Search results for: intensive Care
2624 Comparison of Patient Satisfaction and Observer Rating of Outpatient Care among Public Hospitals in Shanghai
Authors: Tian Yi Du, Guan Rong Fan, Dong Dong Zou, Di Xue
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Background: The patient satisfaction survey is becoming of increasing importance for hospitals or other providers to get more reimbursement and/or more governmental subsidies. However, when the results of patient satisfaction survey are compared among medical institutions, there are some concerns. The primary objectives of this study were to evaluate patient satisfaction in tertiary hospitals of Shanghai and to compare the satisfaction rating on physician services between patients and observers. Methods: Two hundred outpatients were randomly selected for patient satisfaction survey in each of 28 public tertiary hospitals of Shanghai. Four or five volunteers were selected to observe 5 physicians’ practice in each of above hospitals and rated observed physicians’ practice. The outpatients that the volunteers observed their physician practice also filled in the satisfaction questionnaires. The rating scale for outpatient survey and volunteers’ observation was: 1 (very dissatisfied) to 6 (very satisfied). If the rating was equal to or greater than 5, we considered the outpatients and volunteers were satisfied with the services. The validity and reliability of the measure were assessed. Multivariate regressions for each of the 4 dimensions and overall of patient satisfaction were used in analyses. Paired t tests were applied to analyze the rating agreement on physician services between outpatients and volunteers. Results: Overall, 90% of surveyed outpatients were satisfied with outpatient care in the tertiary public hospitals of Shanghai. The lowest three satisfaction rates were seen in the items of ‘Restrooms were sanitary and not crowded’ (81%), ‘It was convenient for the patient to pay medical bills’ (82%), and ‘Medical cost in the hospital was reasonable’ (84%). After adjusting the characteristics of patients, the patient satisfaction in general hospitals was higher than that in specialty hospitals. In addition, after controlling the patient characteristics and number of hospital visits, the hospitals with higher outpatient cost per visit had lower patient satisfaction. Paired t tests showed that the rating on 6 items in the dimension of physician services (total 14 items) was significantly different between outpatients and observers, in which 5 were rated lower by the observers than by the outpatients. Conclusions: The hospital managers and physicians should use patient satisfaction and observers’ evaluation to detect the room for improvement in areas such as social skills cost control, and medical ethics.Keywords: patient satisfaction, observation, quality, hospital
Procedia PDF Downloads 3162623 Recovery and Εncapsulation of Μarine Derived Antifouling Agents
Authors: Marina Stramarkou, Sofia Papadaki, Maria Kaloupi, Ioannis Batzakas
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Biofouling is a complex problem of the aquaculture industry, as it reduces the efficiency of the equipment and causes significant losses of cultured organisms. Nowadays, the current antifouling methods are proved to be labor intensive, have limited lifetime and use toxic substances that result in fish mortality. Several species of marine algae produce a wide variety of biogenic compounds with antibacterial and antifouling properties, which are effective in the prevention and control of biofouling and can be incorporated in antifouling coatings. In the present work, Fucus spiralis, a species of macro algae, and Chlorella vulgaris, a well-known species of microalgae, were used for the isolation and recovery of bioactive compounds, belonging to groups of fatty acids, lipopeptides and amides. The recovery of the compounds was achieved through the application of the ultrasound- assisted extraction, an environmentally friendly method, using green, non-toxic solvents. Moreover, the coating of the antifouling agents was done by innovative encapsulation and coating methods, such as electro-hydrodynamic process. For the encapsulation of the bioactive compounds natural matrices were used, such as polysaccharides and proteins. Water extracts that were incorporated in protein matrices were considered the most efficient antifouling coating.Keywords: algae, electrospinning, fatty acids, ultrasound-assisted extraction
Procedia PDF Downloads 3352622 Application of Transportation Models for Analysing Future Intercity and Intracity Travel Patterns in Kuwait
Authors: Srikanth Pandurangi, Basheer Mohammed, Nezar Al Sayegh
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In order to meet the increasing demand for housing care for Kuwaiti citizens, the government authorities in Kuwait are undertaking a series of projects in the form of new large cities, outside the current urban area. Al Mutlaa City located to the north-west of the Kuwait Metropolitan Area is one such project out of the 15 planned new cities. The city accommodates a wide variety of residential developments, employment opportunities, commercial, recreational, health care and institutional uses. This paper examines the application of comprehensive transportation demand modeling works undertaken in VISUM platform to understand the future intracity and intercity travel distribution patterns in Kuwait. The scope of models developed varied in levels of detail: strategic model update, sub-area models representing future demand of Al Mutlaa City, sub-area models built to estimate the demand in the residential neighborhoods of the city. This paper aims at offering model update framework that facilitates easy integration between sub-area models and strategic national models for unified traffic forecasts. This paper presents the transportation demand modeling results utilized in informing the planning of multi-modal transportation system for Al Mutlaa City. This paper also presents the household survey data collection efforts undertaken using GPS devices (first time in Kuwait) and notebook computer based digital survey forms for interviewing representative sample of citizens and residents. The survey results formed the basis of estimating trip generation rates and trip distribution coefficients used in the strategic base year model calibration and validation process.Keywords: innovative methods in transportation data collection, integrated public transportation system, traffic forecasts, transportation modeling, travel behavior
Procedia PDF Downloads 2152621 The Influence of Polymorphisms of NER System Genes on the Risk of Colorectal Cancer in the Polish Population
Authors: Ireneusz Majsterek, Karolina Przybylowska, Lukasz Dziki, Adam Dziki, Jacek Kabzinski
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Colorectal cancer (CRC) is one of the deadliest cancers. Every year we see an increase in the number of cases, and in spite of intensive research etiology of the disease remains unknown. For many years, researchers are seeking to associate genetic factors with an increased risk of CRC, so far it has proved to be a compelling link between the MMR system of DNA repair and hereditary nonpolyposis colorectal cancers (HNPCC). Currently, research is focused on finding the relationship between the remaining DNA repair systems and an increased risk of developing colorectal cancer. The aim of the study was to determine the relationship between gene polymorphisms Ser835Ser of XPF gene and Gly23Ala of XPA gene–elements of NER DNA repair system, and modulation of the risk of colorectal cancer in the Polish population. Determination of the molecular basis of carcinogenesis process and predicting increased risk will allow qualifying patients to increased risk group and including them in preventive program. We used blood collected from 110 patients diagnosed with colorectal cancer. The control group consisted of equal number of healthy people. Genotyping was performed by TaqMan method. The obtained results indicate that the genotype 23Gly/Ala of XPA gene is associated with an increased risk of colorectal cancer, while 23Ala/Ala as well as TCT allele of Ser835Ser of XPF gene may reduce the risk of CRC.Keywords: NER, colorectal cancer, XPA, XPF, polymorphisms
Procedia PDF Downloads 5612620 Comparative Study of Deep Reinforcement Learning Algorithm Against Evolutionary Algorithms for Finding the Optimal Values in a Simulated Environment Space
Authors: Akshay Paranjape, Nils Plettenberg, Robert Schmitt
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Traditional optimization methods like evolutionary algorithms are widely used in production processes to find an optimal or near-optimal solution of control parameters based on the simulated environment space of a process. These algorithms are computationally intensive and therefore do not provide the opportunity for real-time optimization. This paper utilizes the Deep Reinforcement Learning (DRL) framework to find an optimal or near-optimal solution for control parameters. A model based on maximum a posteriori policy optimization (Hybrid-MPO) that can handle both numerical and categorical parameters is used as a benchmark for comparison. A comparative study shows that DRL can find optimal solutions of similar quality as compared to evolutionary algorithms while requiring significantly less time making them preferable for real-time optimization. The results are confirmed in a large-scale validation study on datasets from production and other fields. A trained XGBoost model is used as a surrogate for process simulation. Finally, multiple ways to improve the model are discussed.Keywords: reinforcement learning, evolutionary algorithms, production process optimization, real-time optimization, hybrid-MPO
Procedia PDF Downloads 1052619 Attitude towards Biology among Academic Talented Students in Term of Gender: Case Study of ASASIpintar Pre–University Programme
Authors: Sy Ing Ong, N. Norazman, H. W. You, A. Zahidi, R. Ahmad Faisal
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The decline in students’ involvement in the fields of Science, Technology, Engineering and Mathematics (STEM) worldwide is alarming. In Malaysia, this scenario also draws the attention of Ministry of Education due to the high demand for professionals in STEM industries and for the sake of country development. Intensive researches have been done worldwide to identify the best solution to improve the enrolment of students in science studies. Attitude is being identified as one of the key factors that will influence students’ interest and achievement in academic. Male students are always associated with negative attitudes compared to female students towards the study of Biological science. Hence, this study investigates the attitudes of students towards Biology in the setting of an academic talented institution in Malaysia namely ASASIpintar Pre-University Programme. A total of 84 students were randomly selected from 127 students as the samples of this study. The instrument of Biology Attitude Scale (BAS) from Russell and Hollander (1975) was used to identify the attitudes of samples. Based on the analysis, there was no significant difference in the students’ mean attitude towards Biology subject in this institution between genders with a significant level of p = 0.05. This indicated that gender is not a key factor that influences students’ attitude towards Biology in this study. Future research can be done on other factors that will contribute to the attitude of students towards biology in Malaysia, especially for academically talented students.Keywords: academic talented, attitude, biology, gender
Procedia PDF Downloads 2182618 Multimodal Integration of EEG, fMRI and Positron Emission Tomography Data Using Principal Component Analysis for Prognosis in Coma Patients
Authors: Denis Jordan, Daniel Golkowski, Mathias Lukas, Katharina Merz, Caroline Mlynarcik, Max Maurer, Valentin Riedl, Stefan Foerster, Eberhard F. Kochs, Andreas Bender, Ruediger Ilg
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Introduction: So far, clinical assessments that rely on behavioral responses to differentiate coma states or even predict outcome in coma patients are unreliable, e.g. because of some patients’ motor disabilities. The present study was aimed to provide prognosis in coma patients using markers from electroencephalogram (EEG), blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). Unsuperwised principal component analysis (PCA) was used for multimodal integration of markers. Methods: Approved by the local ethics committee of the Technical University of Munich (Germany) 20 patients (aged 18-89) with severe brain damage were acquired through intensive care units at the Klinikum rechts der Isar in Munich and at the Therapiezentrum Burgau (Germany). At the day of EEG/fMRI/PET measurement (date I) patients (<3.5 month in coma) were grouped in the minimal conscious state (MCS) or vegetative state (VS) on the basis of their clinical presentation (coma recovery scale-revised, CRS-R). Follow-up assessment (date II) was also based on CRS-R in a period of 8 to 24 month after date I. At date I, 63 channel EEG (Brain Products, Gilching, Germany) was recorded outside the scanner, and subsequently simultaneous FDG-PET/fMRI was acquired on an integrated Siemens Biograph mMR 3T scanner (Siemens Healthineers, Erlangen Germany). Power spectral densities, permutation entropy (PE) and symbolic transfer entropy (STE) were calculated in/between frontal, temporal, parietal and occipital EEG channels. PE and STE are based on symbolic time series analysis and were already introduced as robust markers separating wakefulness from unconsciousness in EEG during general anesthesia. While PE quantifies the regularity structure of the neighboring order of signal values (a surrogate of cortical information processing), STE reflects information transfer between two signals (a surrogate of directed connectivity in cortical networks). fMRI was carried out using SPM12 (Wellcome Trust Center for Neuroimaging, University of London, UK). Functional images were realigned, segmented, normalized and smoothed. PET was acquired for 45 minutes in list-mode. For absolute quantification of brain’s glucose consumption rate in FDG-PET, kinetic modelling was performed with Patlak’s plot method. BOLD signal intensity in fMRI and glucose uptake in PET was calculated in 8 distinct cortical areas. PCA was performed over all markers from EEG/fMRI/PET. Prognosis (persistent VS and deceased patients vs. recovery to MCS/awake from date I to date II) was evaluated using the area under the curve (AUC) including bootstrap confidence intervals (CI, *: p<0.05). Results: Prognosis was reliably indicated by the first component of PCA (AUC=0.99*, CI=0.92-1.00) showing a higher AUC when compared to the best single markers (EEG: AUC<0.96*, fMRI: AUC<0.86*, PET: AUC<0.60). CRS-R did not show prediction (AUC=0.51, CI=0.29-0.78). Conclusion: In a multimodal analysis of EEG/fMRI/PET in coma patients, PCA lead to a reliable prognosis. The impact of this result is evident, as clinical estimates of prognosis are inapt at time and could be supported by quantitative biomarkers from EEG, fMRI and PET. Due to the small sample size, further investigations are required, in particular allowing superwised learning instead of the basic approach of unsuperwised PCA.Keywords: coma states and prognosis, electroencephalogram, entropy, functional magnetic resonance imaging, machine learning, positron emission tomography, principal component analysis
Procedia PDF Downloads 3322617 Enhancing Oral Pre-Exposure Prophylaxis Uptake and Continuation among Adolescent Girls and Young Women in Busia District East Central Uganda
Authors: Jameson Mirimu, Edward Mawejje, Ibra Twinomujuni
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Introduction: Adolescent girls and young women (AGYW) are a vulnerable category whose risk of acquiring HIV is 20 times compared to the general population accounting for 25% of the new infections. Despite proven scientific evidence of preventing HIV acquisition, Oral Pre-Exposure Prophylaxis (PreP) is less used as one of the biomedical interventions among the AGYW. By 2020, only 31000-32000 of the targeted 90,000 persons in Uganda enrolled on Oral PreP LPHS-EC project employed a combination of Expanded Peer Outreach Approach (EPOA) and Effective client follow-up to increase PreP initiation (PrEP_NEW) and continuation for more than three months (PrEP_CT). Method: Quantitatively, data from National Key population Combination tracker retrospectively analyzed by M&E, focused group discussion with AGYWs and Health care workers to identify barriers. Barriers found; hesitancy of AGYW, misconceptions about Oral PrEP, inadequate knowledge and skills in handling adolescent and Data quality issues. To address the mentioned barriers, youth friendly corners initiated in study sites, identified PrEP Champions among the AGYW, oral PrEP dialogues, group Antenatal counselling, CQI Projects initiated, weekly perfomance meetings to track performance. Results: Routine program data review PrEP_NEW and PrEP_CT increased from 5% (4/80) and 4% (2/54), respectively, in July 2022 to 90% (72/80) and 79% (43/54) respectively for PrEP_NEW and PrEP_CT at the end of March 2023. Lessons Learnt: Demystifying misconception about oral Prep through provision of adequate information by involving health care workers through skills enhancement, CQI projects are critical intervention. Conclusion: With improved safe spaces, skills enhancement of health workers, stakeholders’ engagement through Oral Prep dialogues is critical in improving PreP uptake and continuity among the AGYWS.Keywords: prep, uptake, continuation, AGYW
Procedia PDF Downloads 682616 Failure Analysis and Verification Using an Integrated Method for Automotive Electric/Electronic Systems
Authors: Lei Chen, Jian Jiao, Tingdi Zhao
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Failures of automotive electric/electronic systems, which are universally considered to be safety-critical and software-intensive, may cause catastrophic accidents. Analysis and verification of failures in these kinds of systems is a big challenge with increasing system complexity. Model-checking is often employed to allow formal verification by ensuring that the system model conforms to specified safety properties. The system-level effects of failures are established, and the effects on system behavior are observed through the formal verification. A hazard analysis technique, called Systems-Theoretic Process Analysis, is capable of identifying design flaws which may cause potential failure hazardous, including software and system design errors and unsafe interactions among multiple system components. This paper provides a concept on how to use model-checking integrated with Systems-Theoretic Process Analysis to perform failure analysis and verification of automotive electric/electronic systems. As a result, safety requirements are optimized, and failure propagation paths are found. Finally, an automotive electric/electronic system case study is used to verify the effectiveness and practicability of the method.Keywords: failure analysis and verification, model checking, system-theoretic process analysis, automotive electric/electronic system
Procedia PDF Downloads 1122615 Developing a SOA-Based E-Healthcare Systems
Authors: Hend Albassam, Nouf Alrumaih
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Nowadays we are in the age of technologies and communication and there is no doubt that technologies such as the Internet can offer many advantages for many business fields, and the health field is no execution. In fact, using the Internet provide us with a new path to improve the quality of health care throughout the world. The e-healthcare offers many advantages such as: efficiency by reducing the cost and avoiding duplicate diagnostics, empowerment of patients by enabling them to access their medical records, enhancing the quality of healthcare and enabling information exchange and communication between healthcare organizations. There are many problems that result from using papers as a way of communication, for example, paper-based prescriptions. Usually, the doctor writes a prescription and gives it to the patient who in turn carries it to the pharmacy. After that, the pharmacist takes the prescription to fill it and give it to the patient. Sometimes the pharmacist might find difficulty in reading the doctor’s handwriting; the patient could change and counterfeit the prescription. These existing problems and many others heighten the need to improve the quality of the healthcare. This project is set out to develop a distributed e-healthcare system that offers some features of e-health and addresses some of the above-mentioned problems. The developed system provides an electronic health record (EHR) and enables communication between separate health care organizations such as the clinic, pharmacy and laboratory. To develop this system, the Service Oriented Architecture (SOA) is adopted as a design approach, which helps to design several independent modules that communicate by using web services. The layering design pattern is used in designing each module as it provides reusability that allows the business logic layer to be reused by different higher layers such as the web service or the website in our system. The experimental analysis has shown that the project has successfully achieved its aims toward solving the problems related to the paper-based healthcare systems and it enables different health organization to communicate effectively. It implements four independent modules including healthcare provider, pharmacy, laboratory and medication information provider. Each module provides different functionalities and is used by a different type of user. These modules interoperate with each other using a set of web services.Keywords: e-health, services oriented architecture (SOA), web services, interoperability
Procedia PDF Downloads 3002614 Prevalence and Correlates of Complementary and Alternative Medicine Use among Diabetic Patients in Lebanon: A Cross-Sectional Study
Authors: Farah Naja, Mohamad Alameddine
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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy
Procedia PDF Downloads 3422613 Beliefs, Attitudes, and Understanding of Childhood Cancer Among White and Latino Parents in the Phoenix Metropolitan Area: A Comparative Study
Authors: Florence Awde
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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities
Procedia PDF Downloads 572612 Frailty Patterns in the US and Implications for Long-Term Care
Authors: Joelle Fong
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Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.Keywords: actuarial modeling, cohort analysis, frail elderly, health
Procedia PDF Downloads 2392611 A Range of Steel Production in Japan towards 2050
Authors: Reina Kawase
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Japan set the goal of 80% reduction in GHG emissions by 2050. To consider countermeasures for reducing GHG emission, the production estimation of energy intensive materials, such as steel, is essential. About 50% of steel production is exported in Japan, so it is necessary to consider steel production including export. Steel productions from 2005-2050 in Japan were estimated under various global assumptions based on combination of scenarios such as goods trade scenarios and steel making process selection scenarios. Process selection scenarios decide volume of steel production by process (basic oxygen furnace and electric arc furnace) with considering steel consumption projection, supply-demand balance of steel, and scrap surplus. The range of steel production by process was analyzed. Maximum steel production was estimated under the scenario which consumes scrap in domestic steel production at maximum level. In 2035, steel production reaches 149 million ton because of increase in electric arc furnace steel. However, it decreases towards 2050 and amounts to 120 million ton, which is almost same as a current level. Minimum steel production is under the scenario which assumes technology progress in steel making and supply-demand balance consideration in each region. Steel production decreases from base year and is 44 million ton in 2050.Keywords: goods trade scenario, steel making process selection scenario, steel production, global warming
Procedia PDF Downloads 3792610 Thermodynamic Cycle Using Cyclopentane for Waste Heat Recovery Power Generation from Clinker Cooler Exhaust Flue Gas
Authors: Vijayakumar Kunche
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Waste heat recovery from Pre Heater exhaust gases and Clinker cooler vent gases is now common place in Cement Industry. Most common practice is to use Steam Rankine cycle for heat to power conversion. In this process, waste heat from the flue gas is recovered through a Heat Recovery steam generator where steam is generated and fed to a conventional Steam turbine generator. However steam Rankine cycle tends to have lesser efficiency for smaller power plants with less than 5MW capacity and where the steam temperature at the inlet of the turbine is less than 350 deg C. further a steam Rankine cycle needs treated water and maintenance intensive. These problems can be overcome by using Thermodynamic cycle using Cyclopentane vapour in place of steam. This innovative cycle is best suited for Heat recovery in cement plants and results in best possible heat to power conversion efficiency. This paper discusses about Heat Recovery Power generation using innovative thermal cycle which uses Cyclopentane vapour in place of water- steam. And how this technology has been adopted for a Clinker cooler hot gas from mid-tap.Keywords: clinker cooler, energy efficiency, organic rankine cycle, waste heat recovery
Procedia PDF Downloads 2302609 Energy Analysis of Sugarcane Production: A Case Study in Metehara Sugar Factory in Ethiopia
Authors: Wasihun Girma Hailemariam
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Energy is one of the key elements required for every agricultural activity, especially for large scale agricultural production such as sugarcane cultivation which mostly is used to produce sugar and bioethanol from sugarcane. In such kinds of resource (energy) intensive activities, energy analysis of the production system and looking for other alternatives which can reduce energy inputs of the sugarcane production process are steps forward for resource management. The purpose of this study was to determine input energy (direct and indirect) per hectare of sugarcane production sector of Metehara sugar factory in Ethiopia. Total energy consumption of the production system was 61,642 MJ/ha-yr. This total input energy is a cumulative value of different inputs (direct and indirect inputs) in the production system. The contribution of these different inputs is discussed and a scenario of substituting the most influential input by other alternative input which can replace the original input in its nutrient content was discussed. In this study the most influential input for increased energy consumption was application of organic fertilizer which accounted for 50 % of the total energy consumption. Filter cake which is a residue from the sugar production in the factory was used to substitute the organic fertilizer and the reduction in the energy consumption of the sugarcane production was discussedKeywords: energy analysis, organic fertilizer, resource management, sugarcane
Procedia PDF Downloads 1472608 Effective Solvents for Proteins Recovery from Microalgae
Authors: Win Nee Phong, Tau Chuan Ling, Pau Loke Show
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From an industrial perspective, the exploitation of microalgae for protein source is of great economical and commercial interest due to numerous attractive characteristics. Nonetheless, the release of protein from microalgae is limited by the multiple layers of the rigid thick cell wall that generally contain a large proportion of cellulose. Thus an efficient cell disruption process is required to rupture the cell wall. The conventional downstream processing methods which typically involve several unit operational steps such as disruption, isolation, extraction, concentration and purification are energy-intensive and costly. To reduce the overall cost and establish a feasible technology for the success of the large-scale production, microalgal industry today demands a more cost-effective and eco-friendly technique in downstream processing. One of the main challenges to extract the proteins from microalgae is the presence of rigid cell wall. This study aims to provide some guidance on the selection of the efficient solvent to facilitate the proteins released during the cell disruption process. The effects of solvent types such as methanol, ethanol, 1-propanol and water in rupturing the microalgae cell wall were studied. It is interesting to know that water is the most effective solvent to recover proteins from microalgae and the cost is cheapest among all other solvents.Keywords: green, microalgae, protein, solvents
Procedia PDF Downloads 2492607 Rapid Sexual and Reproductive Health Pathways for Women Accessing Drug and Alcohol Treatment
Authors: Molly Parker
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Unintended pregnancy rates in Australia are amongst the highest in the developed world. Women with Substance Use Disorder often have riskier sexual behavior with nil contraceptive use and face disproportionately higher unintended pregnancies and Sexually Transmitted Infections, alongside Substance Use in Pregnancy (SUP) climbing at an alarming rate. In an inner-city Drug and Alcohol (D&A) service, significant barriers to sexual and reproductive health services have been identified, aligning with research. Rapid pathways were created for women seeking D&A treatment to be referred to Sexual and Reproductive Health services for the administration of Long-acting reversible contraception (LARC) and sexual health screening. For clients attending a D&A service, this is an opportunistic time to offer sexual and reproductive health services. Collaboration and multidisciplinary team input between D&A and sexual health and reproductive services are paramount, with rapid referral pathways being identified as the main strategy to improve access to sexual and reproductive health support for this population. With this evidence, a rapid referral pathway was created for women using the D&A service to access LARC, particularly in view of fertility often returning once stable on D&A treatment. A closed-ended survey was used for D&A staff to identify gaps in reproductive health knowledge and views of referral accessibility. Results demonstrated a lack of knowledge of contraception and appropriate referral processes. A closed-ended survey for clients was created to establish the need and access to services and to quantify data. A follow-up data collection will be reviewed to access uptake and satisfaction of the intervention from clients. Sexual health screening access was also identified as a deficit, particularly concerning due to the higher rates of STIs in this cohort. A rapid referral pathway will be undergoing implementation, reducing risks of untreated STIS both pre and post-conception. Similarly, pre and post-intervention structured surveys will be used to identify client satisfaction from the pathway. Although currently in progress, the research and pathway aim to be completed by December 2023. This research and implementation of sexual and reproductive health pathways from the D&A service have significant health and well-being benefits to clients and the wider community, including possible fetal/infancy outcomes. Women now have rapid access to sexual and reproductive health services, with the aim of reducing unplanned pregnancies, poor outcomes associated with SUP, client/staff trauma from termination of pregnancy, and client/staff trauma following the assumption of care of the child due to substance use, the financial cost for out of home care as required, the poor outcomes of untreated STIs to the fetus in pregnancy and the spread of STIs in the wider community. As evidence suggests, the implementation of a streamlined referral process is required between D&A and sexual and reproductive health services and has positive feedback from both clinicians and clients in improving care.Keywords: substance use in pregnancy, drug and alcohol, substance use disorder, sexual health, reproductive health, contraception, long-acting reversible contraception, neonatal abstinence syndrome, FASD, sexually transmitted infections, sexually transmitted infections pregnancy
Procedia PDF Downloads 552606 Hardness map of Human Tarsals, Meta Tarsals and Phalanges of Toes
Authors: Irfan Anjum Manarvi, Zahid Ali kaimkhani
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Predicting location of the fracture in human bones has been a keen area of research for the past few decades. A variety of tests for hardness, deformation, and strain field measurement have been conducted in the past; but considered insufficient due to various limitations. Researchers, therefore, have proposed further studies due to inaccuracies in measurement methods, testing machines, and experimental errors. Advancement and availability of hardware, measuring instrumentation, and testing machines can now provide remedies to these limitations. The human foot is a critical part of the body exposed to various forces throughout its life. A number of products are developed for using it for protection and care, which many times do not provide sufficient protection and may itself become a source of stress due to non-consideration of the delicacy of bones in the feet. A continuous strain or overloading on feet may occur resulting to discomfort and even fracture. Mechanical properties of Tarsals, Metatarsals, and phalanges are, therefore, the primary area of consideration for all such design applications. Hardness is one of the mechanical properties which are considered very important to establish the mechanical resistance behavior of a material against applied loads. Past researchers have worked in the areas of investigating mechanical properties of these bones. However, their results were based on a limited number of experiments and taking average values of hardness due to either limitation of samples or testing instruments. Therefore, they proposed further studies in this area. The present research has been carried out to develop a hardness map of the human foot by measuring micro hardness at various locations of these bones. Results are compiled in the form of distance from a reference point on a bone and the hardness values for each surface. The number of test results is far more than previous studies and are spread over a typical bone to give a complete hardness map of these bones. These results could also be used to establish other properties such as stress and strain distribution in the bones. Also, industrial engineers could use it for design and development of various accessories for human feet health care and comfort and further research in the same areas.Keywords: tarsals, metatarsals, phalanges, hardness testing, biomechanics of human foot
Procedia PDF Downloads 4172605 Effectiveness of a Pasifika Women’s Diabetes Wellness Program (PWDWP) – Co-design With, by and for MāOri and Pasifika Women Living in Queensland
Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos
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Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management
Procedia PDF Downloads 812604 Method for Improving Antidepressants Adherence in Patients with Depressive Disorder: Systemic Review and Meta-Analysis
Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool
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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis
Procedia PDF Downloads 1292603 Oxidative Stability of an Iranian Ghee (Butter Fat) Versus Soybean Oil During Storage at Different Temperatures
Authors: Kooshan Nayebzadeh, Maryam Enteshari
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In this study, the oxidative stability of soybean oil under different storage temperatures (4 and 25 ˚C) and during 6-month shelf-life was investigated by various analytical methods and headspace-liquid phase microextraction (HS-LPME) coupled to gas chromatography-mass spectrometry (GC-MS). Oxidation changes were monitored by analytical parameters consisted of acid value (AV), peroxide value (PV), p-Anisidine value (p-AV), thiobarbituric acid value (TBA), fatty acids profile, iodine value (IV) and oxidative stability index (OSI). In addition, concentrations of hexanal and heptanal as secondary volatile oxidation compounds were determined by HS-LPME/GC-MS technique. Rate of oxidation in soybean oil which stored at 25 ˚C was so higher. The AV, p-AV, and TBA were gradually increased during 6 months, while the amount of unsaturated fatty acids, IV, and OSI decreased. Other parameters included concentrations of both hexanal and heptanal, and PV exhibited increasing trend during primitive months of storage; then, at the end of third and fourth months a sudden decrement was understood for the concentrations of hexanal and heptanal and the amount of PV, simultaneously. The latter parameters increased again until the end of shelf-time. As a result, the temperature and time were effective factors in oxidative stability of soybean oil. Also intensive correlations were found for soybean oil at 4 ˚C between AV and TBA (r2=0.96), PV and p-AV (r2=0.9), IV and TBA (-r2=0.9), and for soybean oil stored at 4 ˚C between p-AV and TBA (r2=0.99).Keywords: headspace-liquid phase microextraction, oxidation, shelf-life, soybean oil
Procedia PDF Downloads 3922602 IoT Based Soil Moisture Monitoring System for Indoor Plants
Authors: Gul Rahim Rahimi
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The IoT-based soil moisture monitoring system for indoor plants is designed to address the challenges of maintaining optimal moisture levels in soil for plant growth and health. The system utilizes sensor technology to collect real-time data on soil moisture levels, which is then processed and analyzed using machine learning algorithms. This allows for accurate and timely monitoring of soil moisture levels, ensuring plants receive the appropriate amount of water to thrive. The main objectives of the system are twofold: to keep plants fresh and healthy by preventing water deficiency and to provide users with comprehensive insights into the water content of the soil on a daily and hourly basis. By monitoring soil moisture levels, users can identify patterns and trends in water consumption, allowing for more informed decision-making regarding watering schedules and plant care. The scope of the system extends to the agriculture industry, where it can be utilized to minimize the efforts required by farmers to monitor soil moisture levels manually. By automating the process of soil moisture monitoring, farmers can optimize water usage, improve crop yields, and reduce the risk of plant diseases associated with over or under-watering. Key technologies employed in the system include the Capacitive Soil Moisture Sensor V1.2 for accurate soil moisture measurement, the Node MCU ESP8266-12E Board for data transmission and communication, and the Arduino framework for programming and development. Additionally, machine learning algorithms are utilized to analyze the collected data and provide actionable insights. Cloud storage is utilized to store and manage the data collected from multiple sensors, allowing for easy access and retrieval of information. Overall, the IoT-based soil moisture monitoring system offers a scalable and efficient solution for indoor plant care, with potential applications in agriculture and beyond. By harnessing the power of IoT and machine learning, the system empowers users to make informed decisions about plant watering, leading to healthier and more vibrant indoor environments.Keywords: IoT-based, soil moisture monitoring, indoor plants, water management
Procedia PDF Downloads 432601 An Educational Electronic Health Record with a Configurable User Interface
Authors: Floriane Shala, Evangeline Wagner, Yichun Zhao
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Background: Proper educational training and support are proven to be major components of EHR (Electronic Health Record) implementation and use. However, the majority of health providers are not sufficiently trained in EHR use, leading to adverse events, errors, and decreased quality of care. In response to this, students studying Health Information Science, Public Health, Nursing, and Medicine should all gain a thorough understanding of EHR use at different levels for different purposes. The design of a usable and safe EHR system that accommodates the needs and workflows of different users, user groups, and disciplines is required for EHR learning to be efficient and effective. Objectives: This project builds several artifacts which seek to address both the educational and usability aspects of an educational EHR. The artifacts proposed are models for and examples of such an EHR with a configurable UI to be learned by students who need a background in EHR use during their degrees. Methods: Review literature and gather professional opinions from domain experts on usability, the use of workflow patterns, UI configurability and design, and the educational aspect of EHR use. Conduct interviews in a semi-casual virtual setting with open discussion in order to gain a deeper understanding of the principal aspects of EHR use in educational settings. Select a specific task and user group to illustrate how the proposed solution will function based on the current research. Develop three artifacts based on the available research, professional opinions, and prior knowledge of the topic. The artifacts capture the user task and user’s interactions with the EHR for learning. The first generic model provides a general understanding of the EHR system process. The second model is a specific example of performing the task of MRI ordering with a configurable UI. The third artifact includes UI mock-ups showcasing the models in a practical and visual way. Significance: Due to the lack of educational EHRs, medical professionals do not receive sufficient EHR training. Implementing an educational EHR with a usable and configurable interface to suit the needs of different user groups and disciplines will help facilitate EHR learning and training and ultimately improve the quality of patient care.Keywords: education, EHR, usability, configurable
Procedia PDF Downloads 1512600 Cocrystals of Etodolac: A Crystal Engineering Approach with an Endeavor to Enhance Its Biopharmaceutical Assets
Authors: Sakshi Tomar, Renu Chadha
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Cocrystallization comprises a selective route to the intensive design of pharmaceutical products with desired physiochemical and pharmacokinetic properties. The present study is focused on the preparation, characterization, and evaluation of etodolac (ET) co-crystals with coformers nicotinamide (ETNI) and Glutaric acid (ETGA), using cocrystallization approach. Preliminarily examination of the prepared co-crystal was done by differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR), powder X-ray diffraction (PXRD). DSC thermographs of ETNI and ETGA cocrystals showed single sharp melting endotherms at 144°C and 135°C, respectively, which were different from the melting of drugs and coformers. FT-IR study points towards carbonyl-acid interaction sandwiched between the involving molecules. The emergence of new peaks in the PXRD pattern confirms the formation of new crystalline solid forms. Both the cocrystals exhibited better apparent solubility, and 3.8-5.0 folds increase in IDR were established, as compared to pure etodolac. Evaluations of these solid forms were done using anti-osteoarthritic activities. All the results indicate that etodolac cocrystals possess better anti-osteoarthritic efficacy than free drug. Thus loom of cocrystallization has been found to be a viable approach to resolve the solubility and bioavailability issues that circumvent the use of potential antiosteoarthritic molecules.Keywords: bioavailability, etodolac, nicotinamide, osteoarthritis
Procedia PDF Downloads 1942599 Advanced Approach to Analysis the Thin Strip Profile in Cold Rolling of Pair Roll Crossing and Shifting Mill Using an Arbitrary Lagrangian-Eulerian Technique
Authors: Abdulrahman Aljabri, Essam R. I. Mahmoud, Hamad Almohamedi, Zhengyi Jiang
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Cold rolled thin strip has received intensive attention through technological and theoretical progress in the rolling process, as well as researchers have focused on its control during rolling as an essential parameter for producing thinner strip with good shape and profile. An advanced approach has been proposed to analysis the thin strip profile in cold rolling of pair roll crossing and shifting mill using Finite Element Analysis (FEA) with an ALE technique. The ALE (Arbitrary Lagrangian-Eulerian) techniques to enable more flexibility of the ALE technique in the adjustment of the finite element mesh, which provides a significant tool for simulating the thin strip under realistic rolling process constraint and provide accurate model results. The FEA can provide theoretical basis for the 3D model of controlling the strip shape and profile in thin strip rolling, and deliver an optimal rolling process parameter, and suggest corrective changes during cold rolling of thin strip.Keywords: pair roll crossing, work roll shifting, strip shape and profile, finite element modeling
Procedia PDF Downloads 902598 Exploring the Physical Environment and Building Features in Earthquake Disaster Areas
Authors: Chang Hsueh-Sheng, Chen Tzu-Ling
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Earthquake is an unpredictable natural disaster and intensive earthquakes have caused serious impacts on social-economic system, environmental and social resilience. Conventional ways to mitigate earthquake disaster are to enhance building codes and advance structural engineering measures. However, earthquake-induced ground damage such as liquefaction, land subsidence, landslide happen on places nearby earthquake prone or poor soil condition areas. Therefore, this study uses spatial statistical analysis to explore the spatial pattern of damaged buildings. Afterwards, principle components analysis (PCA) is applied to categorize the similar features in different kinds of clustered patterns. The results show that serious landslide prone area, close to fault, vegetated ground surface and mudslide prone area are common in those highly damaged buildings. In addition, the oldest building might not be directly referred to the most vulnerable one. In fact, it seems that buildings built between 1974 and 1989 become more fragile during the earthquake. The incorporation of both spatial statistical analyses and PCA can provide more accurate information to subsidize retrofit programs to enhance earthquake resistance in particular areas.Keywords: earthquake disaster, spatial statistic analysis, principle components analysis (pca), clustered patterns
Procedia PDF Downloads 3062597 An Experiential Learning of Ontology-Based Multi-document Summarization by Removal Summarization Techniques
Authors: Pranjali Avinash Yadav-Deshmukh
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Remarkable development of the Internet along with the new technological innovation, such as high-speed systems and affordable large storage space have led to a tremendous increase in the amount and accessibility to digital records. For any person, studying of all these data is tremendously time intensive, so there is a great need to access effective multi-document summarization (MDS) systems, which can successfully reduce details found in several records into a short, understandable summary or conclusion. For semantic representation of textual details in ontology area, as a theoretical design, our system provides a significant structure. The stability of using the ontology in fixing multi-document summarization problems in the sector of catastrophe control is finding its recommended design. Saliency ranking is usually allocated to each phrase and phrases are rated according to the ranking, then the top rated phrases are chosen as the conclusion. With regards to the conclusion quality, wide tests on a selection of media announcements are appropriate for “Jammu Kashmir Overflow in 2014” records. Ontology centered multi-document summarization methods using “NLP centered extraction” outshine other baselines. Our participation in recommended component is to implement the details removal methods (NLP) to enhance the results.Keywords: disaster management, extraction technique, k-means, multi-document summarization, NLP, ontology, sentence extraction
Procedia PDF Downloads 3782596 Fostering Fresh Graduate Students’ Confidence in Speaking English: An Action Research to Students of Muria Kudus University, Central Java, Indonesia
Authors: Farid Noor Romadlon
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Welcoming the ASEAN Economic Community and globalization, people need to have a good communication skill. Being able to speak English is one of important qualification in this skill and as global citizen. This study focused on fostering fresh graduate students’ confidence in speaking English. So, students have good performance in speaking. There were thirty (30) students from first semester of English Education Department who joined Intensive Course class as the subject. They had poor motivation to speak English since English is a foreign language which is not exposed in their environment. This study used Three Communicative Activities technique in twelve successive meetings totally. It was done in two cycles (six meetings for each) since there were some activities should be improved in the first session (cycle). Oral test was administered to find the quantitative result and observation conducted to strengthen the finding. The result indicated that Three Communicative Activities improved students’ confidence in speaking English. They had significant progress in their performance in the class. The technique which allowed students to have more spaces to explore and express their ideas to their friends increased their confidence in their performance. The group or cooperative activities stimulated students to think critically in the discussion and promoted their confidence to talk more.Keywords: students’ confidence, three communicative activities, speaking, Muria Kudus University
Procedia PDF Downloads 2062595 The Use of Modern Technology to Enhance English Language Teaching and Learning: An Analysis
Authors: Fazilet Alachaher (Benzerdjeb)
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From the chalkboard to the abacus and beyond, technology has always played an important role in education. Educational technology refers to any teaching tool that helps supports learning, and given the rapid advancements in Information Technology and multimedia applications, the potential to support the teaching of foreign languages in our universities is ever greater. In language teaching and learning, we have a lot of to choose from the world of technology: TV, CDs, DVDs, Computers, the Internet, Email, and Blogs. The use of modern technologies can enrich the experience of learning a foreign language because they provide features that are not present in traditional technology. They can offer a wide range of multimedia resources, opportunities for intensive one-to-one learning in language labs and resources for authentic materials, which can be motivating to both students and teachers. The advent of Information and Communication Technology (ICT) and online interaction can also open up new range of self-access and distance learning opportunities The two last decades have witnessed a revolution due to the onset of technology, and has changed the dynamics of various industries, and has also influenced the way people live and work in society. That is why using the multimedia to create a certain context to teach English has its unique advantages. This paper tries then to analyse the necessity of multimedia technology to language teaching and brings out the problems faced by using these technologies. It also aims at making English teachers aware of the strategies to use it in an effective manner.Keywords: strategies English teaching, multimedia technology, advantages, disadvantages, English learning
Procedia PDF Downloads 450