Search results for: stigma towards mental illness
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2373

Search results for: stigma towards mental illness

633 Clinical Nursing Experience in Managing a Uterine Cancer Patient with Psychogenic Shock During the Extracorporeal Membrane Oxygenation Weaning Process

Authors: Syue-Wen Lin

Abstract:

Objective: This article discusses the nursing experience of caring for a uterine cancer patient who experienced cardiogenic shock and was weaned off ECMO. The patient was placed on ECMO due to cardiogenic shock and initially struggled with anxiety caused by the physical discomfort from the disease and multiple medical devices, as well as the isolation in the ICU and restrictions on physical activity. Over time, the patient was able to wean off ECMO and perform daily activities and rehabilitation independently. Methods: The nursing period was from January 6 to January 9. Through observation, direct care, interviews, physical assessments, and case reviews, the intensive care team and bypass personnel conducted a comprehensive assessment using Gordon's 11 functional health patterns. The assessment identified three main nursing health problems: pain, anxiety, and decreased cardiac tissue perfusion. Results: The author consulted a psychologist to employ open communication techniques and empathetic care to build a trusting nurse-patient relationship. A patient-centered intensive cancer care plan was developed. Pain was assessed using a pain scale, and pain medications were adjusted in consultation with a pharmacist. Lavender essential oil therapy, light music, and pillows were used to distract and alleviate pain. The patient was encouraged to express feelings and family members were invited to increase visits and provide companionship to reduce the uncertainty caused by cancer and illness. Vital signs were closely monitored, and nursing interventions were provided to maintain adequate myocardial perfusion. Post-ECMO, the patient was encouraged to engage in rehabilitation and cardiopulmonary training. Conclusion: A key takeaway from the care process is the importance of observing not only the patient's vital signs but also their psychological state, especially when dealing with cancer patients on ECMO. The patient's greatest source of comfort was the presence of family, which helped alleviate anxiety. Healthcare providers play multiple critical roles as advocates, coordinators, educators, and counselors, listening to and accepting the patient’s emotional responses. The report aims to provide clinical cancer nurses with a reference to improve the quality of care and alleviate cancer-related discomfort.

Keywords: ECMO, uterine cancer, palliative care, Gordon's 11 functional health patterns

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632 Adaptation and Habituation to new Complete Dentures

Authors: Mohamed Khaled Ahmed Azzam

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Complete dentures, a non biological appliance, were and are still used to replace missing teeth and surrounding structures. Its main objectives are esthetics, speech, function and psychological state improvement. Dentists must realize that, just as dentate patients vary in their dental treatment complexity; edentulous patients also vary in the difficulty of their treatment plan. There are two main problems facing the removable Prosthodontist which harden his/her task how to please his patient with their new dentures being: Denture construction which however its fabrication is at the highest standards still is an unpleasant experience to all patients in the beginning and improves by time. This varies from one to several years according to the patient’s attitude, age, gender, socio-economical level and culture. The second problem of edentulous patients is both physical and psychological. Good interview, communication and note how patients present themselves for the concerns of their appearance, overall attitude and expectations concerning treatment is very important physically. On the psychological aspect patients have great difficulty to cope with new dentures to the extent of not using them at all. Hence their mind preparation should be commenced from day one by more than one method. This had a great impact on the acceptance which led to habituation to their dentures and patients were appreciative and pleased. In conclusion to successfully treat edentulous patients a great deal of information is required to complete a proper diagnosis, including patient mental attitude, past and present medical and dental conditions, and extra and intra-oral examinations. In addition to the clinical experience and skill of the whole dental team.

Keywords: complete dentures, edentulous patients, management of denture, psychological mind preparation

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631 Dimensional Investigation of Food Addiction in Individuals Who Have Undergone Bariatric Surgery

Authors: Ligia Florio, João Mauricio Castaldelli-Maia

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Background: Food addiction (FA) emerged in the 1990s as a possible contributor to the increasing prevalence of obesity and overweight, in conjunction with changing food environments and mental health conditions. However, FA is not yet listed as one of the disorders in the DSM-5 and/or the ICD-11. Although there are controversies and debates in the literature about the classification and construct of FA, the most common approach to access it is the use of a research tool - the Yale Food Addiction Scale (YFAS) - which approximates the concept of FA to the concept diagnosis of dependence on psychoactive substances. There is a need to explore the dimensional phenotypes accessed by YFAS in different population groups for a better understanding and scientific support of FA diagnoses. Methods: The primary objective of this project was to investigate the construct validity of the FA concept by mYFAS 2.0 in individuals who underwent bariatric surgery (n = 100) at the Hospital Estadual Mário Covas since 2011. Statistical analyzes were conducted using the STATA software. In this sense, structural or factor validity was the type of construct validity investigated using exploratory factor analysis (EFA) and item response theory (IRT) techniques. Results: EFA showed that the one-dimensional model was the most parsimonious. The IRT showed that all criteria contributed to the latent structure, presenting discrimination values greater than 0.5, with most presenting values greater than 2. Conclusion: This study reinforces a FA dimension in patients who underwent bariatric surgery. Within this dimension, we identified the most severe and discriminating criteria for the diagnosis of FA.

Keywords: obesity, food addiction, bariatric surgery, regain

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630 Exam Stress and Emotional Eating Among Lebanese University Students: A Correlational Study

Authors: Marielle Mansour

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Background: Integrating university students into an academic environment can be intense, with significant intellectual and emotional challenges. Stress, particularly during exam periods, plays a crucial role in students' eating habits, often influencing their food choices through mechanisms such as emotional eating. Objective: This study aims to understand the impact of exam stress on emotional eating among university students in Lebanon, Methodology: A cross-sectional study was conducted among 700 students aged 18 to 25 years in Lebanon, using online questionnaires to assess perceived stress using the Perceived Stress Scale (PSS) and emotional eating behaviors with the Dutch Eating Behavior Questionnaire (DEBQ). Data was analyzed to identify correlations between stress and emotional eating. Results: A significant positive correlation was observed between levels of perceived stress and increased emotional eating, with marked differences depending on participants' gender and field of study. This trend highlights the concerning impact of academic stress on students' food choices, including an increased prevalence of emotional eating among women and those studying in demanding disciplines like health sciences and engineering. Conclusion: This research contributes to the understanding of the complex links between academic stress and emotional eating behaviors among university students in Lebanon. To improve the mental and physical health of students, it is essential to implement tailored educational and support initiatives aimed at reducing stress and promoting balanced dietary choices in learning environments.

Keywords: exam stress, emotional eating, university students, stress management, Lebanon

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629 The Nurse Practitioner’s Role Functions in Multi-Specialist Team When Caring for a Metastatic Colon Cancer Patient with Acute Intestinal Obstruction

Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Yu-Ting Su, Joffrey Hsu, Hui-Zhu Chen

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Acute intestinal obstruction is one of the differentials of acute abdomen and requires timely alleviation of intestinal distention and abdominal pain to avoid perforation, intra-abdominal infection, and peritonitis. Investigation to identify the cause of obstruction will direct treatment planning and allow for more effective management. In this study, we present a 71-year-old female presenting with symptoms of acute intestinal obstruction for five days. After extensive history taking, physical exam, medical imaging, and pathology, the patient was diagnosed with colon cancer with lung metastasis and acute intestinal obstruction. The patient was placed on nil per os status with intravenous fluid support, intravenous antibiotics, and a decompression nasogastric tube was placed. The patient received decompression with colostomy creation surgery. After assessing the patient’s clinical condition and tumor staging, a multidisciplinary healthcare team created an individualized treatment plan, which included plans to prepare the patient for home self-care and maintain good mental health with regular monitoring in the clinic setting. This case demonstrates the importance of early diagnosis, effective treatment, and a multidisciplinary approach to the management of acute intestinal obstruction secondary to colon cancer.

Keywords: acute intestinal obstruction, colostomy surgery, metastatic colon cancer, multidisciplinary healthcare team

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628 Spirituality in Education (Enhance the Human Mind Competencies)

Authors: Kshama Sharma

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Education is one of the most powerful tools to transform the world into a just, sustainable, and more peaceful place for existing lives across the globe. However, its recent objective approach focused on materialistic, factual, and existing knowledge, has a constraint of human experiences that is limited to certain dimensions only. And leads to a materialistic world which is deprived of spiritual approaches and makes it less compassionate, and more grades oriented. To make it more comprehensive, education should explore the subjective approaches towards spiritualism to connect lives with the greater self and consciousness of cosmic intelligence. This approach will bring a major shift in the orientation of pedagogical processes, assessment strategies, and administrative management of the present education system. Spirituality often related to the religious aspect of human civilization and development, however, when universal consciousness /cosmic intelligence (which is often claimed as dark energy) and the human mind competencies works in coherence and coordination then the efficiency of human mind reaches to a different dimension and achieve extraordinary level of human understanding. Quantitative analysis of the existing secondary data from the different agencies working in the field of meditation had been analyzed to conclude its implications on human mind and further how it can effectively use in education to bring the desired and expected results. Any kind of meditation practice affects the cognitive, mental, physical, emotional, and conscious state of mind. If aligned with the teaching and learning methodology will lead to conscious learner and peaceful world.

Keywords: spirituality, cosmic intelligence, consciousness, mind competencies

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627 Designing a Combined Outpatient and Day Treatment Eating Disorder Program for Adolescents and Transitional Aged Youth: A Naturalistic Case Study

Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

Abstract:

Background and significance: Patients with eating disorders have traditionally been an underserviced population within the publicly-funded Canadian healthcare system. This situation was worsened by the COVID-19 pandemic and accompanying public health measures, such as “lockdowns” which led to increased isolation, changes in routine, and other disruptions. Illness severity and prevalence rose significantly with corresponding increases in patient suffering and poor outcomes. In Ontario, Canada, the provincial government responded by increasing funding for the treatment of eating disorders, including the launch of a new day program at an intermediate, regional health centre that already housed an outpatient treatment service. The funding was received in March 2022. The care team sought to optimize this opportunity by designing a program that would fit well within the resource-constrained context in Ontario. Methods: This case study will detail how the team consulted the literature and sought patient and family input to design a program that optimizes patient outcomes and supports for patients and families while they await treatment. Early steps include a review of the literature, expert consultation and patient and family focus groups. Interprofessional consensus was sought at each step with the team adopting a shared leadership and patient-centered approach. Methods will include interviews, observations and document reviews to detail a rich description of the process undertaken to design the program, including evaluation measures adopted. Interim findings pertaining to the early stages of the program-building process will be detailed as well as early lessons and ongoing evolution of the program and design process. Program implementation and outcome evaluation will continue throughout 2022 and early 2023 with further publication and presentation of study results expected in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to the design and implementation of eating disorder treatment services that combine outpatient and day treatment services in a resource-constrained context.

Keywords: eating disorders, day program, interprofessional, outpatient, adolescents, transitional aged youth

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626 Examination of Predictive Factors of Depression among Asian American Adolescents: A Narrative Review

Authors: Annisa Siu, Ping Zou

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Background: Existent literature addressing Asian American children and adolescents reveals that this population is experiencing rates of depression comparable to those of European American and other ethnic minority youths. Within the last decade, increased attention has been given to Asian American adolescent mental health. Methods: 44 articles were extracted from Pubmed, PsycINFO, EMBASE, and Proquest CINAHL. Data were subject to thematic analyses and categorized into factors under individual, familial, and community levels. Results: Of all the individual factors, age and gender were the most supported in their relationship with depressive symptoms. Likewise, living situations, parent-child relations, peer relations, and broader environmental factors were strongly evidenced. The remaining psychosocial factors faced contrary evidence or were insubstantially addressed in the empirical literature. Discussion: The identified psychosocial factors within this study offer a starting point for future research to examine what factors should be included in formal or informal methods of screening/consultations. Clinicians should aim to understand the cultural influences specific to Asian American adolescents, particularly the central role that family relations may have on their depressive symptoms. Conclusion: Low awareness of culturally linked expressions of psychological distress can lead to misdiagnosis or under-diagnosis of depression in Asian American youth. Further evidence is needed to clarify the relationship of psychosocial factors linked to Asian American adolescent depressive symptoms.

Keywords: adolescent, Asian American, depression, psychosocial factors

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625 The Role of Psychological Resilience in Predicting Psychological Distress in Kuwaiti Adults during Corona Varies Pandemic

Authors: Al-Tammar M. Shahah

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Background and Objective: A novel pneumonia caused by coronavirus disease 2019 (COVID-19), which is spreading domestically and internationally, has been identified by the Chinese city of Wuhan since the end of December 2019. Limited studies examined the psychological experience such as anxiety, depression, and stress during Corona pandemic. Moreover, to the best of author's knowledge, there is no study to date has examined the psychological resilience and mental health during Corona pandemic in Kuwait. Therefore, the present research investigates the role of psychological resilience in predicting psychological distress among Kuwaiti adults during Corona pandemic. Method: Kuwaiti citizens (N = 735) completed an online survey, which includes four scales the Hospital Anxiety and Depression Scale HADS (anxiety and depression), the Connor-Davidson Resilience Scale (CD-RISC-25), and the Perceived Stress Scale (PSS). A cross-sectional correlational design was used. Results: A high level of stress was observed, with 59% reported moderate to severe stress. In contrast, low levels of anxiety and depression were observed; with 70% reporting no anxiety symptoms and 74% report no depression symptoms. Psychological resilience was negatively correlated with anxiety, depression, and stress, consistent with previous studies. As expected, resilience was found to account for significant variance in anxiety and stress after controlling for quarantine variables and demographic variables. Conclusion: The findings suggest that increasing psychological resilience might help reduce psychological distress after confronting with stressful live events in Kuwaiti citizen.

Keywords: anxiety, corona, depression, psychological resilience, stress

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624 Intensive Care Unit Patient Self-Determination When Facing Cardiovascular Surgery for the First Time

Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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623 Comparative Analysis of the Psychosocial Impact of Skin Diseases in India

Authors: Priyanka Jain, Sushila Pareek

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Skin disease is often considered to be ‘only cosmetic’ by many medical professionals and lay-people alike but unlike most internal illnesses, skin disease is often immediately visible to others and therefore people suffering from dermatological conditions may suffer serious social and emotional consequences. The purpose of this research was to compare patients suffering from acne, alopecia areata (AA) and melanosis on perceived stress, social appearance anxiety and coping. The study included 120 patients (acne = 40 AA = 40 melanosis = 40) ages ranged from 15 to 25 years. Perceived Stress Scale (PSS), Social Appearance Anxiety Scale (SAAS), and The Brief COPE were administered to the patients. Analytical evaluation was done by Kruskal Wallis and ANOVA-tests. The results of the present study clearly revealed that perceived stress and social appearance anxiety were highest in patients with AA followed by acne patients and found least in patients with melanosis. With regard to coping, self-distraction as a coping technique was found highest in patients suffering from AA followed by acne and then melanosis. Denial was highest in acne patients followed by AA and experienced least by patients with melanosis. Behavioural disengagement was almost equal in patients with melanosis and acne and a little less in patients suffering from AA Acceptance was highest in patients with melanosis, followed by AA and least in acne patients. Self-blame was found highest in patients with acne, followed by AA patients further followed by patients suffering from melanosis. This study is an attempt to stimulate professionals working in the field of dermatology and mental health to explore their supportive communication and increase awareness regarding the difficulties that patients with skin disease can face.

Keywords: coping, dermatology, perceived stress, psychosocial impact, social appearance anxiety

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622 Social Anxiety Connection with Individual Characteristics: Theory of Mind, Verbal Irony Comprehension and Personal Traits

Authors: Anano Tenieshvili, Teona Lodia

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Social anxiety disorder (SAD) is one of the most common mental health problems not only in adults but also in adolescents. Individuals with SAD exhibit difficulties in interpersonal relationships, understanding emotions, and regulating them as well. For social and emotional adaptation, it is crucial to identify, understand, accept and manage emotions correctly. Researchers actively learn those factors that contribute to the development and maintenance of this condition. Therefore, the main purpose of this study is to acquire knowledge about the association between social anxiety and individual characteristics, such as theory of mind (ToM), verbal irony comprehension, and personal traits. 112 adolescents aged from 12 to 18 were selected for this research. 15 of them are diagnosed with Social anxiety disorder. Statistical analysis was performed on the entire sample, and furthermore, two groups, adolescents with and without social anxiety disorder, were compared separately. Social anxiety and personal traits were assessed by questionnaires. Theory of mind and comprehension of verbal irony were measured using tests. Statistical analysis indicated a positive relationship between social anxiety and comprehension of ironic criticism. Moreover, social anxiety was significantly positively correlated with neuroticism and isolation tendency, whereas it was negatively related to extraversion and frustration tolerance. On top of that, statistical analysis revealed a positive relationship between ToM and verbal irony comprehension. However, the relationship between social anxiety and ToM was not statistically significant. In conclusion, the current research expands knowledge about social anxiety and supports the results of some previous studies.

Keywords: personal traits, social anxiety, theory of mind, verbal irony comprehension

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621 Social Anxiety Connection with Individual Characteristics: Theory of Mind, Verbal Irony Comprehension and Personal Traits

Authors: Anano Tenieshvili, Teona Lodia

Abstract:

Social anxiety disorder (SAD) is one of the most common mental health problems not only in adults but also in adolescents. Individuals with SAD exhibit difficulties in interpersonal relationships, understanding emotions and regulating them as well. For social and emotional adaptation, it is crucial to identify, understand, accept and manage emotions correctly. Researchers actively learn those factors that contribute to the development and maintenance of this condition. Therefore, the main purpose of this study is to acquire knowledge about the association between social anxiety and individual characteristics, such as the theory of mind (ToM), verbal irony comprehension and personal traits. 112 adolescents aged from 12 to 18 were selected for this research. 15 of them are diagnosed with Social anxiety disorder. Statistical analysis was performed on the entire sample and furthermore, two groups, adolescents with and without a social anxiety disorder, were compared separately. Social anxiety and personal traits were assessed by questionnaires. Theory of mind and comprehension of verbal irony was measured using tests. Statistical analysis indicated a positive relationship between social anxiety and comprehension of ironic criticism. Moreover, social anxiety was significantly positively correlated with neuroticism and isolation tendency, whereas it was negatively related to extraversion and frustration tolerance. On top of that, statistical analysis revealed a positive relationship between ToM and verbal irony comprehension. However, the relationship between social anxiety and ToM was not statistically significant. In conclusion, the current research expands knowledge about social anxiety and supports the results of some previous studies.

Keywords: personal traits, social anxiety, theory of mind, verbal irony comprehension

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620 Neuroplasticity in Language Acquisition in English as Foreign Language Classrooms

Authors: Sabitha Rahim

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In the context of teaching vocabulary of English as Foreign Language (EFL), the confluence of memory and retention is one of the most significant factors in students' language acquisition. The progress of students engaged in foreign language acquisition is often stymied by vocabulary attrition, which leads to learners' lack of confidence and motivation. However, among other factors, little research has investigated the importance of neuroplasticity in Foreign Language acquisition and how underused neural pathways lead to the loss of plasticity, thereby affecting the learners’ vocabulary retention and motivation. This research explored the effect of enhancing vocabulary acquisition of EFL students in the Foundation Year at King Abdulaziz University through various methods and neuroplasticity exercises that reinforced their attention, motivation, and engagement. It analyzed the results to determine if stimulating the brain of EFL learners by various physical and mental activities led to the improvement in short and long term memory in vocabulary retention. The main data collection methods were student surveys, assessment records of teachers, student achievement test results, and students' follow-up interviews. A key implication of this research is for the institutions to consider having multiple varieties of student activities promoting brain plasticity within the classrooms as an effective tool for foreign language acquisition. Building awareness among the faculty and adapting the curriculum to include activities that promote brain plasticity ensures an enhanced learning environment and effective language acquisition in EFL classrooms.

Keywords: language acquisition, neural paths, neuroplasticity, vocabulary attrition

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619 Designing a Waitlist Intervention for Adult Patients Awaiting Outpatient Treatment for Eating Disorders: Preliminary Findings from a Pilot Test

Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

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In Canada, as prevalence rates and severity of illness have increased among patients suffering from eating disorders, wait times have grown substantially. Patients in Canada often face wait times in excess of 12 months. It is known that delaying treatment for eating disorders contributes to poor patient outcomes and higher rates of symptom relapse. Improving interim services for adult patients awaiting outpatient treatment is a priority for an outpatient eating disorders clinic in Ontario, Canada. The clinical setting currently provides care for adults diagnosed with anorexia nervosa, bulimia nervosa and binge eating disorder. At present, the only support provided while patients are on the waitlist consists of communication with primary care providers regarding parameters for medical monitoring. The significance of this study will be to test the feasibility, acceptability and efficacy of an intervention to support adult patients awaiting outpatient eating disorder treatment for anorexia nervosa, bulimia nervosa and binge eating disorder. Methods: An intervention including psychoeducation, supportive resources, self-monitoring, and auxiliary referral will be pilot-tested with a group of patients in the summer of 2022 and detailed using a prospective cohort case study research design. The team will host patient focus groups in May 2022 to gather input informing the content of the intervention. The intervention will be pilot tested with newly-referred patients in June and July 2022. Patients who participate in the intervention will be asked to complete a survey evaluating the utility of the intervention and for suggestions, they may have for improvement. Preliminary findings describing the existing literature pertaining to waitlist interventions for patients with eating disorders, data gathered from the focus groups and early pilot testing results will be presented. Data analysis will continue throughout 2022 and early 2023 for follow-up publication and presentation in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to providing interim support to those patients waiting for treatment for eating disorders and, by extension, to improve outcomes for this population.

Keywords: eating disorders, waitlist management, intervention study, pilot test

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618 Students’ Perceptions of Well-Being and School-Based Well-Being Programs and Interventions

Authors: Amanda Madden

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The purpose of this research was to identify students understanding of well-being and perceptions of the effective components of school-based well-being programs they have participated in during their time in secondary school. With one in four adolescents suffering from some form of mental health disorder, which has the potential to directly impact their academic ability, schools have moved towards a more holistic approach to education, resulting in the growth of school-based well-being programs. There is limited research on the effectiveness of school-based well-being programs, with fewer studies examining students’ perspectives on their well-being. A mixed-method design was utilized, framed by a social constructivist methodology. Quantitative data was collected through a researcher-developed self-report survey, and qualitative data were collected through one-on-one interviews and a semi-structured focus group undertaken with Year 12 students from three independent co-educational schools in Western Australia. Preliminary findings indicate that participants have experienced a minimal impact, either positively or negatively, on their well-being from school-based well-being programs. The data detailed that adolescents consider happiness, positive attitude, good physical health, balance, emotional fulfillment and confidence components of well-being. The findings also highlighted sports, positive family relationships, positive friendships, and pets positively enhanced well-being. This research suggests that researchers and educational leaders should consider students’ understanding of well-being in the development of school-based well-being assessments and interventions. Students are the recipients of school-based well-being programs and are best placed to inform what they will and will not respond to in the determination of appropriate well-being content.

Keywords: wellbeing, school based wellbeing, adolescents, wellbeing interventions

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617 Assessing the Gap between the Policies and Existing Living Conditions of Migrant Construction Workers: A Case Study of Vijayawada

Authors: Ayushi Mishra

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Migrant construction workers or construction labors are one of the majority of the working population in our urban and rural areas. Even after being the majority, their involvement in the upbringing of the economy is hardly ever documented or recognized. Non-permanent or migrant workers face loads of exploitations and susceptibilities than other informal sector workers in India which in turn has affected the productivity of the labors. The relation of their employment and migration and the links of these dynamics to their housing and other basic needs in the city are mostly unstated. Even the urban planning and housing policies do not make thoughtful provision for them, they forcing them to live in extremely wretched conditions. And even if the policies are made, it frequently happens that they are not implemented. As the issue is very much prevalent in today’s time in India with so many large-scale and labor extensive projects going on, this study focuses on the assessment of the gap between the existing government policies and the current scenario of the construction workers in ongoing projects of Vijayawada, Andhra Pradesh. A few of the policies for construction workers conditions a lot of things, out of which only a few are functional which makes this study to assess the reason behind the unorganized living condition and poor physical, the social and mental health of construction workers of Vijayawada. In present, the dignity of construction labors is compromised every day on construction sites, in terms of work and basic rights which leads to many other problems in future. So to work for the betterment of this community, knowledge on the differences is very much required and hence this study is a little effort to replenish the difference and compare the policies with the existing conditions of construction labors in Vijayawada.

Keywords: construction, labours, policy, productivity

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616 Breast Cancer as a Response to Distress in Women with or without a History of Precancerous Breast Disease

Authors: Viacheslav Sushko, Viktor Sushko

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Pre-cancerous breast diseases are pathological changes that precede the appearance of adenocarcinoma. The most common benign breast disease is mastopathy. We examined the life and disease history of 114 women aged 58-69 who were diagnosed with adenocarcinoma of the breast at different stages of development. They filled out the Reeder Scale to determine the level of stress. The results of the study revealed that 62 of them had mastopathy at the age of 30-45 years old. These women refused surgical treatment for mastopathy. Five to six years before their diagnosis of adenocarcinoma of the mammary gland, 84 women had experienced severe stress (death of a beloved close relative, torture accompanied by rape, prolonged stay in extreme conditions (under bombardment and bombardment). In the assessment of data from completed Reeder scales, 114 women had a high level of mental stress, with a score from 1-1.72. The 84 women who suffered from severe stress showed overeating or a significant decrease in food intake, insomnia, apathy, increased irritability and restlessness, loss of interest in sexual relationships, forgetfulness, difficulty in performing routine work, prolonged uncontrollable headaches, unexplained fatigue, heart pain, reduced capacity for work. In conclusion, it is important to provide psychotherapy for breast cancer patients as the diagnosis, and the different stages of treatment are very stressful. It is also advisable to see a psychiatrist at an early stage and prevent distress and treat precancerous breast disease.

Keywords: breast cancer, distress, mastopathy, severe stress

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615 Family Caregiver Transitions and Health in Old Age: A Longitudinal Perspective

Authors: Cecilia Fagerstrom, Solve Elmstahl, Lena S. Wranker

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The conditions of increased morbidity in an aging population cause the need for family care to become more common at an advanced age. The role of family caregivers may well last for a long time but may also change over time, from being caregivers to being non-caregivers or vice versa. Although demands associated with family caring change as individuals enter into, engage with, and exit from this role, the evidence regarding the impact of family caregiving transitions on the health of older carers is still limited. This study comprised individuals (n=2294, 60+years) from the southern part of Sweden included in the project Swedish National study of Aging and Care. Caregiving transitions are discussed in the categories: enter, exit, and continuing during a six-year period. Individuals who exited caregiving during the time were older than those who continued or entered into the role of caregiving. At the six-year follow-up, caregivers who were continuing or had exited caregiving were more often worried about their own health compared to baseline. Resembling findings were not found in those who entered caregiving. Family caregiving transitions of exiting, entering or continuing had no effect on the individuals’ functional, physical and mental health expect for participants who entered in caregiving. For them, entering the role of family caregiving was associated with an improvement in physical health during the six years follow up period. Conclusion: Although the health impact of different caregiving transitions in late life does not differ, individual conditions and health at baseline are important parameters to take into consideration to improve long-term health in family caregivers.

Keywords: family caregiving, health, old age, transition

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614 Mitigating the Negative Health Effects from Stress - A Social Network Analysis

Authors: Jennifer A. Kowalkowski

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Production agriculture (farming) is a physically, emotionally, and cognitively stressful occupation, where workers have little control over the stressors that impact both their work and their lives. In an occupation already rife with hazards, these occupational-related stressors have been shown to increase farm workers’ risks for illness, injury, disability, and death associated with their work. Despite efforts to mitigate the negative health effects from occupational-related stress (ORS) and to promote health and well-being (HWB) among farmers in the US, marked improvements have not been attained. Social support accessed through social networks has been shown to buffer against the negative health effects from stress, yet no studies have directly examined these relationships among farmers. The purpose of this study was to use social network analysis to explore the social networks of farm owner-operators and the social supports available to them for mitigating the negative health effects of ORS. A convenience sample of 71 farm owner-operators from a Midwestern County in the US completed and returned a mailed survey (55.5% response rate) that solicited information about their social networks related to ORS. Farmers reported an average of 2.4 individuals in their personal networks and higher levels of comfort discussing ORS with female network members. Farmers also identified few connections (3.4% density) and indicated low comfort with members of affiliation networks specific to ORS. Findings from this study highlighted that farmers accessed different social networks and resources for their personal HWB than for issues related to occupational(farm-related) health and safety. In addition, farmers’ social networks for personal HWB were smaller, with different relational characteristics than reported in studies of farmers’ social networks related to occupational health and safety. Collectively, these findings suggest that farmers conceptualize personal HWB differently than farm health and safety. Therefore, the same research approaches and targets that guide occupational health and safety research may not be appropriate for personal HWB for farmers. Interventions and programming targeting ORS and HWB have largely been offered through the same platforms or mechanisms as occupational health and safety programs. This may be attributed to the significant overlap between the farm as a family business and place of residence, or that ORS stems from farm-related issues. However, these assumptions translated to health research of farmers and farm families from the occupational health and safety literature have not been directly studied or challenged. Thismay explain why past interventions have not been effective at improving health outcomes for farmers and farm families. A close examination of findings from this study raises important questions for researchers who study agricultural health. Findings from this study have significant implications for future research agendas focused on addressing ORS, HWB, and health disparities for farmersand farm families.

Keywords: agricultural health, occupational-related stress, social networks, well-being

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613 Deficits in Perceptual and Musical Memory in Individuals with Major Depressive Disorder

Authors: Toledo-Fernandez Aldebaran

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Introduction: One of the least explored cognitive functions in relation with depression is the one related to musical stimuli. Music perception and memory can become impaired as well. The term amusia is used to define a type of agnosia caused by damage to basic processes that creates a general inability to perceive music. Therefore, the main objective is to explore performance-based and self-report deficits in music perception and memory on people with major depressive disorder (MDD). Method: Data was collected through April-October 2021 recruiting people who met the eligibility criteria and using the Montreal Battery of Evaluation of Amusia (MBEA) to evaluate performance-based music perception and memory, along with the module for depression of the Mini International Neuropsychiatric Interview, and the Amusic Dysfunction Inventory (ADI) which evaluates the participants’ self-report concerning their abilities in music perception. Results: 64 participants were evaluated. The main study, referring to analyzing the differences between people with MDD and the control group, only showed one statistical difference on the Interval subtest of the MBEA. No difference was found in the dimensions assessed by the ADI. Conclusion: Deficits in interval perception can be explained by mental fatigue, to which people with depression are more vulnerable, rather than by specific deficits in musical perception and memory associated with depressive disorder. Additionally, significant associations were found between musical deficits as observed by performance-based evidence and music dysfunction according to self-report, which could suggest that some people with depression are capable of detecting these deficits in themselves.

Keywords: depression, amusia, music, perception, memory

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612 Strategies to Promote Safety and Reduce the Vulnerability of Urban Worn-out Textures to the Potential Risk of Earthquake

Authors: Bahareh Montakhabi

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Earthquake is known as one of the deadliest natural disasters, with a high potential for damage to life and property. Some of Iran's cities were completely destroyed after major earthquakes, and the people of the region suffered a lot of mental, financial and psychological damage. Tehran is one of the cities located on the fault line. According to experts, the only city that could be severely damaged by a moderate earthquake in Earthquake Engineering Intensity Scale (EEIS) (70% destruction) is Tehran because Tehran is built precisely on the fault. Seismic risk assessment (SRA) of cities in the scale of urban areas and neighborhoods is the first phase of the earthquake crisis management process, which can provide the information required to make optimal use of available resources and facilities in order to reduce the destructive effects and consequences of an earthquake. This study has investigated strategies to promote safety and reduce the vulnerability of worn-out urban textures in the District 12 of Tehran to the potential risk of earthquake aimed at prioritizing the factors affecting the vulnerability of worn-out urban textures to earthquake crises and how to reduce them, using the analytical-exploratory method, analytical hierarchy process (AHP), Expert choice and SWOT technique. The results of SWAT and AHP analysis of the vulnerability of the worn-out textures of District 12 to internal threats (1.70) and external threats (2.40) indicate weak safety of the textures of District 12 regarding internal and external factors and a high possibility of damage.

Keywords: risk management, vulnerability, worn-out textures, earthquake

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611 Ensuring Compliancy in Traditional Tibetan Medicine Treatment Through Patient Education

Authors: Nashalla Gwyn Nyinda

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The ancient system of Tibetan Medicine, known as Sowa Rigpa across the Himalayan regions, is a systematic system of healing encouraging balance primarily through diet and behavior modifications. With the rise of the popularity of Tibetan Medicine, compliance is critical to successful treatment outcomes. As patients learn more about who they are as individuals and how their elemental balances or imbalances affect disorders and mental-emotional balance, they develop faith and dedication to their healing process. Specifically, regarding diet and behavior and the basic principles of the medical system, patient compliance increases dramatically in all treatment areas when they understand why a treatment or dietary prescription guidance is effective. Successful responses to Tibetan treatment rely on a buy-in from the patient. Trust between the slower process of Traditional medicine treatments, the Tibetan physician and the patient is a cornerstone of treatment. The resulting decrease in the use of allopathic medicine and better health outcomes for acute and chronic disorders are well documented. This paper addresses essential points of the Tibetan Medicine system, dialogue between doctor and patient focused on appropriate and seasonal changing dietetics. Such fluctuating treatment approaches, based on external elemental factors, dramatically increase treatment outcomes. Specifically, this work addresses why allopathic medicine models may need more trust development between practitioner and patient.

Keywords: compliancy in treatment, diet and lifestyle medicine, nature and elements as medicine, seasonal diets, Sowa Rigpa, traditional Tibetan medicine, treatment outcomes

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610 Effects of the Natural Compound on SARS-CoV-2 Spike Protein-Mediated Metabolic Alteration in THP-1 Cells Explored by the ¹H-NMR-Based Metabolomics Approach

Authors: Gyaltsen Dakpa, K. J. Senthil Kumar, Nai-Wen Tsao, Sheng-Yang Wang

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Context: Coronavirus disease 2019 (COVID-19) is a severe respiratory illness caused by the SARS-CoV-2 virus. One of the hallmarks of COVID-19 is a change in metabolism, which can lead to increased severity and mortality. The mechanism of SARS-CoV-2-mediated perturbations of metabolic pathways has yet to be fully understood. Research Aim: This study aimed to investigate the metabolic alteration caused by SARS-CoV-2 spike protein in Phorbol 12-myristate 13-acetate (PMA)-induced human monocytes (THP-1) and to examine the regulatory effect of natural compounds like Antcins A on SARS-CoV-2 spike protein-induced metabolic alteration. Methodology: The study used a combination of proton nuclear magnetic resonance (1H-NMR) and MetaboAnalyst 5.0 software. THP-1 cells were treated with SARS-CoV-2 spike protein or control, and the metabolomic profiles of the cells were compared. Antcin A was also added to the cells to assess its regulatory effect on SARS-CoV-2 spike protein-induced metabolic alteration. Findings: The study results showed that treatment with SARS-CoV-2 spike protein significantly altered the metabolomic profiles of THP-1 cells. Eight metabolites, including glycerol-phosphocholine, glycine, canadine, sarcosine, phosphoenolpyruvic acid, glutamine, glutamate, and N, N-dimethylglycine, were significantly different between control and spike-protein treatment groups. Antcin A significantly reversed the changes in these metabolites. In addition, treatment with antacid A significantly inhibited SARS-CoV-2 spike protein-mediated up-regulation of TLR-4 and ACE2 receptors. Theoretical Importance The findings of this study suggest that SARS-CoV-2 spike protein can cause significant metabolic alterations in THP-1 cells. Antcin A, a natural compound, has the potential to reverse these metabolic alterations and may be a potential candidate for developing preventive or therapeutic agents for COVID-19. Data Collection: The data for this study was collected from THP-1 cells that were treated with SARS-CoV-2 spike protein or a control. The metabolomic profiles of the cells were then compared using 1H-NMR and MetaboAnalyst 5.0 software. Analysis Procedures: The metabolomic profiles of the THP-1 cells were analyzed using 1H-NMR and MetaboAnalyst 5.0 software. The software was used to identify and quantify the cells' metabolites and compare the control and spike-protein treatment groups. Questions Addressed: The question addressed by this study was whether SARS-CoV-2 spike protein could cause metabolic alterations in THP-1 cells and whether Antcin A can reverse these alterations. Conclusion: The findings of this study suggest that SARS-CoV-2 spike protein can cause significant metabolic alterations in THP-1 cells. Antcin A, a natural compound, has the potential to reverse these metabolic alterations and may be a potential candidate for developing preventive or therapeutic agents for COVID-19.

Keywords: SARS-CoV-2-spike, ¹H-NMR, metabolomics, antcin-A, taiwanofungus camphoratus

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609 Older Adult Grandparents' Voices as a Principle Care Giver in a Skipped-Generation Family

Authors: Kerdsiri Hongthai, Darunee Jongudomkarn, Rutja Phuphaibul

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In Thailand, many adults in rural areas migrate to seek employ¬ment resulting in skipped-generation family where grandparents care for grandchildren with no other adults present. This is a preliminary study using qualitative case study methods, aimed to explore the situations of older adult grandparents' experiences in skipped-generation family in North-East of Thailand. Data were collected by in-depth inter¬views with 6 grandparents living in skipped-generation families; 5 females and 1 males grandparents, aged 62-75, some of them have diabetes mellitus, hypertension, during November to December, 2017. The finding themes are: ‘Caught up in the middle’: the older adults were pleased to have grandchildren but, at the same time, acknowledge the burden that this placed on them, especially when the migrant children failed to send enough money back to support the family. ‘Getting bad health’: they reported to be fatigued and stressed due to burden of caring for their grandchildren without support. This situation can aggravate problems of poor health status and be worsening economic status of the grandparents. In some cases of deprivation, the grandparents feel that having to be the sole care providers of their grandchildren can negative adversely affect their mental status. It is important to find out in other sectors similar to Thailand and lead to more in-depth research to answer the research questions about policy and social support in skipped-generation family in the future.

Keywords: older adult grandparents, experiences, principle care giver, skipped-generation family

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608 Water and Beverage Consumption among Children and Adolescents in Tehran Metropolitan City of Iran

Authors: Mitra Abtahi, Esmat Nasseri, Morteza Abodllahi

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Introduction: Adequate hydration is necessary for proper physical and mental function. The aim of this study is to determine the consumption of water and all other beverages in children (8-13 years) and adolescents (14-17 years) in Tehran metropolitan city of Iran. Materials and Methods: In this cross-sectional study, 455 children (8-13 years) and 334 adolescents (14-17 years) were retrieved from north, center, and south of Tehran (18 schools). Instrument for data collection consisted of a “demographic and general health” questionnaire and a “7-day fluid record”. Data analyses were performed with SPSS 16 software. Results: The mean total consumption of fluids in school children was 1302 ± 500.6 ml/day. The highest mean intakes were observed for water (666 ± 398 ml/day), followed by milk (239 ± 183 ml/day), regular soft beverages (RSB) (188 ± 148 ml/day), and juices (60 ± 74 ml/day). Water, hot drinks (mainly tea) and soft drinks intake was significantly more in boys than girls. A significantly lower intake of milk and a higher intake of RSB and hot beverages (mainly tea) have been seen among adolescents compared to children. Conclusion: The most important finding is that mean fluid intake of children and adolescents does not meet international adequate intake references for water and fluids. This finding may suggest the necessity of development of the local references. To improve fluid intake habits of children and adolescents, relevant policy making and actions are warranted.

Keywords: adolescents, beverages, children, water

Procedia PDF Downloads 174
607 Effect of a Mindfulness Application on Graduate Nursing Student’s Stress and Anxiety

Authors: Susan K. Steele-Moses, Aimee Badeaux

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Background Literature: Nurse anesthesia education placed high demands on students both personally and professionally. High levels of anxiety affect student’s mental, emotional, and physical well-being, which impacts their student success. Whereas more research has focused on the health and well-being of graduate students, far less has focused specifically on nurse anesthesia students (SNRAs), who may experience higher levels of anxiety due to the rigor of their academic program. Current literature describes stressors experienced by SRNAs that cause anxiety and affect their performance, including personal, academic, clinical, interpersonal, emotional, and financial. Sample: DNP-NA 2025 and DNP-NA 2024 cohorts (N = 36). Eighteen (66.7%) students participated in the study. Instrumentation: The DASS-21 was used to measure stress (7 items; α = .87) and anxiety (7 items; α = .74) from the participants. Intervention: The mind-shift meditation app, based on cognitive behavioral therapy, is being used daily before clinical and exams to decrease nurse anesthesia students’ stress and anxiety over time. Results: At baseline, the students exhibited a moderate level of stress, but their anxiety levels were low. The range of scores was 4-21 (out of 28) for stress (M = 12.88; SD = 5.40) and 0-16 (out of 28) for anxiety (M = 6.81; SD = 5.04). Both stress and anxiety were normally distributed [SW = .242 (stress); SW = .210 (anxiety)] without any outliers. There was a significant difference between their stress and anxiety levels (t = 5.55; p < .001) at baseline. Stress and anxiety will be measured over time, with the change analyzed using repeated measures ANOVA. Implications for Practice: The use of purposeful mindfulness meditation has been shown to decrease stress and anxiety in nursing students.

Keywords: mindfulness, meditation, graduate nursing education, nursing education

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606 Harmful Algal Poisoning Symptoms in Coastal Areas of Nigeria

Authors: Medina Kadiri

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Nigeria has an extensive coastline of 853 km long between latitude 4°10′ to 6°20′ N and longitude 2°45′ to 8°35′ E and situated in the Gulf of Guinea within the Guinea Current Large Marine Ecosystem. There is a substantial coastal community relying on this region for their livelihood of fishing, aquaculture, mariculture for various sea foods either for consumption or economic sustenance or both. Socio-economic study was conducted, using questionnaires and interview, to investigate the health symptoms of harmful algae experienced by these communities on consumption of sea foods. Eighteen symptoms were recorded. Of the respondents who experienced symptoms after consumption of sea foods, overall, more people (33.5%) experienced vomiting as a symptom, followed by nausea (14.03%) and then diarrhea (13.57%). Others were headache (9.95%), mouth tingling (8.6%) and tiredness (7.24%).The least were muscle pain, rashes, confusion, chills, burning sensation, breathing difficulty and balance difficulty which represented 0.45% each and the rest (dizziness, digestive tract tumors, itching, memory loss, & stomach pain) were less than 3% each. In terms of frequency, the most frequent symptom was diarrhea with 87.5% occurrence, closely followed by vomiting with 81.3%. Tiredness was 75% while nausea was 62.5% and headache 50%. Others such as dizziness, itching, memory loss, mouth tingling and stomach pain had about 40% occurrence or less. The least occurring symptoms were muscle pain, rashes, confusion, chills and balance difficulty and burning sensation occurring only once i.e 6.3%. Breathing difficulty was last but one with 12.5%. Visible symptom from seafood and the particular seafood consumed that prompted the visible symptoms, shows that 3.5% of the entire respondents who ate crab experienced various symptoms ranging from vomiting (2.4%), itching (0.5%) and headache (0.4%). For periwinkle, vomiting had 1.7%, while 1.2% represented diarrhea and nausea symptom comprised 0.8% of all the respondents who ate periwinkle. Some respondents who consumed fish shows that 0.4% of the respondents had Itching. From the respondents who preferred to consume shrimps/crayfish and crab, shrimps/crayfish, crab and periwinkle, the most common illness was tiredness (1.2%), while 0.5% had experienced diarrhea and many others. However, for most respondents who claimed to have no preference for any seafood, with 55.7% affirming this with vomiting being the highest (6.1%), followed closely by mouth tingling/ burning sensation (5.8%). Examining the seasonal influence on visible symptoms revealed that vomiting occurred more in the month of January with 5.5%, while headache and itching were predominant in October with (2.8%). Nausea has 3.1% in January than any season of the year, 2.6% of the entire respondents opined to have experience diarrhea in October than in any other season of the year. Regular evaluation of harmful algal poisoning symptoms is recommended for coastal communities.

Keywords: coastal, harmful algae, human poisoning symptoms, Nigeria, phycotoxins

Procedia PDF Downloads 286
605 Heat: A Healthy Eating Programme

Authors: Osagbai Joshua Eriki, Ngozi Agunwamba, Alice Hill, Lorna Almond, Maniya Duffy, Devashini Naidoo, David Ho, Raman Deo

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Aims: To evaluate the baseline eating pattern in a psychiatric hospital through quantifying purchases of food and drink items at the hospital shop and to implement a traffic light healthy eating labeling system. Method: A electronic till with reporting capabilities was purchased. A two-week period of baseline data collection was conducted. Thereafter, a system for labeling items based on the nutritional value of the food items at the hospital shop was implemented. Green labeling represented the items with the lowest calories and red the most. Further data was collated on the number and types of items purchased by patients according to the category, and the initial effectiveness of the system was evaluated. Result: Despite the implementation of the traffic light system, the red category had the highest number of items purchased by patients, highlighting the importance of promoting healthy eating choices. However, the study also showed that the system was effective in promoting healthy options, as the number of items purchased from the green category increased during the study period. Conclusion: The implementation of a traffic light labeling system for items sold at the hospital shop offers a promising approach to promoting healthy eating habits and choices. This is likely to contribute to a toolkit of measures when considering the multifactorial challenges that obesity and weight issues pose for long-stay psychiatric inpatients

Keywords: mental health, nutrition, food, healthy

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604 Effects of Screen Time on Children from a Systems Engineering Perspective

Authors: Misagh Faezipour

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This paper explores the effects of screen time on children from a systems engineering perspective. We reviewed literature from several related works on the effects of screen time on children to explore all factors and interrelationships that would impact children that are subjected to using long screen times. Factors such as kids' age, parent attitudes, parent screen time influence, amount of time kids spend with technology, psychosocial and physical health outcomes, reduced mental imagery, problem-solving and adaptive thinking skills, obesity, unhealthy diet, depressive symptoms, health problems, disruption in sleep behavior, decrease in physical activities, problematic relationship with mothers, language, social, emotional delays, are examples of some factors that could be either a cause or effect of screen time. A systems engineering perspective is used to explore all the factors and factor relationships that were discovered through literature. A causal model is used to illustrate a graphical representation of these factors and their relationships. Through the causal model, the factors with the highest impacts can be realized. Future work would be to develop a system dynamics model to view the dynamic behavior of the relationships and observe the impact of changes in different factors in the model. The different changes on the input of the model, such as a healthier diet or obesity rate, would depict the effect of the screen time in the model and portray the effect on the children’s health and other factors that are important, which also works as a decision support tool.

Keywords: children, causal model, screen time, systems engineering, system dynamics

Procedia PDF Downloads 144