDS patients, Acceptance of drug users and Fear. All data were imported and analyzed with the software SPSS 22 for windows. Results: In total data was collected from168 respondents, that among them 107 (65%) were women and majority of the participants were medical doctors. Women had more acceptance attitudes rather than men towards drug abusers. We found significant differences regarding expressing negative attitudes among HCW who were more than 50 years old comparing with other age groups in all four aspects. Medical doctors expressed more acceptances towards people with HIV and drug users comparing two other groups. Also our study revealed that the group with working experience 21 years and more, showed more discriminatory attitudes comparing other groups. Conclusion: Based on our study findings, there are significant differences regarding respondent’s attitudes based on gender, medical specialty and working experience in health care system. People struggling with HIV and drug use need nonjudgmental and positive behaviors from health care workers and physicians in order to help them for harm reduction and receiving appropriate treatment.

Keywords: hiv, addiction, attitudes, healthcare workers

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Authors: Lauren Provost

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The digital world remains increasingly vulnerable, making the development of effective cybersecurity approaches even more critical in supporting the success of the digital economy and national security. Although approaches to cybersecurity have shifted and improved in the last decade with new models, especially with cloud computing and mobility, a record number of high severity vulnerabilities were recorded in the National Institute of Standards and Technology (NIST), and its National Vulnerability Database (NVD) in 2020. This is due, in part, to the increasing complexity of cyber ecosystems. Security must be approached with a more comprehensive, multi-tool strategy that addresses the complexity of cyber ecosystems, including the human factor. Ethical hacking has emerged as such an approach: a more effective, multi-strategy, comprehensive approach to cyber security's most pressing needs, especially understanding the human factor. Research on ethical hacking, however, is limited in scope. The two main objectives of this work are to (1) provide highlights of case studies in ethical hacking, (2) provide a conceptual framework for research in ethical hacking that embraces and addresses both technical and nontechnical security measures. Recommendations include an improved conceptual framework for research centered on ethical hacking that addresses many factors and attributes of significant attacks that threaten computer security; a more robust, integrative multi-layered framework embracing the complexity of cybersecurity ecosystems.

Keywords: ethical hacking, literature review, penetration testing, social engineering

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Authors: Gina L. Solano

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This project endeavors to enhance learning experiences for undergraduate pre-service teachers and graduate K-12 educators by leveraging artificial intelligence (AI). Firstly, the initiative delves into integrating AI within undergraduate education courses, fostering traditional literacy skills essential for academic success and extending their applicability beyond the classroom. Education students will explore AI tools to design literacy-focused activities aligned with their curriculum. Secondly, the project investigates the utilization of AI to craft instructional materials employing gamification strategies (e.g., digital and classic games, badges, quests) to amplify student engagement and motivation in mastering course content. Lastly, it aims to create a professional repertoire that can be applied by pre-service and current teachers in P-12 classrooms, promoting seamless integration for those already in teaching positions. The project's impact extends to benefiting college students, including pre-service and graduate teachers, as they enhance literacy and digital skills through AI. It also benefits current P-12 educators who can integrate AI into their classrooms, fostering innovative teaching practices. Moreover, the project contributes to faculty development, allowing them to cultivate low-risk and engaging classroom environments, ultimately enriching the learning journey. The insights gained from this project can be shared within and beyond the discipline to advance the broader field of study.

Keywords: artificial intelligence, gamification, learning experiences, literacy skills, engagement

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Authors: Sanjay Ranade

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Traditional film theory assumes the cinema audience in a darkened room where cinema is projected on to a white screen, and the audience suspends their sense of reality. Shifts in audiences due to changes in cultural tastes or trends have been studied for decades. In the past two decades, however, the audience, especially the youth, has shifted to digital media for the consumption of cinema. As a result, not only are audiences watching cinema on different devices, they are also consuming cinema in places and ways never imagined before. Public transport often crowded to the brim with a lot of ambient content, and a variety of workplaces have become sites for cinema viewing. Cinema is watched piecemeal and at different times of the day. Audiences use devices such as mobile phones and tablets to watch cinema. The cinema viewing experience is getting redesigned by the user. The emerging design allows the spectator to not only consume images and narratives but also produce, reproduce, and manipulate existing images and narratives, thereby participating in the process and influencing it. Spectatorship studies stress on the importance of subjectivity when dealing with the structure of the film text and the cultural and psychological implications in the engagement between the spectator and the film text. Indian cinema has been booming and contributing to global movie production significantly. In 2005 film production was 1000 films a year and doubled to 2000 by 2016. Digital technology helped push this growth in 2012. Film studies in India have had a decided Euro-American bias. The studies have chiefly analysed the content for ideological leanings or myth or as reflections of society, societal changes, or articulation of identity or presented retrospectives of directors, actors, music directors, etc. The one factor relegated to the background has been the spectator. If they have been addressed, they are treated as a collective of class or gender. India has a performative tradition going back several centuries. How Indians receive cinema is an important aspect to study with respect to film studies. This exploratory and descriptive study looked at 162 young media students studying cinema at the undergraduate and postgraduate levels. The students, speaking as many as 20 languages amongst them, were drawn from across the country’s media schools. The study looked at nine film societies registered with the Federation of Film Societies of India. A structured questionnaire was made and distributed online through media teachers for the students. The film societies were approached through the regional office of the FFSI in Mumbai. Lastly, group discussions were held in Mumbai with students and teachers of media. A group consisted of between five and twelve student participants, along with one or two teachers. All the respondents looked at themselves as spectators and shared their experiences of spectators of cinema, providing a very rich insight into Indian conditions of viewing cinema and challenges for cinema ahead.

Keywords: audience, digital, film studies, reception, reception spectatorship

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Authors: Annalise Weckesser, Alex Wade, Clara Joergensen, Jerome Turner

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Introduction: Digital mobile technologies afford Generation M a number of opportunities in terms of communication, creativity and connectivity in their social interactions. Yet these young people’s use of such technologies is often the source of moral panic with accordant social anxiety especially prevalent in media representations of teen ‘sexting,’ or the sending of sexually explicit images via smartphones. Thus far, most responses to youth sexting have largely been ineffective or unjust with adult authorities sometimes blaming victims of non-consensual sexting, using child pornography laws to paradoxically criminalise those they are designed to protect, and/or advising teenagers to simply abstain from the practice. Prevention strategies are further skewed, with sex education initiatives often targeted at girls, implying that they shoulder the responsibility of minimising the risks associated with sexting (e.g. revenge porn and sexual predation). Purpose of Study: Despite increasing public interest and concern about ‘teen sexting,’ there remains a dearth of research with young people regarding their experiences of navigating sex and relationships in the current digital media landscape. Furthermore, young people's views on sexting are rarely solicited in the policy and educational strategies aimed at them. To address this research-policy-education gap, an interdisciplinary team of four researchers (from anthropology, media, sociology and education) have undertaken a peer-to-peer research project to co-create a sexual health intervention. Methods: In the winter of 2015-2016, the research team conducted serial group interviews with four cohorts of students (aged 13 to 15) from a secondary school in the West Midlands, UK. To facilitate open dialogue, girls and boys were interviewed separately, and each group consisted of no more than four pupils. The team employed a range of participatory techniques to elicit young people’s views on sexting, its consequences, and its interventions. A final focus group session was conducted with all 14 male and female participants to explore developing a peer-to-peer ‘safe sexting’ education intervention. Findings: This presentation will highlight the ongoing, ‘old school’ sexual double standards at work within this new digital frontier. In the sharing of ‘nudes’ (teens’ preferred term to ‘sexting’) via social media apps (e.g. Snapchat and WhatsApp), girls felt sharing images was inherently risky and feared being blamed and ‘slut-shamed.’ In contrast, boys were seen to gain in social status if they accumulated nudes of female peers. Further, if boys had nudes of themselves shared without consent, they felt they were expected to simply ‘tough it out.’ The presentation will also explore what forms of supports teens desire to help them in their day-to-day navigation of these digitally mediated, heteronormative performances of teen femininity and masculinity expected of them. Conclusion: This is the first research project, within UK, conducted with rather than about teens and the phenomenon of sexting. It marks a timely and important contribution to the nascent, but growing body of knowledge on gender, sexual politics and the digital mobility of sexual images created by and circulated amongst young people.

Keywords: teens, sexting, gender, sexual politics

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Authors: Nikita Bharadia, Vikas Gupta, Sushant Koshy

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Mobile phone applications (“apps”) have generated substantial interest among marketers and researchers because of the developments in the smartphone technology and the availability of affordable phones to a large number of consumers. Apps are enabling brands to engage with consumers at any time and any place. This study utilizes a pre-test/post-test experimental design to determine if apps can have a persuasive impact on the consumer attitude towards the brand and her purchase intention. The study also tests the impact of informational vs. interactive style of apps on categories with high and low level of involvement. The results show that for high involvement brands, consumers have a predetermined brand image and apps that satisfy consumer needs through an interactive interface can increase purchase intention. For low involvement brands, while informational apps do not create substantial engagement, interactive apps can increase consumer focus on the brand and establish personal connect with the consumers. This has a positive impact in the attitude towards the brand. These results suggest that understanding how to maximize the consumer interaction with mobile phone apps will be a key topic of future research. This research indicates that managers need to evaluate the how apps can solve consumer needs before investing resources towards digital marketing campaign for their brands, following the global trend to capitalize on the digital platforms.

Keywords: App execution style, high and low involvement categories, mobile marketing, smartphone applications

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Authors: Esther Pearl Palmer

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Driven by the increased pressure on Higher Education Institutions (HEIs) to produce work-ready graduates for the modern world of work, this study reflects on triad teaching and learning practices to increase student engagement and employability. In the South African higher education context, the employability of graduates is imperative in strengthening the country’s economy and in increasing competitiveness. Within this context, the field of Human Resource Management (HRM) calls for innovative methods and approaches to teaching and learning and assessing the skills and competencies of graduates to render them employable. Digital competency in Human Resource Information Systems (HRIS) is an important component and prerequisite for employment in HRM. The purpose of this research is to reflect on the subject HRIS developed by lecturers at the Central University of Technology, Free State (CUT), with the intention to actively engage students in real-world learning activities and increase their employability. The Enrichment Triad Model (ETM) was used as theoretical framework to develop the subject as it supports a triad teaching and learning approach to education. It is, furthermore, an inter-structured model that supports collaboration between industry, academics and students. The study follows a mixed-method approach to reflect on the learning experiences of the industry, academics and students in the subject field over the past three years. This paper is a work in progress and seeks to broaden the scope of extant studies about student engagement in work-related learning to increase employability. Based on the ETM as theoretical framework and pedagogical practice, this paper proposes that following a triad teaching and learning approach will increase work-related skills of students. Findings from the study show that students, academics and industry alike regard educational opportunities that incorporate active learning experiences with the world of work enhances student engagement in learning and renders them more employable.

Keywords: digital competence, enriched triad model, human resource information systems, student engagement, triad pedagogy.

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Authors: Betül Sönmez, Aytolan Yıldırım

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Objective: This systematic review aims to methodically analyze studies regarding mobbing behavior prevalence, individuals performing this behavior and the effects of mobbing on Turkish nurses. Background: Worldwide reports on mobbing cases have increased in the past years, a similar trend also observable in Turkey. It has been demonstrated that among healthcare workers, mobbing is significantly widespread in nurses. The number of studies carried out in this regard has also increased. Method: The main criteria for choosing articles in this systematic review were nurses located in Turkey, regardless of any specific date. In November 2014, a search using the keywords 'mobbing, bullying, psychological terror/violence, emotional violence, nurses, healthcare workers, Turkey' in PubMed, Science Direct, Ebscohost, National Thesis Centre database and Google search engine led to 71 studies in this field. 33 studies were not met the inclusion criteria specified for this study. Results: The findings were obtained using the results of 38 studies carried out in the past 13 years in Turkey, a large sample consisting of 8,877 nurses. Analysis of the incidences of mobbing behavior revealed a broad spectrum, ranging from none-slight experiences to 100% experiences. The most frequently observed mobbing behaviors include attacking personality, blocking communication and attacking professional and social reputation. Victims mostly experienced mobbing from their managers, the most common consequence of these actions being psychological effects. Conclusions: The results of studies with various scales indicate exposure of nurses to similar mobbing behavior. The high frequency of exposure of nurses to mobbing behavior in such a large sample highlights the importance of considering this issue in terms of individual and institutional consequences that adversely affect the performance of nurses.

Keywords: mobbing, bullying, workplace violence, nurses, Turkey

Procedia PDF Downloads 277