Search results for: emergency department admission

Authors: Luana N. Cardozo, Debora A. S. Coutinho, Fabiola Lagher, Bruno J. G. Silva, Ivonilce Venture, Mainara Tesser, Graciela Venera

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Ostrich oil is used as food in Brazil, and it has been the subject of scientific research because it contains essential fatty acids (Omega 3, 6, 7, and 9), which provide benefits to human health. Alkylglycerols are lipid ethers consisted of a saturated or unsaturated hydrocarbon chain joined by ether-type bonding to one of the glycerol hydroxyls. It is known that supplementation with alkylglycerols can act significantly on the functioning of immune system cells, both in pathological situations and in homeostasis. Objective: Analyze the presence of alkylglycerols in ostrich oil. Methods: The ostrich oil was bought from an industry that manufactures the product for sale as food, located in Mirante da Serra, northern Brazil. The samples were sent for analysis to the chemistry department of the Federal University of Paraná, where they were analyzed by the gas chromatography method. Results: The analysis of the ostrich oil presented alkylglycerols in area 514505154. Comparison, it is possible to observe that shark liver oil contains the area 26190196, and the difference between both is highly significant. Conclusion: The importance of alkylglycerol supplementation for the immune system is known. The analysis of the results made it possible to verify the presence of alkylglycerols in the ostrich oil, which is five times higher than in the shark liver oil, that would be the largest source food, but was surpassed by the ostrich oil until the present time. The present study emphasizes that ostrich oil can be considered a food source of alkylglycerols and may play a promising role in the immune system because it contains such substance, but further studies are needed to prove its performance in the body.

Keywords: ostrich oil, nutritional composition, alkylglycerols, food

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Authors: Smiso Buthelezi, Petros Dlamini, Dennis Ocholla

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The study assesses the University of Zululand's practices for documenting, sharing, and accessing indigenous knowledge. Two research objectives guided it: to determine how indigenous knowledge (IK) is developed at the University of Zululand and how indigenous knowledge (IK) is documented at the University of Zululand. The study adopted both interpretive and positivist research paradigms. Ultimately, qualitative and quantitative research methods were used. The qualitative research approach collected data from academic and non-academic staff members. Interviews were conducted with 18 academic staff members and 5 with support staff members. The quantitative research approach was used to collect data from indigenous knowledge (IK) theses and dissertations from the University of Zululand Institutional Repository between 2009-2019. The study results revealed that many departments across the University of Zululand were involved in creating indigenous knowledge (IK)-related content. The department of African Languages was noted to be more involved in creating IK-related content. Moreover, the documentation of the content related to indigenous knowledge (IK) at the University of Zululand is done frequently but is not readily known. It was found that the creation and documentation of indigenous knowledge by different departments faced several challenges. The common challenges are a lack of interest among indigenous knowledge (IK) owners in sharing their knowledge, the local language as a barrier, and a shortage of proper tools for recording and capturing indigenous knowledge (IK). One of the study recommendations is the need for an indigenous knowledge systems (IKS) policy to be in place at the University of Zululand.

Keywords: knowledge creation, SECI model, information and communication technology., indigenous knowledge

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Authors: Pachawo Bisani, Goodall Nyirenda

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The Malawi National Antiretroviral Therapy (NART) Electronic Medical Record (EMR) system was designed and developed with guidance from the Ministry of Health through the Department of HIV and AIDS (DHA) with the aim of supporting the management of HIV patient data and reporting in high prevalence ART clinics. As of 2021, the system has been scaled up to over 206 facilities across the country. The system is integrated with the clinical decision support system (CDSS) to assist healthcare providers in making a decision about an individual patient at a particular point in time. Despite NART EMR undergoing several evaluations and assessments, little has been done to evaluate the clinical decision support system in the NART EMR system. Hence, the study aimed to evaluate the use of CDSS in the NART EMR system in Malawi. The study adopted a mixed-method approach, and data was collected through interviews, observations, and questionnaires. The study has revealed that the CDSS tools were integrated into the ART clinic workflow, making it easy for the user to use it. The study has also revealed challenges in system reliability and information accuracy. Despite the challenges, the study further revealed that the system is effective and efficient, and overall, users are satisfied with the system. The study recommends that the implementers focus more on the logic behind the clinical decision-support intervention in order to address some of the concerns and enhance the accuracy of the information supplied. The study further suggests consulting the system's actual users throughout implementation.

Keywords: clinical decision support system, electronic medical record system, usability, antiretroviral therapy

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Authors: Sahar Heidary, Ramin Ghasemi Shayan

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The recent coronavirus disease 2019 (COVID-19) occurrence has carried considerabletrials to the world health system, comprising the training of dental and maxillofacial radiology (DMFR). DMFR will keep avital role in healthcare throughout this disaster. Severe acute breathing disease coronavirus 2 (SARS-CoV-2), the virus producing the current coronavirus disease 2019 (COVID-19) pandemic, is not only extremely contagious but can make solemn consequences in susceptible persons comprising dental patients and dental health care personnel (DHCPs). Reactions to COVID-19 have been available by the Cores for Infection Switch and Inhibition and the American Dental Association, but a more detailed answer is necessary for the harmless preparation of oral and maxillofacial radiology. Our goal is to evaluation the existing information just how the illness threatens patients and DHCPs and how to define which patients are possible to be SARS-CoV-2 infected; study how the usage of private shielding utensils and contamination control measures based on recent top observes, and knowledge can decrease the danger of virus spread in radiologic trials; and scrutinize how intraoral radiography, with its actually superior danger of scattering the infection, might be changed by extraoralradiographic methods for definite diagnostic jobs. In the pandemic, teleradiology has been extensively recycled for diagnostic determinations of COVID-19 patients, for discussions with radiologists in crisis cases, or managing of distance among radiology clinics. Dentists can have the digital radiographic images of their emergency patients through online service area also by electronic message or messaging applications to view in their smart phones, laptops, or other electronic devices.

Keywords: radiology, dental, oral, COVID-19, infection

Procedia PDF Downloads 159

Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

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Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

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Authors: Mirza Sultan Ahmad, Mubashra Ahmad, Ramlah Mehmood, Nazia Mahboob, Waqar Nasir

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Objective: To ascertain the prevalence of thrombocytopenia and study changes in MPV and PDW among cases of vivax malaria. Design: Descriptive analytic study. Place and duration of study: Department of pediatrics, Fazle Omar Hospital, from January to December 2012. Methodology: All patients from birth to 16 years age, who presented in Fazle- Omar hospital, Rabwah from January to December 2012 were included in this study. Hundred patients with other febrile illnesses were taken as control. Full blood counts were checked by Madonic CA 620 analyzer. Name, age, sex, weight, platelet counts. MPV, PDW, any evidence of bleeding, outcome of cases included in this study and taken as control were recorded on data sheets. Results: One hundred and forty-two patients were included in this study. There was no incidence of death or active bleeding. Median platelet count was 109000/mm3. Thrombocytopenia was present in 108 (76.1%) patients. Severe thrombocytopenia was present in 10(7%) patients. Minimum count was 27000/mm3 and maximum was 341000/mm3. Platelet counts of control group was significantly more as compared with study group.(p<.001) Median MPV was 8.70. Minimum value was 6.40 and maximum was 11.90. MPV of study group was significantly more than control group.(p<.001) Median PDW was 11.30. Minimum value was 8.5 and maximum was 16.70. There was no difference between PDW of study and control groups (p=0.246). Conclusions: Thrombocytopenia is a common complication among pediatric cases of vivax malaria. MPV of cases of vivax malaria is higher than control group.

Keywords: malaria vivax, platelet, mean platelet volume, thrombocytopenia

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Authors: Maria Medrano, Cristina Cadenas-Sanchez, Maddi Oses, Lide Arenaza, Maria Amasene, Idoia Labayen

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The COVID-19 outbreak began in December 2019 in China and was rapidly expanded globally. Emergency measures, such as social distance or home confinement, were adopted by many country governments to prevent its transmission. In Spain, one of the most affected countries, the schools were closed, and one of the most severe mandatory home confinement was established for children from 14th March to 26th April 2020. The hypothesis of this study was that the measures adopted during the COVID-19 pandemic may have negatively affected physical activity and screen time of children. However, few studies have examined the effects of COVID-19 pandemic on lifestyle behaviours. Thus, the aim of the current work was to analyse the effects of the COVID-19 confinement on physical activity and screen time in Spanish children. For the current purpose, a total of 113 children and adolescents (12.0 ± 2.6 yr., 51.3% boys, 24.0% with overweight/obesity according to the World Obesity Federation) of the MUGI project were included in the analyses. Physical activity and screen time were longitudinally assessed by 'The Youth Activity Profile' questionnaire (YAP). Differences in physical activity and screen time before and during the confinement were assessed by dependent t-test. Before the confinement, 60% did not meet physical activity recommendations ( ≥ 60/min/day of moderate to vigorous physical activity), and 61% used screens ≥ 2 h/day. During the COVID-19 confinement, children decreased their physical activity levels (-91 ± 55 min/day, p < 0.001) and increased screen time ( ± 2.6 h/day, p < 0.001). The prevalence of children that worsened physical activity and screen time during the COVID-19 confinement were 95.2% and 69.8%, respectively. The current study evidence the negative effects of the COVID-19 confinement on physical activity and screen time in Spanish children. These findings should be taken into account to develop and implement future public health strategies for preserving children's lifestyle behaviours and health during and after the COVID-19 pandemic.

Keywords: COVID-19, lifestyle changes, paediatric, physical activity, screen time

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Authors: G. S. Androulakis, G. Deli, M. Kaisari, N. Mihos

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Teaching practices at the university level have changed and developed during the last decade. Implementation of inverted classroom method in secondary education consists of a well-formed basis for academic teachers. On the other hand, distance learning is a well-known field in education research and widespread as a method of teaching. Nonetheless, the new pandemic found many Universities all over the world unprepared, which made adaptations to new methods of teaching a necessity. In this paper, we analyze a model of an inverted university classroom in a distance learning context. Thus, the main purpose of our research is to investigate students’ difficulties as they transit to a new style of teaching and explore their learning development during a semester totally different from others. Our teaching experiment took place at the Business Administration department of the University of Patras, in the context of two courses: Calculus, a course aimed at first-year students, and Statistics, a course aimed at second-year students. Second-year students had the opportunity to attend courses in the university classroom. First-year students started their semester with distance learning. Using a comparative study of these two groups, we explored significant differences in students’ learning procedures. Focused group interviews, written tests, analyses of students’ dialogues were used in a mixed quantity and quality research. Our analysis reveals students’ skills, capabilities but also a difficulty in following, non-traditional style of teaching. The inverted classroom model, according to our findings, offers benefits in the educational procedure, even in a distance learning environment.

Keywords: distance learning, higher education, inverted classroom, mathematics teaching

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Authors: R. Unnikrishnan, K. Shankar

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In the case of high-speed fighter aircrafts, seat ejection is designed mainly for the safety of the pilot in case of an emergency. Strong windblast due to the high velocity of flight is one main difficulty in clearing the tail of the aircraft. Excessive G-forces generated, immobilizes the pilot from escape. In most of the cases, seats are ejected out of the aircrafts by explosives or by rocket motors attached to the bottom of the seat. Ejection forces are primarily in the vertical direction with the objective of attaining the maximum possible velocity in a specified period of time. The safe ejection parameters are studied to estimate the critical time of ejection for various geometries and velocities of flight. An equivalent analytical 2-dimensional biomechanical model of the human spine has been modelled consisting of vertebrae and intervertebral discs with a lumped mass approach. The 24 vertebrae, which consists of the cervical, thoracic and lumbar regions, in addition to the head mass and the pelvis has been designed as 26 rigid structures and the intervertebral discs are assumed as 25 flexible joint structures. The rigid structures are modelled as mass elements and the flexible joints as spring and damper elements. Here, the motions are restricted only in the mid-sagittal plane to form a 26 degree of freedom system. The equations of motions are derived for translational movement of the spinal column. An ejection force with a linearly increasing acceleration profile is applied as vertical base excitation on to the pelvis. The dynamic vibrational response of each vertebra in time-domain is estimated.

Keywords: biomechanical model, lumped mass, seat ejection, vibrational response

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Authors: Aishvarya Gupta, Keerthana Anand, Sasirekha Rengaraj, Latha Chathurvedula

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Introduction: Advances in assisted reproductive technology and increase in the proportion of infertile couples have both contributed to the steep increase in the incidence of twin pregnancies in past decades. Maternal and perinatal complications are higher in twins than in singleton pregnancies. Studies comparing the maternal and perinatal outcomes of ART twin pregnancies versus spontaneously conceived twin pregnancies report heterogeneous results making it unclear whether the complications are due to twin gestation per se or because of assisted reproductive techniques. The present study aims to compare both maternal and perinatal outcomes in twin pregnancies which are spontaneously conceived and after assisted conception methods, so that targeted steps can be undertaken in order to improve maternal and perinatal outcome of twins. Objectives: To study perinatal and maternal outcome in twin pregnancies conceived spontaneously as well as with assisted methods and compare the outcomes between the two groups. Setting: Women delivering at JIPMER (tertiary care institute), Pondicherry. Population: 380 women with twin pregnancies who delivered in JIPMER between June 2015 and March 2017 were included in the study. Methods: The study population was divided into two cohorts – one conceived by spontaneous conception and other by assisted reproductive methods. Association of various maternal and perinatal outcomes with the method of conception was assessed using chi square test or Student's t test as appropriate. Multiple logistic regression analysis was done to assess the independent association of assisted conception with maternal outcomes after adjusting for age, parity and BMI. Multiple logistic regression analysis was done to assess the independent association of assisted conception with perinatal outcomes after adjusting for age, parity, BMI, chorionicity, gestational age at delivery and presence of hypertension or gestational diabetes in the mother. A p value of < 0.05 was considered as significant. Result: There was increased proportion of women with GDM (21% v/s 4.29%) and premature rupture of membranes (35% v/s 22.85%) in the assisted conception group and more anemic women in the spontaneous group (71.27% v/s 55.1%). However assisted conception per se increased the incidence of GDM among twin gestations (OR 3.39, 95% CI 1.34 – 8.61) and did not influence any of the other maternal outcomes. Among the perinatal outcomes, assisted conception per se increased the risk of having very preterm (<32 weeks) neonates (OR 3.013, 95% CI 1.432 – 6.337). The mean birth weight did not significantly differ between the two groups (p = 0.429). Though there were higher proportion of babies admitted to NICU in the assisted conception group (48.48% v/s 36.43%), assisted conception per se did not increase the risk of admission to NICU (OR 1.23, 95% CI 0.76 – 1.98). There was no significant difference in perinatal mortality rates between the two groups (p = 0.829). Conclusion: Assisted conception per se increases the risk of developing GDM in women with twin gestation and increases the risk of delivering very preterm babies. Hence measures should be taken to ensure appropriate screening methods for GDM and suitable neonatal care in such pregnancies.

Keywords: assisted conception, maternal outcomes, perinatal outcomes, twin gestation

Procedia PDF Downloads 187

Authors: Mansur Agzamov, Valery Bersnev, Natalia Ivanova, Istam Agzamov, Timur Khayrullaev, Yulduz Agzamova

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Objectives. Treatment of hypertensive intracerebral hematoma (ICH) is controversial. Advantage of one surgical method on other has not been established. Recent reports suggest a favorable effect of minimally invasive surgery. We conducted a small comparative study of different surgical methods. Methods. We analyzed the result of surgical treatment of 176 patients with intracerebral hematomas at the age from 41 to 78 years. Men were been113 (64.2%), women - 63 (35.8%). Level of consciousness: conscious -18, lethargy -63, stupor –55, moderate coma - 40. All patients on admission and in the dynamics underwent computer tomography (CT) of the brain. ICH was located in the putamen in 87 cases, thalamus in 19, in the mix area in 50, in the lobar area in 20. Ninety seven patients of them had an intraventricular hemorrhage component. The baseline volume of the ICH was measured according to a bedside method of measuring CT intracerebral hematomas volume. Depending on the intervention of the patients were divided into three groups. Group 1 patients, 90 patients, operated open craniotomy. Level of consciousness: conscious-11, lethargy-33, stupor–18, moderate coma -18. The hemorrhage was located in the putamen in 51, thalamus in 3, in the mix area in 25, in the lobar area in 11. Group 2 patients, 22 patients, underwent smaller craniotomy with endoscopic-assisted evacuation. Level of consciousness: conscious-4, lethargy-9, stupor–5, moderate coma -4. The hemorrhage was located in the putamen in 5, thalamus in 15, in the mix area in 2. Group 3 patients, 64 patients, was conducted minimally invasive removal of intracerebral hematomas using the original device (patent of Russian Federation № 65382). The device - funnel cannula - which after the special markings introduced into the hematoma cavity. Level of consciousness: conscious-3, lethargy-21, stupor–22, moderate coma -18. The hemorrhage was located in the putamen in 31, in the mix area in 23, thalamus in 1, in the lobar area in 9. Results of treatment were evaluated by Glasgow outcome scale. Results. The study showed that the results of surgical treatment in three groups depending on the degree of consciousness, the volume and localization of hematoma. In group 1, good recovery observed in 8 cases (8.9%), moderate disability in 22 (24.4%), severe disability - 17 (18.9%), death-43 (47.8%). In group 2, good recovery observed in 7 cases (31.8%), moderate disability in 7 (31.8%), severe disability - 5 (29.7%), death-7 (31.8%). In group 3, good recovery was observed in 9 cases (14.1%), moderate disability-17 (26.5%), severe disability-19 (29.7%), death-19 (29.7%). Conclusions. The method of using cannulae allowed to abandon from open craniotomy of the majority of patients with putaminal hematomas. Minimally invasive technique reduced the postoperative mortality and improves treatment outcomes of these patients.

Keywords: nontraumatic intracerebral hematoma, minimal invasive surgical technique, funnel canula, differentiated surcical treatment

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Authors: Pukhtoon Yar

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Peshawar City is experiencing a rapid spatial urban growth primarily as a result of high rate of urbanization along with economic development. This paper was designed to understand the impacts of urbanization on agriculture land use change by particularly focusing on land use change trajectories from the past (1991-2014). We used Landsat imageries (30 meters) for1991along with Spot images (2.5 meters) for year 2014. . The ground truthing of the satellite data was performed by collecting information from Peshawar Development Authority, revenue department, real estate agents and interviews with the officials of city administration. The temporal satellite images were processed by applying supervised maximum likelihood classification technique in ArcGIS 9.3. The procedure resulted into five main classes of land use i.e. built-up area, farmland, barren land, cultivable-wasteland and water bodies. The analysis revealed that, in Peshawar City the built-up environment has been doubled from 8.1 percent in 1991 to over 18.2 percent in 2014 by predominantly encroaching land producing food. Furthermore, the CA-Markov Model predicted that the area under impervious surfaces would continue to flourish during the next three decades. This rapid increase in built-up area is accredited to the lack of proper land use planning and management, which has caused chaotic urban sprawl with detrimental social and environmental consequences.

Keywords: Urban Expansion, Land use, GIS, Remote Sensing, Markov Model, Peshawar City

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Authors: Mitchell T. Grothaus, Cory Grigsby, Timothy S. Hare

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This study aims to determine if there is a relationship between elevated cancer risks in eastern Kentucky and the environmental effects of black shale. Previous research shows that black shale formations, such as those in eastern Kentucky contain high levels of toxic elements including arsenic and radon compared to average rocks and sediment. Similarly, the population of eastern Kentucky has higher rates of many health conditions, including lung cancer and cardiovascular disease, than surrounding regions. These poor health outcomes are typically explained in relation to social, economic, behavioral, and healthcare factors. The rates of many conditions, however, have not decreased as these factors improve with regional development. Black shale is known to affect environmental conditions such as by increasing radiation levels and heavy metal toxicity. We are mapping the effects of black shale through monitoring radiation, microbes, and chemical standards of water sources. In this presentation, we report on our measuring pH, dissolved oxygen, total dissolved solids, conductivity, temperature, and discharge and comparison with water quality standards from the Kentucky Department for Environmental Protection. The conditions of water sources combined with an environmental survey of the surrounding areas provide a greater understanding of why the people in eastern Kentucky face the current health issues.

Keywords: black shale, eastern Kentucky, environmental impact, water quality

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Authors: Mohammed A. Alhoot, Rathika A/P Nagarajan

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Climate change and variability are affecting human health and diseases direct or indirectly through many mechanisms. Change in rain pattern, an increase of temperature and humidity are showing an increased trend in Malaysia. This will affect the biological, physical and chemical component of water through different pathways and will enhance the risk of waterborne diseases. Besides, the warm temperature and humid climate provide very suitable conditions for the growth of pathogenic bacteria. This study is intended to highlight the relationship between the climate changes and the incidence food and water associated infections. Incidences of food and water associated infection and climate data were collected from Malaysian Ministry of health and Malaysian Metrological Department respectively. Maximum and minimum temperature showed high correlation with incidence of typhoid, hepatitis A, dysentery, food poisoning (P value <0.05 significant with 2 tailed / 0.5<[r]). Heavy rainfall does not associated with any outbreaks. Climate change brings out new challenges in controlling food and water associated infections. Adaptation strategies should involve all key stakeholders with a strong regional cooperation to prevent and deal with cross-boundary health crises. Moreover, the role of health care personnel at local, state and national levels is important to ensure the success of these programmes. As has been shown herein, climate variability is an important element influencing the food and water associated epidemiology in Malaysia. The results of this study are crucial to implementing climate changes as a factor to reduce any future outbreaks.

Keywords: climate change, typhoid, hepatitis A, dysentery, food poisoning

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Authors: Mokhtari Karchegani Amir, Maboudi Samad, Azadi Reza, Dastanian Raoof

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Marun's petrochemical cracking furnaces have a very comprehensive operating control system for combustion and related equipment, utilizing advanced instrument circuits. However, after several years of operation, numerous problems arose in the pyrolysis furnaces. A team of experts conducted an audit, revealing that the furnaces were over-designed, leading to excessive consumption of air and fuel. This issue was related to the burners' shutter settings, which had not been configured properly. The operations department had responded by increasing the induced draft fan speed and forcing the instrument switches to counteract the wind effect in the combustion chamber. Using Fluent and Gambit software, the furnaces were analyzed. The findings indicated that this situation elevated the convection part's temperature, causing uneven heat distribution inside the furnace. Consequently, this led to overheating in the convection section and excessive cracking within the coils in the radiation section. The increased convection temperature damaged convection parts and resulted in equipment blockages downstream of the furnaces due to the production of more coke and tar in the process. To address these issues, corrective actions were implemented. The excess air for burners and combustion chambers was properly set, resulting in improved efficiency, reduced emissions of environmentally harmful gases, prevention of creep in coils, decreased fuel consumption, and lower maintenance costs.

Keywords: furnace, coke, CFD analysis, over cracking

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Authors: Yousef Abdulaziz Almolhem

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Geographically, the most Arabic countries locate in areas confined to arid or semiarid regions. For this reason, most of our countries have adopted the seawater desalination as a strategy to overcome this problem. For example, the water supply of AUE, Kuwait, and Saudi Arabia is almost 100% from the seawater desalination plants. Many areas in Saudia Arabia and other countries in the world suffer from lack of fresh water which hinders the development of these areas, despite the availability of saline water and high solar radiation intensity. Furthermore, most developing countries do not have sufficient meteorological data to evaluate if the solar radiation is enough to meet the solar desalination. A mathematical model was developed to simulate and predict the thermal behavior of the solar still which used direct solar energy for distillation of seawater. Measurement data were measured in the Environment and Natural Resources Department, Faculty of Agricultural and Food sciences, King Faisal University, Saudi Arabia, in order to evaluate the present model. The simulation results obtained from this model were compared with the measured data. The main results of this research showed that there are slight differences between the measured and predicted values of the elements studied, which is resultant from the change of some factors considered constants in the model such as the sky clearance, wind velocity and the salt concentration in the water in the basin of the solar still. It can be concluded that the present model can be used to estimate the average total solar radiation and the thermal behavior of the solar still in any area with consideration to the geographical location.

Keywords: mathematical model, sea water, distillation, solar radiation

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Authors: Saleh Mohammad Alqahtani

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Foreign language Anxiety has been found to be a key issue in learning English as foreign language in the classroom. This study investigated the impact of foreign language anxiety on Saudi EFL learners' proficiency in the classroom. A total of 197 respondents had participated in the study, comprising of 96 male and 101 female, who enrolled in preparatory year, first year, second year, and fourth year of English language department at the University of Jeddah. Two instruments were used to answer the study questions. The Foreign Language Classroom Anxiety Scale (FLCAS) was used to identify the levels of foreign language (FL) anxiety for Saudi learners. Moreover, an International English Language Testing System (IELTS) test was used as an objective measure of the learners’ English language proficiency. The data were analyzed using descriptive analyses, t-test, one-way ANOVA, correlation, and regression analysis. The findings revealed that Saudi EFL learners' experience a level of anxiety in the classroom, and there is a significant differences between the course levels in their level of language anxiety. Moreover, it is also found that female students are less anxious in learning English as a foreign language than male students. The results show that foreign language anxiety and English proficiency are negatively related to each other. Furthermore, the study revealed that there were significant differences between Saudi learners in language use anxiety, while there were no significant differences in language class anxiety. The study suggested that teachers should employ a diversity of designed techniques to encourage the environment of the classroom in order to control learners’ FLA, which in turns will improve their EFL proficiency.

Keywords: foreign language anxiety, FLA, language use anxiety, language class anxiety, gender, L2 proficiency

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Authors: Megha Ramnik Kotecha

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To study whether there is any clinical correlation between pterygium and dry eye and to evaluate the status of tear film in patients with pterygium. Methods: 100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20 – 70 years were included in the study. Detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂10 mm and TBUT ˂10 seconds was considered abnormal. Results: Maximum number (52) of patients affected with dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P<0.01).Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec).TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film unstability. On comparision of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing risk of dry eye in pterygia patients to be 1.14 times higher than controls. Conclusion: Whether tear dysfunction is a precursor to pterygium growth or pterygium causes tear dysfunction is still not clear. Research and clinical evidence, however, suggest that there is a relationship between the two. This study is, therefore, undertaken to investigate the correlation between pterygium and dry eye. The patients with pterygia were compared with normals to evaluate their status regarding dryness. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight threatening complications.

Keywords: dry eye, pterygium, Schirmer's test, tear break up time (TBUT)

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Authors: Ameer Khan, Iffat Jamal, Ambreen Azam

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An experiment was conducted in the Department of Botany, University of Sargodha to observe the amelioration of salinity stress in spinach (Spinacia oleracea) by exogenous application of Triacontanol. Two spinach cultivars (Spinacea oleracea and Rumax dentatus) were obtained from the Agriculture Research institute, Faisalabad. This experiment was conducted in pots. Each pot was filled with 9kg mixture of (sand + soil). Different salinity levels (0mM, 60mM, and 120mM) were created with NaCl according to the saturation percentage of soil after two weeks of seed germination. After the two weeks of salinity treatment, different levels of Triacontanol (0µM, 10µM, 20µM) were applied as foliar spray. Triacontanol was applied along with Tween 80 as surfactant. After the two weeks of Triacontanol application different growth, physiological and biochemical parameters were collected from the experimental study. Both treatments of Triacontanol (10µM, 20µM) were effective to ameliorate the effect of salinity, but 20µM Triacontanol was more effective to increase the shoot length, shoot, root fresh and dry weight. Chlorophyll contents were (chl a, chl b, total chl). Different biochemical parameters were also collected from experimental study. Saline growth medium increased the accumulation of protein and decreased the total free amino acids, and total soluble sugar under salt stress. Application of Triacontanol increased the protein contents. Overall, Application of triacontanol mitigated the effect of salinity.

Keywords: salinity, triacontanol, spinach, biochemical, physiological

Procedia PDF Downloads 278

Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Background/Purpose: Previous preclinical and clinical data suggest that increased lymphocytic infiltration would be associated with good prognosis and benefit from immunogenic chemotherapy especially in triple-negative breast cancer (TNBC). We investigated a single-center experience of TNBC and relationship with lymphocytic infiltration. Methods: From January 2004 to December 2012, at the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, we retrospectively reviewed 897 breast cancer patients-clinical outcomes, clinicopathological characteristics, breast cancer subtypes. And we reviewed lymphocytic infiltration of TNBC specimens by two pathologists. Statistical analysis of risk factors associated with recurrence was performed. Results: A total of 897 patients, 76 were TNBC (8.47%). Mean age of TNBC patients were 50.95 (SD10.42) years, mean follow-up periods was 40.06 months. We reviewed 49 slides, and there were 8 recurrent breast cancer patients (16.32%), and 4 patients were expired (8.16%). There were 9 lymphocytic predominant breast cancers (LPBC)-carcinomas with either intratumoral lymphocytes in >60% of tumor cell nests. 1 patient of LPBC was recurred and 8 were not. In multivariate logistic regression, the odds ratio of lymphocytic infiltration was 0.59 (p=0.643). Conclusion: In a single-center experience of TNBC, the lymphocytic infiltration in tumor cell nest might be a good trend on the prognosis but there was not statistically significant.

Keywords: tumor-infiltrating lymphocytes, triple negative breast cancer, medical and health sciences

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Authors: Kathrina Aseanne Acapulco-Gomez, Shayne Julieane Morales, Tzar Francis Verame

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Mean platelet volume (MPV) is the most accurate measure of the size of platelets and is routinely measured by most automated hematological analyzers. Several studies have shown associations between MPV and cardiovascular risks and outcomes. Although its measurement may provide useful data, MPV remains to be a diagnostic tool that is yet to be included in routine clinical decision making. The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios, and to determine the difference of the mean MPV values between those with MI and those in the non-MI controls. The primary search was done through search in electronic databases PubMed, Cochrane Review CENTRAL, HERDIN (Health Research and Development Information Network), Google Scholar, Philippine Journal of Pathology, and Philippine College of Physicians Philippine Journal of Internal Medicine. The reference list of original reports was also searched. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Studies were included if: (1) CBC was taken upon presentation to the ER or upon admission (within 24 hours of symptom onset); (2) myocardial infarction was diagnosed with serum markers, ECG, or according to accepted guidelines by the Cardiology societies (American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC); and, (3) if outcomes were measured as significant difference AND/OR sensitivity and specificity. The authors independently screened for inclusion of all the identified potential studies as a result of the search. Eligible studies were appraised using well-defined criteria. Any disagreement between the reviewers was resolved through discussion and consensus. The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. With a DOR of 2.92, MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. Thus, it is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.

Keywords: mean platelet volume, MPV, myocardial infarction, angina, chest pain

Procedia PDF Downloads 67

Authors: Amy Darwin, Claire Blacklock

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Background: Existing literature about delivering evidence-based mental health and psychosocial support (MHPSS) in emergency settings is limited. It is difficult to monitor and evaluate the approach to MHPSS in informal refugee camps such as ‘The Jungle’ in Calais, where there are multiple service providers and where the majority of providers are volunteers. AIM: To identify experiences of MHPSS delivery by service providers in an informal camp environment in Calais, France and describe MHPSS barriers and opportunities in this type of setting. Method: Qualitative semi-structured interviews were conducted with 13 individuals from different organisations offering MHPSS in Calais and analysed using conventional content analysis. Results: Unsafe, uncertain and unsanitary conditions in the camp meant MHPSS was difficult to implement, and such conditions contributed to the poor mental health of the residents. The majority of MHPSS was offered by volunteers who lacked resources and training, and there was no overall official camp leadership which meant care was poorly coordinated and monitored. Strong relationships existed between volunteers and camp residents, but volunteers felt frustrated that they could not deliver the kind of MHPSS that they felt residents required. Conclusion: While long-term volunteers had built supportive relationships with camp residents, lack of central coordination and leadership of MHPSS services and limited access to trained professionals made implementation of MHPSS problematic. Similarly, the camp lacked the necessary infrastructure to meet residents’ basic needs. Formal recognition of the camp, and clear central leadership were identified as necessary steps to improving MHPSS delivery.

Keywords: calais, mental health, refugees, the jungle, MHPSS

Procedia PDF Downloads 225

Authors: Roel Guinto Jr, John Peter Dacanay, Edison Ramos

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The Philippines now has the fastest-growing HIV epidemic in the entire Asia-Pacific region. According to the January 2023 HIV/AIDS Registry of the Philippines of the Department of Health (DOH), there were 86 newly reported HIV cases involving 19 years old and below. A cure for HIV is not yet readily available but effective preventive measures to prevent its transmission. Pre-Exposure Prophylaxis is a biomedical intervention for HIV infection in the form of a pill. Students play a significant role in identifying solutions to preventing the transmission of HIV Infection, making it critical to assess their Knowledge, Attitude, and Practice of Pre-Exposure Prophylaxis on HIV Infection. A study was conducted among 390 regular students from different college departments at National University – Manila. A structured questionnaire was used to collect data and other statistical tools were used to analyze data. The findings reveal that most students had no knowledge or idea about PreExposure Prophylaxis before being interviewed. It also shows that students have a positive attitude toward the practice of Pre-Exposure Prophylaxis. The study revealed that there is also a significant relationship between the Knowledge and the Socio-demographic profile of the respondents. Knowledge, Attitude, and Practices on PrEP of students were overall identified, and areas of improvement were also recognized. Sex Education and Sexual Health Awareness should be implemented to enhance students’ knowledge of practicing safe sex to help prevent HIV Transmission.

Keywords: HIV, cure, biomedical intervention, pre-exposure prophylaxis, pill, knowledge, attitude, practice, sex education, sexual health awareness

Procedia PDF Downloads 50

Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

Procedia PDF Downloads 123

Authors: T. Malmir, U. Eicker

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Landfilling of organic waste is still the predominant waste management method in the USA and Canada. Strategic plans for waste diversion from landfills are needed to increase material recovery and energy generation from waste. In this paper, we carried out a statistical survey on waste flow in the two cities New York and Montréal and estimated the energy recovery potential for each case. Data collection and analysis of the organic waste (food waste, yard waste, etc.), paper and cardboard, metal, glass, plastic, carton, textile, electronic products and other materials were done based on the reports published by the Department of Sanitation in New York and Service de l'Environnement in Montréal. In order to calculate the gas generation potential of organic waste, Buswell equation was used in which the molar mass of the elements was calculated based on their atomic weight and the amount of organic waste in New York and Montréal. Also, the higher and lower calorific value of the organic waste (solid base) and biogas (gas base) were calculated. According to the results, only 19% (598 kt) and 45% (415 kt) of New York and Montréal waste were diverted from landfills in 2017, respectively. The biogas generation potential of the generated food waste and yard waste amounted to 631 million m³ in New York and 173 million m³ in Montréal. The higher and lower calorific value of food waste were 3482 and 2792 GWh in New York and 441 and 354 GWh in Montréal, respectively. In case of yard waste, they were 816 and 681 GWh in New York and 636 and 531 GWh in Montréal, respectively. Considering the higher calorific value, this amount would mean a contribution of around 2.5% energy in these cities.

Keywords: energy recovery, organic waste, urban energy modelling with INSEL, waste flow

Procedia PDF Downloads 116

Authors: Hamad Albadr

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Joint Commission International (JCI) accreditation process intent to improve the safety and quality of care in the international community through the provision of education, publications, consultation, and evaluation services. These standards apply to the entire organization as well as to each department, unit, or service within the organization. Medical Technology that contains both medical equipment and devices, is an essential part of health care. Appropriate management of equipment maintenance for ensuring medical technology safe, the equipment life is maximized, and the total costs are minimized. JCI medical technology evaluation and accreditation use standards, intents, and measurable elements. The paper focuses on evaluation of JCI standards for medical technology in Saudi Arabian hospitals: a Study Case of PSMMC that define the performance expectation, structures, or functions that must be in place for a hospital to be accredited by JCI through measurable elements that indicate a score during the survey process that identify the requirements for full compliance with the standard specially through Facility Management and Safety (FMS) section that require the hospital establishes and implements a program for inspecting, testing, and maintaining medical technology and documenting the results, to ensure that medical technology is available for use and functioning properly, the hospital performs and documents; an inventory of medical technology; regular inspections of medical technology; testing of medical technology according to its use and manufacturers’ requirements; and performance of preventive maintenance.

Keywords: joint commission international (JCI) accreditation, medical technology, Saudi Arabia, Saudi Arabian hospitals

Procedia PDF Downloads 539

Authors: Salem Alsanusi, Loubna Bentaher

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Response Surface Methods (RSM) provide statistically validated predictive models that can then be manipulated for finding optimal process configurations. Variation transmitted to responses from poorly controlled process factors can be accounted for by the mathematical technique of propagation of error (POE), which facilitates ‘finding the flats’ on the surfaces generated by RSM. The dual response approach to RSM captures the standard deviation of the output as well as the average. It accounts for unknown sources of variation. Dual response plus propagation of error (POE) provides a more useful model of overall response variation. In our case, we implemented this technique in predicting compressive strength of concrete of 28 days in age. Since 28 days is quite time consuming, while it is important to ensure the quality control process. This paper investigates the potential of using design of experiments (DOE-RSM) to predict the compressive strength of concrete at 28th day. Data used for this study was carried out from experiment schemes at university of Benghazi, civil engineering department. A total of 114 sets of data were implemented. ACI mix design method was utilized for the mix design. No admixtures were used, only the main concrete mix constituents such as cement, coarse-aggregate, fine aggregate and water were utilized in all mixes. Different mix proportions of the ingredients and different water cement ratio were used. The proposed mathematical models are capable of predicting the required concrete compressive strength of concrete from early ages.

Keywords: mix proportioning, response surface methodology, compressive strength, optimal design

Procedia PDF Downloads 250

Authors: Kodo Sektani, Apostolos Tsouvalas, Andrei Metrikine

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The reassessment of existing movable bridges in The Netherlands has created the need for acceptance/rejection criteria to assess whether the machineries are meet certain design demands. However, the existing design code defines a different limit state design, meant for new machineries which is based on a simple linear spring-mass model. Observations show that existing bridges do not confirm the model predictions. In fact, movable bridges are nonlinear systems consisting of mechanical components, such as, gears, electric motors and brakes. Next to that, each movable bridge is characterized by a unique set of parameters. However, in the existing code various variables that describe the physical characteristics of the bridge are neglected or replaced by partial factors. For instance, the damping ratio ζ, which is different for drawbridges compared to bascule bridges, is taken as a constant for all bridge types. In this paper, a model is developed that overcomes some of the limitations of existing modelling approaches to capture the dynamics of the powertrain of a class of bridge machineries First, a semidefinite dynamic model is proposed, which accounts for stiffness, damping, and some additional variables of the physical system, which are neglected by the code, such as nonlinear braking torques. The model gives an upper bound of the peak forces/torques occurring in the powertrain during emergency braking. Second, a discrete nonlinear dynamic model is discussed, with realistic motor torque characteristics during normal operation. This model succeeds to accurately predict the full time history of the occurred stress state of the opening and closing cycle for fatigue purposes.

Keywords: Dynamics of movable bridges, Bridge machinery, Powertrains, Torque measurements

Procedia PDF Downloads 135

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.

Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic

Procedia PDF Downloads 52

Authors: Mukhtar Sarkin-Kebbi

Abstract:

Insurgency, religious extremism and other related religious crises become hydra-headed in Nigeria, which caused destruction of human lives and properties worth of billions naira. As result, millions people were displaced and million children were out of school most of whom from Muslims community. The wrong teaching and misinterpretation of Islam by some Muslim community fuel the spread of extremist ideology hatred among Muslim sects, non-Muslims and emergency of extremist groups, like Boko Haram. A multi-religious country like Nigeria to realise its development in all human aspects, there must be unity and religious tolerance. Many agreed that changing the ideologies of insurgents and religious extremism will require intellectual role with vigorous campaign. Muslim scholars can play a vital role in promoting social reform and peaceful coexistence. This paper discusses the importance of unity among Muslim community and religious tolerance in light of the Qur’an and the Hadith. The paper also reviews the relationship between Muslims and non Muslims during the life time the Prophet (S.A.W.) in order to serve as exemplary model. Contemporary issues such as religious extremism, sectarians, intolerance and their consequences were examined. To minify religious intolerance and extremism,the paper identifies the roles to be played by Muslim scholars with references from Qur’an and Sunnah. The paper concludes that to realise overall human development and eternal salvation, Muslim should shun away from any religious crises and embrace unity and religious tolerance. Finally the paper recommends among others that only pious and learned scholars should be allowed to preach in any religious gathering, Muslim should exercise patience, tolerance in dealing with Muslims and non Muslims. Muslims should leave by example from the teaching of Qur’an and Sunnah of the Prophet (S.A.W.).

Keywords: Muslim scholars, peace building, religious extremism, religious tolerance

Procedia PDF Downloads 198