Search results for: post hoc explainer
4048 Deep Brain Stimulation and Motor Cortex Stimulation for Post-Stroke Pain: A Systematic Review and Meta-Analysis
Authors: Siddarth Kannan
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Objectives: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are innovative interventions in order to treat various neuropathic pain disorders such as post-stroke pain. While each treatment has a varying degree of success in managing pain, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised. The aim of this study was to compare the effect of pain relief offered by MCS and DBS on patients with post-stroke pain and to assess if either of these procedures offered better results. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to June 2023 were included (last search date 25 June 2023). Meta-analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using the Visual Analogue Scale (VAS). Data analysis of descriptive statistics was performed using SPSS (Version 27; IBM; Armonk; NY; USA). R statistics (Rstudio Version 4.0.1) was used to perform meta-analysis. Results: Of the 478 articles identified, 27 were included in the analysis (232 patients- 117 DBS & 115 MCS). The pooled number of patients who improved after DBS was 0.68 (95% CI, 0.57-0.77, I2=36%). The pooled number of patients who improved after MCS was 0.72 (95% CI, 0.62-0.80, I2=59%). Further sensitivity analysis was done to include only studies with a minimum of 5 patients in order to assess if there was any impact on the overall results. Nine studies each for DBS and MCS met these criteria. There seemed to be no significant difference in results. Conclusions: The use of surgical interventions such as DBS and MCS is an upcoming field for the treatment of post-stroke pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done in order to determine the appropriate surgical intervention for post-stroke pain.Keywords: post-stroke pain, deep brain stimulation, motor cortex stimulation, pain relief
Procedia PDF Downloads 1284047 Research Methodology and Mixed Methods (Qualitative and Quantitative) for Ph.D. Construction Management – Post-Disaster Reconstruction
Authors: Samuel Quashie
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Ph.D. Construction Management methodology and mixed methods are organized to guide the researcher to assemble and assess data in the research activities. Construction management research is close to business management and social science research. It also contributes to researching the phenomenon and answering the research question, generating an integrated management system for post-disaster reconstruction in construction and related industries. Research methodology and methods drive the research to achieve the goal or goals, contribute to knowledge, or increase knowledge. This statement means the research methodology, mixed methods, aim, objectives, and processes address the research question, facilitate its achievement and foundation to conduct the study. Mixed methods use project-based case studies, interviews, observations, literature and archival document reviews, research questionnaires, and surveys, and evaluation of integrated systems used in the construction industry and related industries to address the research work. The research mixed methods (qualitative, quantitative) define the research topic and establish a more in-depth study. The research methodology is action research, which involves the collaboration of participants and service users to collect and evaluate data, studying the phenomenon, research question(s) to improve the situation in post-disaster reconstruction phase management.Keywords: methodology, Ph.D. research, post-disaster reconstruction, mixed-methods qualitative and quantitative
Procedia PDF Downloads 2234046 Portrayal of Pak-US Relations in Perspective of Bin Laden Killing by the Leading American and British Newspapers: A Content Analysis of the Guardian, the Telegraph, Washington Post and the New York Times
Authors: Shahzad Ali
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This article expounds the coverage of Pak-US relations in the context of Osama Bin Laden killing in four selected leading newspapers of UK and the US viz The Telegraph, The Guardian, The New York Times and The Washington Post during the specific time period of three months, i.e., April-June, 2011. The study is scrutinized on the basis of Operation Neptune Spear. The research study is theoretically linked with the propaganda model of Herman and Chomsky and the Shoemaker and Reeve‘s theory of content effect, specifically the impact of foreign policy as a driving instrument influencing the nature and treatment of the coverage of Pak-US relations. The relations between Pakistan and USA are of great importance in the context of Bin Laden. The Pak-US relations were less aggravated and hostile in pre OBL period but post OBL period worsened these relations. It is also interesting to mention that the policies of these newspapers were dependent on the foreign policy of their countries. It was explored that the news coverage was found favorable as and when the relations Pakistan and the US or UK were cordial and smooth. And it turned into negative and unfavorable when the relations were in strain and deteriorating and endorsed various studies that the Western mainstream media tried to be more nationalistic in projecting official stance while covering foreign coverage instead of adhering to universal cannon of journalism, i.e., objectivity, fairness, and neutrality, etc. Overall 219 news items of these four selected newspapers regarding Pak-US relations in the context of pre and post OBL’s killing operation were undertaken for analysis. The ratio of negative slants was found higher as compared to the positive and neutral slants. Besides, the ratio of news items with unfavorable frames was found higher in post OBL operation in comparison of pre-era of the coverage related to Pak-US relations in the leading British and American newspapers.Keywords: Osama Bin Laden, Pakistan, USA, UK, relations, Guardian, Washington Post, Telegraph, New York Times, Operation Neptune Spear
Procedia PDF Downloads 1644045 Expand Rabies Post-Exposure Prophylaxis to Where It Is Needed the Most
Authors: Henry Wilde, Thiravat Hemachudha
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Human rabies deaths are underreported worldwide at 55,000 annual cases; more than of dengue and Japanese encephalitis. Almost half are children. A recent study from the Philippines of nearly 2,000 rabies deaths revealed that none of had received incomplete or no post exposure prophylaxis. Coming from a canine rabies endemic country, this is not unique. There are two major barriers to reducing human rabies deaths: 1) the large number of unvaccinated dogs and 2) post-exposure prophylaxis (PEP) that is not available, incomplete, not affordable, or not within reach for bite victims travel means. Only the first barrier, inadequate vaccination of dogs, is now being seriously addressed. It is also often not done effectively or sustainably. Rabies PEP has evolved as a complex, prolonged process, usually delegated to centers in larger cities. It is virtually unavailable in villages or small communities where most dog bites occur, victims are poor and usually unable to travel a long distance multiple times to receive PEP. Reseacrh that led to better understanding of the pathophysiology of rabies and immune responses to potent vaccines and immunoglobulin have allowed shortening and making PEP more evidence based. This knowledge needs to be adopted and applied so that PEP can be rendered safely and affordably where needed the most: by village health care workers who have long performed more complex services after appropriate training. Recent research makes this an important and long neglected goal that is now within our means to implement.Keywords: rabies, post-exposure prophylaxis, availability, immunoglobulin
Procedia PDF Downloads 2584044 A Pilot Study to Investigate the Use of Machine Translation Post-Editing Training for Foreign Language Learning
Authors: Hong Zhang
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The main purpose of this study is to show that machine translation (MT) post-editing (PE) training can help our Chinese students learn Spanish as a second language. Our hypothesis is that they might make better use of it by learning PE skills specific for foreign language learning. We have developed PE training materials based on the data collected in a previous study. Training material included the special error types of the output of MT and the error types that our Chinese students studying Spanish could not detect in the experiment last year. This year we performed a pilot study in order to evaluate the PE training materials effectiveness and to what extent PE training helps Chinese students who study the Spanish language. We used screen recording to record these moments and made note of every action done by the students. Participants were speakers of Chinese with intermediate knowledge of Spanish. They were divided into two groups: Group A performed PE training and Group B did not. We prepared a Chinese text for both groups, and participants translated it by themselves (human translation), and then used Google Translate to translate the text and asked them to post-edit the raw MT output. Comparing the results of PE test, Group A could identify and correct the errors faster than Group B students, Group A did especially better in omission, word order, part of speech, terminology, mistranslation, official names, and formal register. From the results of this study, we can see that PE training can help Chinese students learn Spanish as a second language. In the future, we could focus on the students’ struggles during their Spanish studies and complete the PE training materials to teach Chinese students learning Spanish with machine translation.Keywords: machine translation, post-editing, post-editing training, Chinese, Spanish, foreign language learning
Procedia PDF Downloads 1404043 COVID-19 Pandemic and Disruptions in Nigeria’s Domestic Economic Activities: A Pre-post Empirical Investigation
Authors: Amaefule, Leonard Ifeanyi
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The study evaluated the disruptions in Nigeria’s domestic economic activities occasioned by the COVID-19 pandemic: a pre and post-pandemic investigation approach. Domestic economic activities were measured with composite manufacturing purchasing managers index (PMI) and composite non-manufacturing PMI. Production and employment levels indices were proxies for composite manufacturing PMI, while business activities and employment level indices were proxies for non-manufacturing PMI. Data for these indices were sourced from monthly and quarterly publications of the Central Bank of Nigeria for periods covering fifteen (15) months before and 15 months after the outbreak of the virus in Nigeria. Test of equality of means was employed in establishing the significance of the difference of means between the pre and post-pandemic domestic economic activities. Results from the analysis indicated that a significant negative difference exists in each of the measures of domestic economic activities between the pre and post-pandemic periods. These findings, therefore, offer empirical evidence that the COVID-19 pandemic has disrupted domestic economic activities in Nigeria; thus, it exerts a negative influence on the measures of the nation’s domestic economic activities. The study thus recommended (among other things) that the Nigerian government should focus on policies that would enhance domestic production, employment and enhance business activities.Keywords: COVID-19, domestic economic activities, composite manufacturing indices, composite non-manufacturing indices
Procedia PDF Downloads 1664042 Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on Health-Related Quality of Life among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial
Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell
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Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI
Procedia PDF Downloads 1604041 Impact of an Exercise Program on Physical Fitness of a Candidate to Naval Academy: A Case Study
Authors: Ricardo Chaves, Carlos Vasconcelos
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Candidates to join the Naval Academy have to take a set of physical tests, which is crucial for a high level of physical fitness. Thus, the planning of physical exercises for candidates to the Naval School must take into account the improvement of their physical fitness. The aim of this study was to investigate the impact of a 6-month exercise program to improve the physical fitness of an individual who will apply for the Naval Academy. This was a non-experimental pre-post-evaluation study. The patient was male, had 18 years old, and a body mass index of 21.1 kg.m². The patient participated in a 6-month aerobic and strength exercise program (3 sessions per week, 75 minutes duration each session). Physical fitness tests were performed according to the physical fitness requirements for entry into the Naval academy (muscle strength [maximum number of lifts and maximum number of sit-ups for 1 minute]; aerobic fitness [2.4 km run and 200 m swimming test]) before (baseline) and after the exercise intervention (6 months). Regarding muscle strength, in the abdominal test, the improvements between the pre-test (39 abdominals.) and post-test (61 abdominals) were 56.4%. For elevations, there was an increase in its number by 150% between the pre-test (4 elevations) and post-test (10 elevations). With regard to aerobic fitness, in the 2.4 km race, there was an evolution of 32.0% between the pre-test (16.46 min.) and the post-test (12.42 min.). For the 200-meter swimming test, there was a negative variation of 2% between the pre-test (2.25 min.) and post-test (2.28 min). A 6-month aerobic and strength exercise program leads to a positive evolution in the muscular strength of the patient. Regarding aerobic fitness, opposite results were found, with a positive evolution in the 2.4 km running test and a negative evolution in the swimming test. In future exercise programs for the improvement of the physical fitness of candidates for the Naval Academy, more emphasis has to be done on specific swimming training.Keywords: case study, exercise program, Naval Academy, physical fitness
Procedia PDF Downloads 854040 Predictors and 3-Year Outcomes of Compromised Left Circumflex Coronary Artery After Left Main Crossover Stenting
Authors: Hameed Ullah, Karim Elakabawi, Han KE, Najeeb Ullah, Habib Ullah, Sardar Ali Shah, Hamad Haider Khan, Muhammad Asad Khan, Ning Guo, Zuyi Yuan
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Background: Predictors of decreased fractional flow reserve at left circumflex coronary artery after left main (LM) crossover stenting are still lacking. The objectives of the present study were to provide the predictors for low Fractional flow reserve (FFR) at coronary artery (LCx) and the possible treatment strategies for the compromised LCx-together with their long term outcomes. Methods: A total of 563 included patients out of 1974 patients admitted to our hospital from February 2015 to November 2020 with significant distal LM-bifurcation lesions. The enrolled patients underwent single-stent cross-over PCI under IVUS guidance with further LCx intervention as indicated by measured FFR. Results: The included patients showed angiographic significant LCx ostial affection after LM-stenting, but only 116 (20.6%) patients had FFR <0.8. The 3-year composite MACE rates were comparable between the high and low FFR groups (16.8% vs. 15.5%, respectively; P=0.744). In a multivariable analysis, a low FFR in the LCx was associated with post-stenting MLA of the LCx (OR: 0.032, P <0.001), post-stenting LCx-plaque burden (OR: 1.166, P <0.001), post-stenting LM-MLA (OR: 0.821, P =0.038) and pre-stenting LCx-MLA (OR: 0.371, P =0.044). In patients with low FFR, management of compromised LCx with DEB had the lowest 3-year MACE rate (8.1%) as compared to either KBI (17.5%) or stenting group (20.5%), P =0.299. Conclusion: FFR-guided LCx intervention can avoid unnecessary LCx intervention. The post-stenting predictors of low FFR include post-stenting MLA and plaque burden of the LCx and MV stent length. The 3-year MACE rates were comparable between high FFR patients and patients who had low FFR and were adequately managed.Keywords: fractional flow reserve, left main stem, percutaneous coronary interventions, intravascular ultrasound
Procedia PDF Downloads 324039 Students’ Post COVID-19 Experiences with E-Learning Platforms among Undergraduate Students of Public Universities in the Ashanti Region, Ghana
Authors: Michael Oppong, Stephanie Owusu Ansah, Daniel Ofori
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The study investigated students’ post-covid-19 experiences with e-learning platforms among undergraduate students of public universities in the Ashanti region of Ghana. The study respectively drew 289 respondents from two public universities, i.e., Kwame Nkrumah University of Science and Technology (KNUST) Business School and the Kumasi Technical University (KsTU) Business School in Ghana. Given that the population from the two public universities was fairly high, sampling had to be done. The overall population of the study was 480 students randomly sampled from the two public universities using the sampling ratio given by Alreck and Settle (2004). The population constituted 360 students from the Kwame Nkrumah University of Science and Technology (KNUST) Business School and 120 from the Kumasi Technical University Business School (KsTU). The study employed questionnaires as a data collection tool. The data gathered were 289 responses out of 480 questionnaires administered, representing 60.2%. The data was analyzed using pie charts, bar charts, percentages, and line graphs. Findings revealed that the e-learning platforms were still useful. However, the students used it on a weekly basis post-COVID-19, unlike in the COVID-19 era, where it was used daily. All other academic activities, with the exception of examinations, are still undertaken on the e-learning platforms; however, it is underutilized in the post-COVID-19 experience. The study recommends that universities should invest in infrastructure development to enable all academic activities, most especially examinations, to be undertaken using the e-learning platforms to curtail future challenges.Keywords: e-learning platform, undergraduate students, post-COVID-19 experience, public universities
Procedia PDF Downloads 904038 The Impact of Nutrition Education Intervention in Improving the Nutritional Status of Sickle Cell Patients
Authors: Lindy Adoma Dampare, Marina Aferiba Tandoh
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Sickle cell disease (SCD) is an inherited blood disorder that mostly affects individuals in sub-Saharan Africa. Nutritional deficiencies have been well established in SCD patients. In Ghana, studies have revealed the prevalence of malnutrition, especially amongst children with SCD and hence the need to develop an evidence-based comprehensive nutritional therapy for SCD to improve their nutritional status. The aim of the study was to develop and assess the effect of a nutrition education material on the nutritional status of SCD patients in Ghana. This was a pre-post interventional study. Patients between the ages of 2 to 60 years were recruited from the Tema General Hospital. Following a baseline nutrition knowledge (NK), beliefs, sanitary practice and dietary consumption pattern assessment, a twice-monthly nutrition education was carried out for 3 months, followed by a post-intervention assessment. Nutritional status of SCD patients was assessed using a 3-days dietary recall and anthropometric measurements. Nutrition education (NE) was given to SCD adults and caregivers of SCD children. Majority of the caregivers (69%) and SCD adult (82%) at baseline had low NK. The level of NK improved significantly in SCD adults (4.18±1.83 vs. 10.00±1.00, p<0.001) and caregivers (5.58 ± 2.25 vs.10.44± 0.846, p<0.001) after NE. Increase in NK improved dietary intake and dietary consumption pattern of SCD patients. Significant increase in weight (23.2±11.6 vs. 25.9±12.1, p=0.036) and height (118.5±21.9 vs. 123.5±22.2, p=0.011) was observed in SCD children at post intervention. Stunting (10.5% vs. 8.6%, p=0.62) and wasting (22.1% vs. 14.4%, p=0.30) reduced in SCD children after NE although not statistically significant. Reduction (18.2% vs. 9.1%) in underweight and an increase (18.2% vs. 27.3%) in overweight SCD adults was recorded at post intervention. Fat mass remained the same while high muscle mass increased (18.2% vs. 27.3%) at post intervention in SCD adult. Anaemic status of SCD patients improved at post intervention and the improvement was statistically significant amongst SCD children. Nutrition education improved the NK of SCD caregivers and adults hence, improving the dietary consumption pattern and nutrient intake of SCD patients. Overall, NE improved the nutritional status of SCD patients. This study shows the potential of nutrition education in improving the nutritional knowledge, dietary consumption pattern, dietary intake and nutritional status of SCD patients, and should be further explored.Keywords: sickle cell disease, nutrition education, dietary intake, nutritional status
Procedia PDF Downloads 934037 Comparing the Efficacy of Quantitative Electroencephalogram-Based Neurofeedback Therapy Program versus Organizational Skills Training Program to Reduce the Core Symptoms among Children Group of ADHD
Authors: Radwa R. El-Saadany , Medhat Abu Zeid, Tarek Omar, Marwa S. Maqsoud
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Attention deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders characterized by attention deficit, hyperactivity, and impulsivity. Neurofeedback (NF) is one of the neurotherapy treatments that cause brain wave changes. Method: The current pseudo-experimental study with a pre–post-test design was conducted on a population of children with attention deficit hyperactivity disorder (ADHD).The sample size comprised of (30) children selected by random sampling method and assigned to two therapeutic groups: First therapeutic group received a neurofeedback program. Based on QEEG, it reached (10) children. The second therapeutic group received an organization skills training program, it reached (10) and the control group that did not receive programs, it reached (10) children. Results: There are significant differences between pre- and post-assessments among therapeutic groups in reducing the three core symptoms of ADHD in favor of post measurement. There are no significant differences between post-assessment and follow up measurement of the therapeutic groups.Keywords: QEEG-based neurofeedback therapy program, organizational skills training program, attention deficit hyperactivity disorder
Procedia PDF Downloads 694036 Cephalometric Changes of Patient with Class II Division 1 [Malocclusion] Post Orthodontic Treatment with Growth Stimulation: A Case Report
Authors: Pricillia Priska Sianita
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An aesthetic facial profile is one of the goals in Orthodontics treatment. However, this is not easily achieved, especially in patients with Class II Division 1 malocclusion who have the clinical characteristics of convex profile and significant skeletal discrepancy due to mandibular growth deficiency. Malocclusion with skeletal problems require proper treatment timing for growth stimulation, and it must be done in early age and in need of good cooperation from the patient. If this is not done and the patient has passed the growth period, the ideal treatment is orthognathic surgery which is more complicated and more painful. The growth stimulation of skeletal malocclusion requires a careful cephalometric evaluation ranging from diagnosis to determine the parts that require stimulation to post-treatment evaluation to see the success achieved through changes in the measurement of the skeletal parameters shown in the cephalometric analysis. This case report aims to describe skeletal changes cephalometrically that were achieved through orthodontic treatment in growing period. Material and method: Lateral Cephalograms, pre-treatment, and post-treatment of cases of Class II Division 1 malocclusion is selected from a collection of cephalometric radiographic in a private clinic. The Cephalogram is then traced and measured for the skeletal parameters. The result is noted as skeletal condition data of pre-treatment and post-treatment. Furthermore, superimposition is done to see the changes achieved. The results show that growth stimulation through orthodontic treatment can solve the skeletal problem of Class II Division 1 malocclusion and the skeletal changes that occur can be verified through cephalometric analysis. The skeletal changes have an impact on the improvement of patient's facial profile. To sum up, the treatment timing on a skeletal malocclusion is very important to obtain satisfactory results for the improvement of the aesthetic facial profile, and skeletal changes can be verified through cephalometric evaluation of pre- and post-treatment.Keywords: cephalometric evaluation, class II division 1 malocclusion, growth stimulation, skeletal changes, skeletal problems
Procedia PDF Downloads 2454035 A Comparative Study of the Effectiveness of Narrative Therapy in Individual and Group Counseling on Promoting Hope in With Breast Cancer’s Women
Authors: Sajadian Akram, Tavasoli F.
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Breast cancer is the second most common cancer in the world and certainly the most frequent cancer mostly among women. This study was aimed to compare the effectiveness of individual counseling and group narrative therapy on female patients' life expectancy afflicted by breast cancer. The present study is a pre-test-post-test clinical trial. Fifty-five patients with breast cancer were randomly selected in the follow-up period and after their active medical treatment completion. Then, they were randomly divided into two groups: individual counseling and group counseling. Herth hope index (HHI) was used to measure the patients' hope level. Data were analyzed using t-test and SPSS software. hope rate was statistically significant in both groups receiving individual and group narrative therapy in the post-test compared to the pre-test (P <00000). Moreover, the comparative evaluation of hope in both groups (individual & group counseling) in the post-test showed that group narrative counseling is more effective than individual narrative counseling (P <00000). Conclusion: Narrative therapy promotes hope in breast cancer patients effectively. Due to the nature of breast cancer and its psychological effects in the post-treatment period, providing narrative group therapy can improve life quality. Patients' life quality changes in tandem with changes in hope.Keywords: hope, narrative therapy, counseling, breast cancer
Procedia PDF Downloads 1164034 Effects of Hypolipidemic Agents in Aminoglycoside-Induced Experimental Nephrotoxicity in Rats: Biochemical and Histopathological Evidence
Authors: Balakumar Pitchai, Xiang Llan Ang, Sunil Prajapati, Varatharajan Rajavel, Sundram Karupiah, Mohd Baidi Bahari
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The study examined the pretreatment and post-treatment effects of low-doses of fenofibrate and rosuvastatin in gentamicin-induced acute nephrotoxicity in rats. Gentamicin (100 mg/kg/day, i.p.) was administered to rats for 8 days. In the pretreatment protocol, low-dose fenofibrate (30 mg/kg/day, p.o.) or low-dose rosuvastatin (2 mg/kg/day, p.o.) treatments were started a day before the administration of gentamicin and continued for 8 days. In the post-treatment protocol, rats administered gentamicin were treated with low-dose fenofibrate (30 mg/kg/day, p.o.) or low-dose rosuvastatin (2 mg/kg/day, p.o.) for 6 days after the completion of 8 days protocol of gentamicin administration. Gentamicin-associated acute nephrotoxicity in rats was assessed in terms of biochemical analysis and renal histopathological studies. Gentamicin-administered rats showed marked renal functional changes as assessed in terms of a significant increase in serum creatinine and urea levels as compared to normal rats. The renal dysfunction noted in gentamicin administered rats was accompanied with elevated serum uric acid level as compared to normal rats while there was no significant change in lipid profile. Low-dose fenofibrate pretreatment in gentamicin-administered rats afforded a significant renal functional improvements and renoprotection while its post-treatment showed no significant renoprotection. On the other hand, pretreatment with low-dose rosuvastatin partially reduced gentamicin-induced increase in serum creatinine level, but its post-treatment did not afford renal functional improvements in gentamicin-administered rats. However, all pre and post-treatments with low-doses of fenofibrate or rosuvastatin significantly reduced the elevated serum uric acid concentration in gentamicin-administered rats. Renal histopathological analysis showed a discernible incidence of acute tubular necrosis in gentamicin-administered rats which were markedly reduced by low-dose fenofibrate or low-dose rosuvastatin pretreatments; but, not by their post-treatments. In conclusion, low-dose fenofibrate pretreatment considerably prevented gentamicin-induced acute tubular necrosis and renal functional abnormalities in rats while its post-treatment resulted in no significant renoprotective action. In spite of effective prevention of gentamicin-induced acute tubular necrosis, the pretreatment with low-dose rosuvastatin had only a partial and fractional protection on renal functional abnormalities. The post-treatment with low-dose rosuvastatin was ineffective in affording a renoprotection in gentamicin-administered rats.Keywords: gentamicin-nephrotoxicity, low-dose fenofibrate, low-dose rosuvastatin, renoprotection
Procedia PDF Downloads 1994033 Knowledge and Capabilities of Primary Caregivers in Providing Quality Care for Elderly Patients with Post- Operative Hip Fracture, Songklanagarind Hospital
Authors: Manee Hasap, Mongkolchai Hasap, Tasanee Nasae
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The purpose of this study was to evaluate the primary caregivers’ knowledge and capabilities for providing quality care to be hospitalized post-hip fracture surgery elderly patients. The theoretical framework of the study was derived from the concepts of dependent care agency in Orem’s Self-Care theory, and family care provision for the elderly and chronically ill patients. 59 subjects were purposively selected. The subjects were primary caregivers of post-operated hip fracture elderly patients who had been admitted to the Orthopaedic Ward of Songklanagarind Hospital. Demographic data of the caregivers and patients were collected by non-participant observation using the evaluation and recording forms. The reliability of caregivers’ knowledge measurement (0.86) was obtained by KR-20 and that of caregivers’ capabilities for post-operative care evaluation form (0.97) obtained from 2 observers by interrater reliability. The data were analyzed using descriptive statistic, which were frequency, percentage, mean, and standard deviation. The result of this study indicated that elderly patients with post-hip fracture surgery had many pre-discharge self care limitations. Approximately, 75% of the caregivers had knowledge to respond to patient’s essential needs at a high level, while the rest (25%) had this knowledge a moderate level. For observation, 57.63% of the subjects had capabilities in care practice at a moderate level; 28.81% had capabilities in care practice at a high level, while 13.56% had at a low level. The result of this study can be used as basic information for patients and caregivers capabilities developing plan especially, providing patients’ activities, accident surveillance and complications prevention for a good life quality of elderly patients after hip surgery both hospitalization and rehabilitation at home.Keywords: care givers’ knowledge, care givers’ capabilities, elderly hip fracture patients, patients
Procedia PDF Downloads 5514032 Application of Artificial Neural Network for Prediction of High Tensile Steel Strands in Post-Tensioned Slabs
Authors: Gaurav Sancheti
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This study presents an impacting approach of Artificial Neural Networks (ANNs) in determining the quantity of High Tensile Steel (HTS) strands required in post-tensioned (PT) slabs. Various PT slab configurations were generated by varying the span and depth of the slab. For each of these slab configurations, quantity of required HTS strands were recorded. ANNs with backpropagation algorithm and varying architectures were developed and their performance was evaluated in terms of Mean Square Error (MSE). The recorded data for the quantity of HTS strands was used as a feeder database for training the developed ANNs. The networks were validated using various validation techniques. The results show that the proposed ANNs have a great potential with good prediction and generalization capability.Keywords: artificial neural networks, back propagation, conceptual design, high tensile steel strands, post tensioned slabs, validation techniques
Procedia PDF Downloads 2134031 Higher Education Quality Culture: Case Study: Georgia
Authors: Pikria Vardosanidze
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This presentation entitled ”Higher Education Quality Culture – Case Study: Georgia”is concerned with an urgent and crucial issue. Located at the crossroads of Europe and Asia, Georgia is a transnational, post-soviet country. And it is conditioned the peculiarity of our education system. Higher education in Georgia has an extensive history and a challenging period of development consisting of several phases, especially noteworthy of which are 1918 and 1991, marking there storation of Georgia’s independence. Georgia joined the Bologna Process in 2005. Given its geopolitical location, Georgian culture has developed, and still pursues the path of development against the background of the Western and Eastern cultures. Furthermore, socio-politically and culturally, it represents part of Europe. It is of particular interest how post-Soviet states develop in terms of education. What is the path to the European integration for Georgia as a post-Soviet country? How developed is the higher education quality culture in Georgia? And, what should be done in the future? It is important to answer these questions. The research carried out in the field of education is characterized by a certain specificity as does the post-colonial research. The field of education contributes to the development of democratic society as well as to the European integration, the Eastern Partnership and so on. What is crucial for the educational system, apart from transparency and democratization, is the improvement of the quality of education which is one of the most powerful tools dictating the need for a doctoral research as such. As for the research method, the comparative method of research, and the qualitative research are applied.Keywords: internationalization, higher education, policies, Georgia
Procedia PDF Downloads 924030 The Role of Structure Input in Pi in the Acquisition of English Relative Clauses by L1 Saudi Arabic Speakers
Authors: Faraj Alhamami
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The effects of classroom input through structured input activities have been addressing two main lines of inquiry: (1) measuring the effects of structured input activities as a possible causative factor of PI and (2) comparing structured input practice versus other types of instruction or no-training controls. This line of research, the main purpose of this classroom-based research, was to establish which type of activities is the most effective in processing instruction, whether it is the explicit information component and referential activities only or the explicit information component and affective activities only or a combination of the two. The instruments were: a) grammatical judgment task, b) Picture-cued task, and c) a translation task as pre-tests, post-tests and delayed post-tests seven weeks after the intervention. While testing is ongoing, preliminary results shows that the examination of participants' pre-test performance showed that all five groups - the processing instruction including both activities (RA), Traditional group (TI), Referential group (R), Affective group (A), and Control group - performed at a comparable chance or baseline level across the three outcome measures. However, at the post-test stage, the RA, TI, R, and A groups demonstrated significant improvement compared to the Control group in all tasks. Furthermore, significant difference was observed among PI groups (RA, R, and A) at post-test and delayed post-test on some of the tasks when compared to traditional group. Therefore, the findings suggest that the use of the sole application and/or the combination of the structured input activities has succeeded in helping Saudi learners of English make initial form-meaning connections and acquire RRCs in the short and the long term.Keywords: input processing, processing instruction, MOGUL, structure input activities
Procedia PDF Downloads 684029 Early Detection of Lymphedema in Post-Surgery Oncology Patients
Authors: Sneha Noble, Rahul Krishnan, Uma G., D. K. Vijaykumar
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Breast-Cancer related Lymphedema is a major problem that affects many women. Lymphedema is the swelling that generally occurs in the arms or legs caused by the removal of or damage to lymph nodes as a part of cancer treatment. Treating it at the earliest possible stage is the best way to manage the condition and prevent it from leading to pain, recurrent infection, reduced mobility, and impaired function. So, this project aims to focus on the multi-modal approaches to identify the risks of Lymphedema in post-surgical oncology patients and prevent it at the earliest. The Kinect IR Sensor is utilized to capture the images of the body and after image processing techniques, the region of interest is obtained. Then, performing the voxelization method will provide volume measurements in pre-operative and post-operative periods in patients. The formation of a mathematical model will help in the comparison of values. Clinical pathological data of patients will be investigated to assess the factors responsible for the development of lymphedema and its risks.Keywords: Kinect IR sensor, Lymphedema, voxelization, lymph nodes
Procedia PDF Downloads 1294028 A Psychoanalytic Lens: Unmasked Layers of the Self among Post-Graduate Psychology Students in Surviving the COVID-19 Lockdown
Authors: Sharon Sibanda, Benny Motileng
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The World Health Organisation (WHO) identified the Sars-Cov-2 (COVID-19) as a pandemic on the 12ᵗʰ of March 2020, with South Africa recording its first case on the 5ᵗʰ of March 2020. The rapidly spreading virus led the South African government to implement one of the strictest nationwide lockdowns globally, resulting in the closing down of all institutions of higher learning effective March 18ᵗʰ 2020. Thus, this qualitative study primarily aimed to explore whether post-graduate psychology students were in a state of a depleted or cohesive self, post the psychological isolation of COVID-19 risk-adjusted level 5 lockdown. Semi-structured interviews from a qualitative interpretive approach comprising N=6 psychology post-graduate students facilitated a rich understanding of their intra-psychic experiences of the self. Thematic analysis of data gathered from the interviews illuminated how students were forced into the self by the emotional isolation of hard lockdown, with the emergence of core psychic conflict often defended against through external self-object experiences. The findings also suggest that lockdown stripped off this sample of psychology post-graduate students’ defensive escape from the inner self through external self-object distractions. The external self was stripped to the core of the internal self by the isolation of hard lockdown, thereby uncovering the psychic function of roles and defenses amalgamated throughout modern cultural consciousness that dictates self-functioning. The study suggests modelling reflexivity skills in the integration of internal and external self-experience dynamics as part of a training model for continued personal and professional development for psychology students.Keywords: COVID-19, fragmentation, self-object experience, true/false self
Procedia PDF Downloads 524027 Pre-Operative Tool for Facial-Post-Surgical Estimation and Detection
Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary
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Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.Keywords: k-nearest neighbor (knn), face detection, vitiligo, bone deformity
Procedia PDF Downloads 1554026 Therapeutic Hypothermia Post Cardiac Arrest
Authors: Tahsien Mohamed Okasha
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We hypothesized that Post cardiac arrest patients with Glasgow coma scale (GCS) score of less than (8) and who will be exposed to therapeutic hypothermia protocol will exhibit improvement in their neurological performance. Purposive sample of 17 patients who were fulfilling the inclusion criteria during one year collected. The study carried out using Quasi-experimental research design. Four Tools used for data collection of this study: Demographic and medical data sheet, Post cardiac arrest health assessment sheet, Bedside Shivering Assessment Scale (BSAS), and Glasgow Pittsburgh cerebral performance category scale (CPC). Result: the mean age was X̅ ± SD = 53 ± 8.122 years, 47.1% were arrested because of cardiac etiology. 35.3% with initial arrest rhythm ventricular tachycardia (VT), 23.5% with ventricular fibrillation (VF), and 29.4% with A-Systole. Favorable neurological outcome was seen among 70.6%. There was significant statistical difference in WBC, Platelets, blood gases value, random blood sugar. Also Initial arrest rhythm, etiology of cardiac arrest, and shivering status were significantly correlated with cerebral performance categories score. therapeutic hypothermia has positive effects on neurological performance among post cardiac arrest patients with GCS score of less than (8). replication of the study on larger probability sample, with randomized control trial design. Further study for suggesting nursing protocol for patients undergoing therapeutic hypothermia.Keywords: therapeutic hypothermia, neurological performance, after resuscitation from cardiac arrest., resuscitation
Procedia PDF Downloads 914025 Study of Laser Induced Damage Threshold in HfO₂/SiO₂ Multilayer Films after β-Ray Irradiation
Authors: Meihua Fang, Tao Fei
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Post-processing can effectively improve the resistance to laser damage in multilayer films used in a high power laser system. In this work, HfO₂/SiO₂ multilayer films are prepared by e-beam evaporation and then β-ray irradiation is employed as the post-processing method. The particle irradiation affects the laser induced damage threshold (LIDT), which includes defects, surface roughness, packing density, and residual stress. The residual stress that is relaxed during irradiation changes from compressive stress into tensile stress. Our results indicate that appropriate tensile stress can improve LIDT remarkably. In view of the fact that LIDT rises from 8 J/cm² to 12 J/cm², i.e., 50% increase, after the film has been irradiated by 2.2×10¹³/cm² β-ray, the particle irradiation can be used as a controllable and desirable post-processing method to improve the resistance to laser induced damage.Keywords: β-ray irradiation, multilayer film, residual stress, laser-induced damage threshold
Procedia PDF Downloads 1484024 Relative Toxicity of Apparent Pesticides against Safflower Capsule Fly, Acanthiophilus helianthi Rossi (Diptera: Tephritidae) under Laboratory Conditions
Authors: Karim Saeidi
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Safflower capsule fly, Acanthiophilus helianthi Rossi (Diptera: Tephritidae), is a key pest of safflower in Iran. The toxicity of Methidathion, Malathion, Deltamethrin, and Lufenuron to adult males and females of Acanthiophilus helianthi was studied under laboratory conditions. Malathion was the most toxic among the tested compounds followed by Methidathion, Lufenuron, and Deltamethrin to Acanthiophilus helianthi at 24 h post treatment, the respective LC50 values were 0.40 ppm, 0.68 ppm, 10.99 ppm, and 11.75 ppm for males and 0.46 ppm, 0.97 ppm, 13.45 ppm, and 16.32 ppm for females. At 48 h post treatment, Malathion was the most toxic followed by Methidathion, Deltamethrin, and Lufenuron to Acanthiophilus helianthi, LC50 values were 0.08 ppm, 0.54 ppm, 1.80 ppm, and 1.96 ppm for males and 0.34 ppm, 0.64 ppm, 1.88 ppm, and 2.37 ppm for females. At 72 h post treatment, Malathion was the most toxic followed by Methidathion, Lufenuron, and Deltamethrin to Acanthiophilus helianthi LC50 values were 0.04 ppm, 0.33 ppm, 0.44 ppm, and 0.71 ppm for males and 0.09 ppm, 0.36 ppm, 0.75 ppm, and 0.82 ppm for females. It is observed that LC50 values for treated adult females increased more than in the treated adult males at 24 h, 48 h, and 72 h post treatment. It means that the adult males were more susceptible to the tested insecticides than the adult females.Keywords: safflower, Methidathion, Deltamethrin, Lufenuron, Malathion, Tephritidae, safflower capsule fly, Acanthiophilus helianthi
Procedia PDF Downloads 3274023 Bioreactor Simulator Design: Measuring Built Environment Health and Ecological Implications from Post-Consumer Textiles
Authors: Julia DeVoy, Olivia Berlin
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The United States exports over 1.6 billion pounds of post-consumer textiles every year, primarily to countries in the Global South. These textiles make their way to landfills and open-air dumps where they decompose, contaminating water systems and releasing harmful greenhouse gases. Through this inequitable system of waste disposal, countries with less political and economic power are coerced into accepting the environmental and health consequences of over-consumption in the Global North. Thus, the global trade of post-consumer textile waste represents a serious issue of environmental justice and a public health hazard. Our research located, characterizes, and quantifies the environmental and human health risks that occur when post-consumer textiles are left to decompose in landfills and open-air dumps in the Global South. In our work, we make use of United Nations International Trade Statistics data to map the global distribution of post-consumer textiles exported from the United States. Next, we present our landfill simulating reactor designed to measure toxicity of leachate resulting from the decomposition of textiles in developing countries and to quantify the related greenhouse gas emissions. This design makes use of low-cost and sustainable materials to promote frugal innovation and make landfill reactors more accessible. Finally, we describe how the data generated from these tools can be leveraged to inform individual consumer behaviors, local policies around textile waste disposal, and global advocacy efforts to mitigate the environmental harms caused by textile waste.Keywords: sustainability, textile design, public health, built environment
Procedia PDF Downloads 1214022 Endometrial Thickness Cut-Off for Evacuation of Retained Product of Conception
Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie
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Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET
Procedia PDF Downloads 2064021 Protection from Risks of Natural Disasters and Social and Economic Support to the Native Population
Authors: Maria Angela Bedini, Fabio Bronzini
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The risk of natural disasters affects all the countries of the world, whether it refers to seismic events or tsunamis or hydrogeological disasters. In most cases, the risk can be considered in its three components: hazard, exposure, vulnerability (and urban vulnerability). The aim of this paper is to evaluate how the Italian scientific community has related the contribution of these three components, superimposing the three different maps that summarize the fundamental structure of the risk. Based on the three components considered, the study applies the Regional Planning methodology on the three phases of the risk protection and mitigation process: the prevention phase, the emergency intervention phase, the post-disaster phase. The paper illustrates the Italian experience of the pre-during-post-earthquake intervention. Main results: The study deepens these aspects in the belief that “a historical center” and an “island” can present similar problems at the international level, both in the phase of prevention (earthquake, tsunamis, hydrogeological disasters), in emergency phase (protocols and procedures of intervention) and in the post-disaster phase. The conclusions of the research identify the need to plan in advance how to deal with the post-disaster phase and consider it a priority with respect to the simple reconstruction of destroyed buildings. In fact the main result of the post-disaster intervention must be the return and the social and economic support of the indigenous population, and not only the construction of new housing and equipment. In this sense, the results of the research show that the elderly inhabitants of a historic center can be compared to the indigenous population of an atoll of fishermen, as both constitute the most important resource: the human resource. Their return in conditions of security testifies, with their presence, the culture, customs, and values rooted in the history of a people.Keywords: post-disaster interventions, risk of natural disasters in Italy and abroad, seismic events in Italy, social and economic protection and support for the native population of historical centers
Procedia PDF Downloads 934020 From Text to Data: Sentiment Analysis of Presidential Election Political Forums
Authors: Sergio V Davalos, Alison L. Watkins
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User generated content (UGC) such as website post has data associated with it: time of the post, gender, location, type of device, and number of words. The text entered in user generated content (UGC) can provide a valuable dimension for analysis. In this research, each user post is treated as a collection of terms (words). In addition to the number of words per post, the frequency of each term is determined by post and by the sum of occurrences in all posts. This research focuses on one specific aspect of UGC: sentiment. Sentiment analysis (SA) was applied to the content (user posts) of two sets of political forums related to the US presidential elections for 2012 and 2016. Sentiment analysis results in deriving data from the text. This enables the subsequent application of data analytic methods. The SASA (SAIL/SAI Sentiment Analyzer) model was used for sentiment analysis. The application of SASA resulted with a sentiment score for each post. Based on the sentiment scores for the posts there are significant differences between the content and sentiment of the two sets for the 2012 and 2016 presidential election forums. In the 2012 forums, 38% of the forums started with positive sentiment and 16% with negative sentiment. In the 2016 forums, 29% started with positive sentiment and 15% with negative sentiment. There also were changes in sentiment over time. For both elections as the election got closer, the cumulative sentiment score became negative. The candidate who won each election was in the more posts than the losing candidates. In the case of Trump, there were more negative posts than Clinton’s highest number of posts which were positive. KNIME topic modeling was used to derive topics from the posts. There were also changes in topics and keyword emphasis over time. Initially, the political parties were the most referenced and as the election got closer the emphasis changed to the candidates. The performance of the SASA method proved to predict sentiment better than four other methods in Sentibench. The research resulted in deriving sentiment data from text. In combination with other data, the sentiment data provided insight and discovery about user sentiment in the US presidential elections for 2012 and 2016.Keywords: sentiment analysis, text mining, user generated content, US presidential elections
Procedia PDF Downloads 1804019 The Risk of Post-stroke Pneumonia and Its One-Year Disability in Taiwan
Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang
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Background: Evidence exists that pneumonia is a frequently encountered complication after stroke which is associated with a higher rate of mortality and increased long-term disability Purpose: To determine the predictors associated with the risk of one-year disability in acute stroke. Methods: Data for this longitudinal follow-up study were extracted from a tertiary referral medical center’s stroke registry database in Northern Taipei. Eligible patients with acute stroke admitted to the hospital and completed a one-year follow up were recruited for analysis. Favorable outcome was defined as a modified Rankin Scale score ≤ 2. SAS version 9.2 was used for the multivariable regression analyses to examine the factors correlated with the one-year disability in stroke patients. Results: From January 2012 to December 2013, a total of 1373 (mean age: 70.49±15.4 years, 913(66.5%) males) consecutively administered acute stroke patients were recruited. Overall, the rate of one-year disability was 37.20%(404/1086) in those without post-stroke pneumonia. It increased to 82.93 %(238/287) in patients developed post-stroke pneumonia. Factors associated with increased risk of disability were age ≧ 75(OR= 4.845, p<.0001), female /gender (OR=1.568, p =.0062), previous stroke (OR= 1.868, p = <. 0001) ,dementia (OR= 2.872, p =.0047), ventilator use (OR= 4.653, p <. 0001),age ≧ 75 /pneumonia (OR=1.236, p <. 0001) , ICU admission (OR=3.314, p <.0001) , nasogastric tube insertion (OR= 4.28, p <.0001), speech therapy (OR= 1.79, p =.0142), urinary tract infection (OR= 1.865, p =.0018), estimated glomerular filtration rate (eGFR > 60 )(OR= 0.525, p= .0029), Admission NIHSS >11 (OR= 2.101, p = .0099), Length of hospitalization > 30(d) (OR= 5.182, p <.0001). Conclusion: Older age, severe neurological deficit, complications, rehabilitation intervention, length of hospitalization >30(d), and cognitive impairment were significantly associated with Post-stroke functional impairment, especially those with post-stroke pneumonia. These findings could open new avenues in the management of stroke patients.Keywords: stroke, risk, pneumonia, disability
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