Search results for: irrigation level
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 12966

Search results for: irrigation level

10776 Low-Level Forced and Ambient Vibration Tests on URM Building Strengthened by Dampers

Authors: Rafik Taleb, Farid Bouriche, Mehdi Boukri, Fouad Kehila

Abstract:

The aim of the paper is to investigate the dynamic behavior of an unreinforced masonry (URM) building strengthened by DC-90 dampers by ambient and low-level forced vibration tests. Ambient and forced vibration techniques are usually applied to reinforced concrete or steel buildings to understand and identify their dynamic behavior, however, less is known about their applicability for masonry buildings. Ambient vibrations were measured before and after strengthening of the URM building by DC-90 dampers system. For forced vibration test, a series of low amplitude steady state harmonic forced vibration tests were conducted after strengthening using eccentric mass shaker. The resonant frequency curves, mode shapes and damping coefficients as well as stress distribution in the steel braces of the DC-90 dampers have been investigated and could be defined. It was shown that the dynamic behavior of the masonry building, even if not regular and with deformable floors, can be effectively represented. It can be concluded that the strengthening of the building does not change the dynamic properties of the building due to the fact of low amplitude excitation which do not activate the dampers.

Keywords: ambient vibrations, masonry buildings, forced vibrations, structural dynamic identification

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10775 Sustainable Adaptation: Social Equity and Local-Level Climate Adaptation Planning in U.S. Cities

Authors: Duran Fiack, Jeremy Cumberbatch, Michael Sutherland, Nadine Zerphey

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Civic leaders have increasingly relied upon local climate adaptation plans to identify vulnerabilities, prioritize goals, and implement actions in order to prepare cities for the present and projected effects of global climate change. The concept of sustainability is central to these efforts, as climate adaptation discussions are often framed within the context of economic resilience, environmental protection, and the distribution of climate change impacts across various socioeconomic groups. For urban centers, the climate change issue presents unique challenges for each of these dimensions; however, its potential impacts on marginalized populations are extensive. This study draws from the ‘just sustainabilities’ framework to perform a qualitative analysis of climate adaptation plans prepared by 22 of the 100 largest U.S. cities and examine whether, and to what extent, such initiatives prioritize social equity improvements. Past research has found that the integration of sustainability in urban policy and planning often produces outcomes that favor environmental and economic objectives over social equity improvements. We find that social equity is a particularly prominent theme in local-level climate adaptation efforts, relative to environmental quality and economic development. The findings contribute to the literature on climate adaptation and sustainability within the urban context and offer practical insight for local-level stakeholders concerning potential obstacles and opportunities for the integration of social equity initiatives into climate adaptation planning. Given the likelihood that climate changes will continue to impose unique challenges for marginalized communities in urban areas, advancing our understanding of how social equity concerns are integrated into adaptation efforts is likely to become an increasingly critical area of inquiry.

Keywords: climate adaptation plan, climate change, social equity, sustainability

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10774 Estimation of Level of Pesticide in Recurrent Pregnancy Loss and Its Correlation with Paraoxanase1 Gene in North Indian Population

Authors: Apurva Singh, S. P. Jaiswar, Apala Priyadarshini, Akancha Pandey

Abstract:

Objective: The aim of this study is to find the association of PON1 gene polymorphism with pesticides In RPL subjects. Background: Recurrent pregnancy loss (RPL) is defined as three or more sequential abortions before the 20th week of gestation. Pesticides and its derivatives (organochlorine and organophosphate) are proposed to accommodate a ruler chemical for RPL in the sub-humid region of India. The paraoxonase-1 enzyme (PON1) plays an important role in the toxicity of some organophosphate pesticides, with low PON1 activity being associated with higher pesticide sensitivity Methodology: This is a case-control study done in Department of Obstetrics & Gynaecology & Department of Biochemistry, K.G.M.U, Lucknow, India. The subjects were enrolled after fulfilling the inclusion & exclusion criteria. Inclusion criteria: Cases- Subject having two or more spontaneous abortions & Control- Healthy female having one or more alive child was selected. Exclusion criteria: Cases & Control- Subject having the following disease will be excluded from the study Diabetes mellitus, Hypertension, Tuberculosis, Immunocompromised patients, any endocrine disorder and genital, colon or breast cancer any other malignancies. Blood samples were collected in EDTA tubes from cases & healthy control women & genomic DNA was extracted by phenol-chloroform method. The estimation of pesticides residue from blood was done by HPLC. Biochemical estimation was also performed. Genotyping of PON1 gene polymorphism was performed by RFLP. Statistical analysis of the data was performed using the SPSS16.3 software. Results: A sum of total 14 pesticides (12 organochlorine and 2 organophosphate) selected on the basis of their persistent nature and consumption rate. The significant level of pesticide (ppb) estimated by the Mann whiney test and it was found to be significant at higher level of β-HCH (p:0.04), γ-HCH (p:0.001), δ-HCH (p: 0.002), chloropyrifos (p:0.001), pp-DDD (p:0.001) and fenvalrate (p: 0.001) in case group compare to its control. The level of antioxidant enzymes were found to be significantly decreased among the cases. Wild homozygous TT was more frequent and prevalent among control groups. However, heterozygous group (Tt) was more in cases than control groups (CI-0.3-1.3) (p=0.06). Conclusion: Higher levels of pesticides with endocrine disrupting potential in cases indicate the possible role of these compounds as one of the causes of recurrent pregnancy loss. Possibly, increased pesticide level appears to indicate increased levels of oxidative damage that has been associated with the possible cause of Recurrent Miscarriage, it may reflect indirect evidence of toxicity rather than the direct cause. Since both factors are reported to increase risk, individuals with higher levels of these 'Toxic compounds' especially in 'high-risk genotypes' might be more susceptible to recurrent pregnancy loss.

Keywords: paraoxonase, pesticides, PON1, RPL

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10773 Motivating EFL Students to Speak English through Flipped Classroom Implantation

Authors: Mohamad Abdullah

Abstract:

Recent Advancements in technology have stimulated deep change in the language learning classroom. Flipped classroom as a new pedagogical method is at the center of this change. It turns the classroom into a student-centered environment and promotes interactive and autonomous learning. The present study is an attempt to examine the effectiveness of the Flipped Classroom Model (FCM) on students’ motivation level in English speaking performance. This study was carried out with 27 undergraduate female English majors who enrolled in the course of Advanced Communication Skills (ENGL 154) at Buraimi University College (BUC). Data was collected through Motivation in English Speaking Performance Questionnaire (MESPQ) which has been distributed among the participants of this study pre and post the implementation of FCM. SPSS was used for analyzing data. The Paired T-Test which was carried out on the pre-post of (MESPQ) showed a significant difference between them (p < .009) that revealed participants’ tendency to increase their motivation level in English speaking performance after the application of FCM. In addition, respondents of the current study reported positive views about the implementation of FCM.

Keywords: english speaking performance, motivation, flipped classroom model, learner-contentedness

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10772 The Clinical Characteristics and Their Relationship with Sleep Disorders in Patients with Parkinson Disease Accompanied with Cognitive Impairment

Authors: Peng Guo

Abstract:

Objective To investigate the clinical characteristics and changes of video-polysomnography (v-PSG) in Parkinson disease (PD) patients accompanied with cognitive impairment. Methods Three hundred and ninety-four patients with PD were enrolled in Beijing Tiantan Hospital, according to CI level, the patients were divided into PD without cognitive impairment (PD-NCI), PD with mild cognitive impairment (PD-MCI), and PD with dementia (PDD) group. Collect patient's demographic data, including gender, onset age, education level and duration. The cognitive function of PD patients was evaluated by Montreal cognitive assessment (MoCA) scale, and the overall cognitive function and cognitive domains of the three groups were compared.Using v-PSG to assess the sleep status of patients. Correlation analysis of MoCA Scale and v-PSG results in PD-CI group. Results 1. In 394 cases of PD, 94 cases (23.86%) in PD-NCI group , 177 cases(44.92%) in PD-MCI group , 123 cases (31.22%) in PDD group. 2.There was no significant difference in gender, age of onset, education level and duration in PD-NCI group, PD-MCI group and PDD group (P>0.05). 3. The total score of MoCA scale in PD-NCI group, PD-MCI group and PDD group decreased one by one. In PD-NCI group, PD-MCI group and PDD group, the scores of each cognitive domain in MoCA scale decreased significantly(P<0.05). 4.Compared with the PD-MCI group, PDD group had lower total sleep time, lower sleep efficiency (P<0.05). Compared with PD-NCI group, PDD group had lower total sleep time and lower sleep efficiency (P<0.05).5. The sleep efficiency of PD-CI patients is positively correlated with the total score of MoCA scale, visual spatial function, executive function, delayed recall and attention score(P<0.05). Conclusions The incidence of CI in PD patients was high; The cognitive function and cognitive domains of PD-CI patients were significantly impaired; In patients with PD-CI, total sleep time decreased, sleep efficiency decreased, and it was related to overall cognitive function and partial cognitive impairment.

Keywords: Parkinson disease, cognitive impairment, clinical characteristics, sleep disorders, video-polysomnography

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10771 Accountant Strategists Challenge the Dominant Business Model: A Strategy-as-Practice Perspective

Authors: Lindie Grebe

Abstract:

This paper reports on a study that explored the strategizing practices of professional accountants in the mining industry, based on Jarratt and Stiles’ dominant strategizing practice models framework. Drawing on a strategy-as-practice perspective, the paper recognises qualified professional accountants in strategic management such as Chief Executive Officers, as strategy practitioners that perform their strategizing practices and praxis within a specific context. The main findings of this paper were produced through semi-structured individual interviews with accountants that perform strategy on a business level in the South African mining industry. Qualitative data were analysed through conversation analysis over two coding-cycles. Findings describe accountant strategists as practitioners who challenge the dominant business model when a disconnect seems to exist between international corporate level strategy and business level strategy in the South African mining industry. Accountant strategy practitioners described their dominant strategizing practice model as incremental change during strategic planning and as a lived experience during strategy implementation. Findings portrayed these strategists as taking initiative as strategy leaders in a dynamic and volatile environment to combine their accounting background with strategic management and challenge the dominant business model. Understanding how accountant strategists perform strategizing offers insight into the social practice of strategic management. This understanding contributes to the body of knowledge on strategizing in the South African mining industry. In addition, knowledge on the transformation of accountants as strategists could provide valuable practice relevant insights for accounting educators and the accounting profession alike.

Keywords: accountant strategists, dominant strategizing practice models framework, mining industry, strategy-as-practice

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10770 Dimensions of Public Spaces in Indian Market Places Feelings through Human Senses

Authors: Piyush Hajela

Abstract:

Public spaces in Indian market places are vibrant, colorful and carry latent dimensions that make them attractive and popular gathering spaces. These markets satisfy the household needs of the people and also their social, cultural and traditional aspirations. Going to a market place for shopping in India is a great source of entertainment for the people. They would love to spend as much time as possible and stay for longer durations than otherwise required. It is this desire of the people that generates public spaces. Much of these public spaces emerge as squares, plazas, corners of varied shapes and sizes at different locations, and yet provide a conducive environment. Such public spaces grow organically and are discovered by the people themselves. Indian markets serve people of different culture, religion, caste, age, gender which keeps them alive all the year round. Indian is a diverse country and this diversity is reflected clearly in the market places. They hold the people together and promote harmony across cultures. Free access to these market places makes them magnets for social interaction. Public spaces are spread across a city and more or less have established their existence and prominence in a social set up. While few of them are created, others are discovered by the people themselves in their constant search for desirable interactive public spaces. These are the most sought after gathering spaces that have the quality of promoting social interaction, providing free accessibility, provide desirable scale etc. The paper aims at identifying these freely accessible public spaces and the dimensions within it that make these public spaces hold the people for significant duration of time. The dimensions present shall be judged through collective response of human senses in form of safety, comfort and so on through the expressions of the participants. The aim therefore would be to trace the freely accessible public spaces emerged in Indian markets and evaluate them for human response and behavior. The hierarchy of market places in the city of Bhopal is well established as, city center level, sub city-center level, community level, local and convenient level market places. While many city-centers are still referred to as the old or traditional or the core area of the city, the others are part of the planned city. These different levels of market places are studied for emerged public spaces. These emerged public spaces are then documented in detail for unveiling the dimensions they offer through, photographs, visual observations, questionnaires and response of the participants of these public spaces.

Keywords: human comfort, enclosure, safety, social interaction

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10769 The Customer Expectations of Service Provided in a Banpaew Hospital Samutsakorn

Authors: Chanpen Meenakorn

Abstract:

This research aimed to examine the relationships between customer expectations and service quality management of Banpaew Hospital Samutsakorn in Thailand. The study sample consisted of 360 customers in patient unit. Data were collected using self-administered questionnaire. Descriptive statistics used were percentage, mean, and standard deviation. The analytical statistics comprised Pearson’s product moment correlation coefficient analysis. The result showed that service quality of nurses was very good with sustainable development trend. Physical evidence was at a high level, and the process and personal were rated at a high level. Additional, the study suggested that head nurse should be encouraged to improve service quality management, management training. Nurse administrators should create an appropriate nursing department climate, and provide necessary resources in the department. In addition, the nurse administrators should continuously follow up the results of customer expectations and focus on patients/customers, process management, information and knowledge management, and evaluation of service quality also.

Keywords: Banpaew Hospital, Customer Expectations, Service Provided, Samutsakorn

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10768 The Diverse and Flexible Coping Strategies Simulation for Maanshan Nuclear Power Plant

Authors: Chin-Hsien Yeh, Shao-Wen Chen, Wen-Shu Huang, Chun-Fu Huang, Jong-Rong Wang, Jung-Hua Yang, Yuh-Ming Ferng, Chunkuan Shih

Abstract:

In this research, a Fukushima-like conditions is simulated with TRACE and RELAP5. Fukushima Daiichi Nuclear Power Plant (NPP) occurred the disaster which caused by the earthquake and tsunami. This disaster caused extended loss of all AC power (ELAP). Hence, loss of ultimate heat sink (LUHS) happened finally. In order to handle Fukushima-like conditions, Taiwan Atomic Energy Council (AEC) commanded that Taiwan Power Company should propose strategies to ensure the nuclear power plant safety. One of the diverse and flexible coping strategies (FLEX) is a different water injection strategy. It can execute core injection at 20 Kg/cm2 without depressurization. In this study, TRACE and RELAP5 were used to simulate Maanshan nuclear power plant, which is a three loops PWR in Taiwan, under Fukushima-like conditions and make sure the success criteria of FLEX. Reducing core cooling ability is due to failure of emergency core cooling system (ECCS) in extended loss of all AC power situation. The core water level continues to decline because of the seal leakage, and then FLEX is used to save the core water level and make fuel rods covered by water. The result shows that this mitigation strategy can cool the reactor pressure vessel (RPV) as soon as possible under Fukushima-like conditions, and keep the core water level higher than Top of Active Fuel (TAF). The FLEX can ensure the peak cladding temperature (PCT) below than the criteria 1088.7 K. Finally, the FLEX can provide protection for nuclear power plant and make plant safety.

Keywords: TRACE, RELAP5/MOD3.3, ELAP, FLEX

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10767 The Investigation of Correlation between Body Composition and Physical Activity in University Students

Authors: Ferruh Taspinar, Gulce K. Seyyar, Gamze Kurt, Eda O. Okur, Emrah Afsar, Ismail Saracoglu, Betul Taspinar

Abstract:

Alterations of physical activity can effect body composition (especially body fat ratio); however body mass index may not sufficient to indicate these minimal differences. The aim of this study was to evaluate the relationship between body composition and physical activity in university students. In this study, 132 university students (mean age; 21.21±1.51) were included. Tanita BC-418 and International Physical Activity Questionnaire (IPAQ) were used to evaluate participants. The correlation between the parameters was analysed via Spearman correlation analysis. Significance level in statistical analyses was accepted is 0.05. The results showed that there was no correlation between body mass index and physical activity (p>0.05). There was a positive correlation between body muscle ratio and physical activity, whereas a negative correlation between body fat ratio and physical activity (p<0.05). This study showed that body fat and muscle ratio affects the level of physical activity in healthy university students. Therefore, we thought that physical activity might reduce effects of the diseases caused by disturbed body composition. Further studies are required to support this idea.

Keywords: body composition, body mass index, physical activity, university student

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10766 Research Writing Anxiety among Engineering Postgraduate Students in Taiwan

Authors: Mei-Ching Ho

Abstract:

Graduate-level writing practices have gained increasing scholarly attention in recent years. Due to its discipline-specific conventions and requirements, research writing can cause various levels of anxiety for native English speaking and English as a second/foreign language (ESL/EFL) postgraduate students. Although many studies have investigated how writing anxiety can negatively affect writing performance, self-efficacy, and disciplinary discourse socialization process, relatively few have examined the impact of writing anxiety from the perspectives of postgraduate students in EFL contexts. This study aims to 1) examine the level of and the relationship between research writing anxiety and self-efficacy among Taiwanese EFL students at the master's and doctoral levels and 2) to uncover the causes of students' research writing anxiety. The data was collected from an adapted version of Second Language Writing Anxiety Inventory (SLWAI) and Research Writing Self-Efficacy Scale with 218 EFL graduate students in engineering-related fields at two research-oriented universities in Taiwan. A pilot study was conducted to ensure the construct and content validity of the instruments. Semi-structured interviews were also undertaken with 30 survey respondents to better understand the causes of their writing anxiety. The results revealed that while both master's and doctoral students had low to moderate research writing anxiety and self-efficacy, the doctoral students with more experiences in writing research papers in English were more anxious but not necessarily more confident than the master's students. A significantly weak negative correlation was found between the two constructs. The contributing factors for these results include different degree of writing exigency, perceived importance and types of writing tasks, writing for publication as graduation thresholds, and mentoring relationship with thesis/dissertation advisers. The study also identified several causes of graduate-level writing anxiety, of which writing under time constraints and concern on linguistic and rhetorical proficiency appeared to be the major concern. Pedagogical implications regarding facilitating graduate students' writing process and reducing anxiety will also be drawn.

Keywords: writing affect, writing anxiety, writing self-efficacy, EFL, postgraduate students

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10765 Machine Learning in Agriculture: A Brief Review

Authors: Aishi Kundu, Elhan Raza

Abstract:

"Necessity is the mother of invention" - Rapid increase in the global human population has directed the agricultural domain toward machine learning. The basic need of human beings is considered to be food which can be satisfied through farming. Farming is one of the major revenue generators for the Indian economy. Agriculture is not only considered a source of employment but also fulfils humans’ basic needs. So, agriculture is considered to be the source of employment and a pillar of the economy in developing countries like India. This paper provides a brief review of the progress made in implementing Machine Learning in the agricultural sector. Accurate predictions are necessary at the right time to boost production and to aid the timely and systematic distribution of agricultural commodities to make their availability in the market faster and more effective. This paper includes a thorough analysis of various machine learning algorithms applied in different aspects of agriculture (crop management, soil management, water management, yield tracking, livestock management, etc.).Due to climate changes, crop production is affected. Machine learning can analyse the changing patterns and come up with a suitable approach to minimize loss and maximize yield. Machine Learning algorithms/ models (regression, support vector machines, bayesian models, artificial neural networks, decision trees, etc.) are used in smart agriculture to analyze and predict specific outcomes which can be vital in increasing the productivity of the Agricultural Food Industry. It is to demonstrate vividly agricultural works under machine learning to sensor data. Machine Learning is the ongoing technology benefitting farmers to improve gains in agriculture and minimize losses. This paper discusses how the irrigation and farming management systems evolve in real-time efficiently. Artificial Intelligence (AI) enabled programs to emerge with rich apprehension for the support of farmers with an immense examination of data.

Keywords: machine Learning, artificial intelligence, crop management, precision farming, smart farming, pre-harvesting, harvesting, post-harvesting

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10764 Operation Strategy of Multi-Energy Storage System Considering Power System Reliability

Authors: Wook-Won Kim, Je-Seok Shin, Jin-O Kim

Abstract:

As the penetration of Energy Storage System (ESS) increases in the power system due to higher performance and lower cost than ever, ESS is expanding its role to the ancillary service as well as the storage of extra energy from the intermittent renewable energy resources. For multi-ESS with different capacity and SOC level each other, it is required to make the optimal schedule of SOC level use the multi-ESS effectively. This paper proposes the energy allocation method for the multiple battery ESS with reliability constraint, in order to make the ESS discharge the required energy as long as possible. A simple but effective method is proposed in this paper, to satisfy the power for the spinning reserve requirement while improving the system reliability. Modelling of ESS is also proposed, and reliability is evaluated by using the combined reliability model which includes the proposed ESS model and conventional generation one. In the case study, it can be observed that the required power is distributed to each ESS adequately and accordingly, the SOC is scheduled to improve the reliability indices such as Loss of Load Probability (LOLP) and Loss of Load Expectation (LOLE).

Keywords: multiple energy storage system (MESS), energy allocation method, SOC schedule, reliability constraints

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10763 Artificial Intelligence: Obstacles Patterns and Implications

Authors: Placide Poba-Nzaou, Anicet Tchibozo, Malatsi Galani, Ali Etkkali, Erwin Halim

Abstract:

Artificial intelligence (AI) is a general-purpose technology that is transforming many industries, working life and society by stimulating economic growth and innovation. Despite the huge potential of benefits to be generated, the adoption of AI varies from one organization to another, from one region to another, and from one industry to another, due in part to obstacles that can inhibit an organization or organizations located in a specific geographic region or operating in a specific industry from adopting AI technology. In this context, these obstacles and their implications for AI adoption from the perspective of configurational theory is important for at least three reasons: (1) understanding these obstacles is the first step in enabling policymakers and providers to make an informed decision in stimulating AI adoption (2) most studies have investigating obstacles or challenges of AI adoption in isolation with linear assumptions while configurational theory offers a holistic and multifaceted way of investigating the intricate interactions between perceived obstacles and barriers helping to assess their synergetic combination while holding assumptions of non-linearity leading to insights that would otherwise be out of the scope of studies investigating these obstacles in isolation. This study aims to pursue two objectives: (1) characterize organizations by uncovering the typical profiles of combinations of 15 internal and external obstacles that may prevent organizations from adopting AI technology, (2) assess the variation in terms of intensity of AI adoption associated with each configuration. We used data from a survey of AI adoption by organizations conducted throughout the EU27, Norway, Iceland and the UK (N=7549). Cluster analysis and discriminant analysis help uncover configurations of organizations based on the 15 obstacles, including eight external and seven internal. Second, we compared the clusters according to AI adoption intensity using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. The study uncovers three strongly separated clusters of organizations based on perceived obstacles to AI adoption. The clusters are labeled according to their magnitude of perceived obstacles to AI adoption: (1) Cluster I – High Level of perceived obstacles (N = 2449, 32.4%)(2) Cluster II – Low Level of perceived obstacles (N =1879, 24.9%) (3) Cluster III – Moderate Level of perceived obstacles (N =3221, 42.7%). The proposed taxonomy goes beyond the normative understanding of perceived obstacles to AI adoption and associated implications: it provides a well-structured and parsimonious lens that is useful for policymakers, AI technology providers, and researchers. Surprisingly, the ANOVAs revealed a “high level of perceived obstacles” cluster associated with a significantly high intensity of AI adoption.

Keywords: Artificial intelligence (AI), obstacles, adoption, taxonomy.

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10762 Tajwīd and Mawwāl Toward Khushūʿ in Islam and Tarab in Arab Music: Common Musical Elements

Authors: Mohammad Moussa Khalaf

Abstract:

As a significant term in Arab music, ṭarab identifies a particular expression of feelings and emotions, especially in the vocal practice of Arab music. Ṭarab aims to take both the performer and the audience from a normal feeling state to a new state of spiritual feeling through the art of mawwāl. Because of the expertise required for mawwāl, the ability to reach ṭarab has long been considered an indication that a musician has reached a high musical level. Another significant Islamic concept related to feelings and emotions is khushūʿ. It is known that one of the ways to get Khāsheʿ (humble to God) is the artistic reading of the holy Qur’ān. The artistic recitation of the Qur’ān is tajwīd. Like mawwāl, tajwīd requires a high-level rendition to lead the listener to the special emotional state. The research will focus on the relationships between ṭarab, khushūʿ, tajwīd, and mawwāl in Islamic-Arab culture in a way that has not been addressed previously. The relationships between tajwid and mawwāl, ṭarab and khushūʿ would be identified through the examination of musical factors, socio-cultural factors, and emotional factors.

Keywords: Arab music, Ṭarab, Mawwāl, Khushūʿ, Tajwīd, Islam

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10761 Utilization of Kitchen Waste inside Green House Chamber: A Community Level Biogas Programme

Authors: Ravi P. Agrahari

Abstract:

The present study was undertaken with the objective of evaluating kitchen waste as an alternative organic material for biogas production in community level biogas plant. The field study was carried out for one month (January 19, 2012– February 17, 2012) at Centre for Energy Studies, IIT Delhi, New Delhi, India. This study involves the uses of greenhouse canopy to increase the temperature for the production of biogas in winter period. In continuation, a semi-continuous study was conducted for one month with the retention time of 30 days under batch system. The gas generated from the biogas plant was utilized for cooking (burner) and lighting (lamp) purposes. Gas productions in the winter season registered lower than other months. It can be concluded that the solar greenhouse assisted biogas plant can be efficiently adopted in colder region or in winter season because temperature plays a major role in biogas production. 

Keywords: biogas, green house chamber, organic material, solar intensity, batch system

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10760 Hematuria Following Magnesium Sulfate Administration in a Pregnant Patient with Renal Tubular Acidosis

Authors: Jan Gayl Barcelon, N. Gorgonio

Abstract:

Renal tubular acidosis, a medical condition that involves the accumulation of acid in the body due to failure of the kidneys to maintain normal urine and blood pH, is rarely encountered in pregnancy. The effect of renal tubular acidosis in pregnancy is not fully established. It may worsen during pregnancy and cause maternal and fetal morbidity. A 30-year-old primigravida was diagnosed with renal tubular acidosis at age 7, but due to uncontrolled disease progression, she developed rickets at age 10. She was first seen in our institution at eight weeks gestation and maintained on bicarbonate and potassium supplementation. At 26 weeks gestation, she was diagnosed with polyhydramnios, causing on and off irregular uterine contractions. At 30 weeks gestation, despite oral Nifedipine, premature labor was uncontrolled; hence she was admitted for tocolysis. With elevated creatinine (123 umol/L) and a normal blood urea nitrogen level (6.70 mmol/L), she was referred to Nephrology Service, which cleared the patient prior to MgSO₄ drip. Dosing of 4g MgSO₄ over 20 minutes followed by a maintenance of 2g/hour x 24 hours for neuroprotection and tocolysis was ordered. Two hours after MgSO₄ drip initiation, hematuria developed with adequate urine output. The infusion was immediately stopped. The serum magnesium level was high normal at 6.7 mEq/L. After 4 hours of renal clearance, the repeat serum magnesium level was normal (2.7 mEq/L) and with clear urine output. The patient was then given Nifedipine 30mg/tab, 3x a day which controlled the uterine contractions. At 37 weeks gestation, the patient delivered via primary low transverse Cesarean Section to a live female with a birthweight of 2470gm, appropriate for gestational age. The use of MgSO₄ for the control of premature labor in patients with chronic renal disease secondary to renal tubular can cause hematuria.

Keywords: hematuria, magnesium sulfate, premature labor, renal tubular acidosis

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10759 Education of Mothers and Influence on the Development of Intrauterine Growth Restriction

Authors: Sabina Garayeva

Abstract:

To determine the significant risk factors for intrauterine growth restriction (IUGR), we carried out a thorough study of the social status of the parents of children with IUGR. We observed 315 mothers who gave birth to children with (IUGR), of which 172 mothers with asymmetric type and 143 mothers with symmetric type of IUGR. Through a detailed survey was gathered detailed information about education of parents. The results show that the majority of mothers with IUGR had secondary education (44,8 ± 2,8%), and fathers - higher education (35,2 ± 2,7%). Whereas in the control group, the largest number of parents had higher education (mother 35,3 ± 4,4%, fathers 42,9 ± 4,5%). Number of mothers with secondary education with IUGR was significantly (p1 <0,01; χ2 = 22,67) differs from the number of mothers with physiological pregnancy with the same level of education. Meanwhile, in the group with a symmetrical embodiment of IUGR mothers with secondary formation of significantly greater 53,1 ± 4,2%, than the asymmetric embodiment IUGR 37,8 ± 3,7% (p2 <0,05; χ2 = 8 06). Among fathers with secondary education significant difference was noted in the symmetric version of IUGR 37,8 ± 4,1% more than in the control group (p1 <0,05), and among parents of children with asymmetric IUGR option prevailed fathers with higher education - 37 2 ± 3,7%. Thus, our results revealed a low educational level of the mother as a risk factor for IUGR, which further help to develop preventive and therapeutic measures to eliminate the severity of its consequences. As seen from the data presented, mothers of children with asymmetric IUGR had a school education and fathers - higher education, while in the symmetric type of both parents had secondary education. It is found that frequency of children, born with IUGR, of mothers - housewives and fathers, engage in physical labor, was high. Thus, the analysis conducted by the social status of the parents with IUGR revealed a low level of education and unemployed mothers as risk factors for this disease, which in the future will help to develop preventive and therapeutic measures to eliminate the severity of its.

Keywords: intrauterine growth restriction, education of mothers, education influence, IUGR

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10758 ISSR-PCR Based Genetic Diversity Analysis on Copper Tolerant versus Wild Type Strains of Unicellular alga Chlorella Vulgaris

Authors: Abdullah M. Alzahrani

Abstract:

The unicellular alga Chlorella vulgaris was isolated from Al-Asfar Lake, which is located in the Al-Ahsa province of Saudi Arabia. Two different isolates were sub-cultured under laboratory conditions. The wild type was grown under a regular concentration of copper, whereas the other isolate was grown under a progressively increasing copper concentration. An Inter Simple Sequence Repeats (ISSR) analysis was performed using DNA isolated from the wild type and tolerant strains. The sum of the scored bands of the wild type was 155, with 100 (64.5%) considered to be polymorphic bands, whereas the resistant strain displayed 147 bands, with 92 (62.6%) considered to be polymorphic bands. The sum of the scored bands of a mixed sample was 117 bands, of which only 4 (3.4%) were considered to be polymorphic. The average Nei's genetic diversity (h) and Shannon-Weiner diversity indices (I) were 0.3891 and 0.5394, respectively. These results clearly indicate that the adaptation to a high level of copper in Chlorella vulgaris is not merely physiological but rather driven by modifications at the genomic level.

Keywords: chlorella vulgaris, copper tolerance, genetic diversity, green algae

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10757 Factors Influencing Walking in Bandar Baru Bangi, Malaysia

Authors: Zeinab Aliyas

Abstract:

Walking is known as the most common type of physical activity that helps mental and physical health of people. In the recent years, promoting walking activity in neighborhood areas and cities become as one of the important issues in terms of sustainable cities. Therefore the study aimed to investigate the influence of fear of crime and personal barriers as social and personal factor respectively on neighborhood walking. 464 questionnaires in Bandar Baru Bangi in Malaysia was distributed to collect data, and finally, 424 questionnaires were qualified to be used in the study. The Smart-PLS was used to analyze the data. The findings of the study revealed that individual barriers and fear of crime both have significant influence on the level of walking behavior in the neighborhood area. It was found that fear of crime has higher influence on walking behavior in comparison to individual factors. The finding of this study can help urban researcher and planner to know the significant influence of crime safety and individual attitudes on the level of walking activity.

Keywords: fear of crime, neighborhood walking, personal barriers, residential neighborhood

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10756 Elucidating the Defensive Role of Silicon-Induced Biochemical Responses in Wheat Exposed to Drought and Diuraphis noxia Infestation

Authors: Lintle Mohase, Ninikoe Lebusa, Mpho Stephen Mafa

Abstract:

Wheat is an economically important cereal crop. However, the changing climatic conditions that intensify drought in production areas, and additional pest infestation, such as the Russian wheat aphid (RWA, Diuraphis noxia), severely hamper its production. Drought and pest management require an additional water supply through irrigation and applying inorganic nutrients (including silicon) as alternative strategies to mitigate the stress effects. Therefore, other approaches are needed to enhance wheat productivity during drought stress and aphid abundance. Two wheat cultivars were raised under greenhouse conditions, exposed to drought stress, and treated with silicon before infestation with the South African RWA biotype 2 (RWASA2). The morphological evaluations showed that severe drought or a combination of drought and infestation significantly reduced the plant height of wheat cultivars. Silicon treatment did not alleviate the growth reduction. The biochemical responses were measured using spectrophotometric assays with specific substrates. An evaluation of the enzyme activities associated with oxidative stress and defence responses indicated that drought stress increased NADPH oxidase activity, while silicon treatment significantly reduced it in drought-stressed and infested plants. At 48 and 72 hours sampling periods, a combination of silicon, drought and infestation treatment significantly increased peroxidase activity compared to drought and infestation treatment. The treatment also increased β-1,3-glucanase activity 72 hours after infestation. In addition, silicon and drought treatment increased glucose but reduced sucrose accumulation. Furthermore, silicon, drought, and infestation treatment combinations reduced the sucrose content. Finally, silicon significantly increased the trehalose content under severe drought and infestation, evident at 48 and 72-hour sampling periods. Our findings shed light on silicon’s ability to induce protective biochemical responses during drought and aphid infestation.

Keywords: drought, enzyme activity, silicon, soluble sugars, Russian wheat aphid, wheat

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10755 The Management Accountant’s Roles for Creation of Corporate Shared Value

Authors: Prateep Wajeetongratana

Abstract:

This study investigates the management accountant’s roles that link with the creation of corporate shared value to enable more effective decision-making and improve the information needs of stakeholders. Mixed method is employed to collect using triangulation for credibility. A quantitative approach is employed to conduct a survey of 200 Thai companies providing annual reports in the Stock Exchange of Thailand. The results of the study reveal that environmental and social data incorporated in a corporate social responsibility (CSR) disclosure are based on the indicators of the Global Reporting Initiatives (GRI) at a statistically significant level of 0.01. Environmental and social indicators in CSR are associated with environmental and social data disclosed in the annual report to support stakeholders’ and the public’s interests that are addressed and show that a significant relationship between environmental and social in CSR disclosures and the information in annual reports is statistically significant at the 0.01 level.

Keywords: corporate social responsibility, creating shared value, management accountant’s roles, stock exchange of Thailand

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10754 Eating Disorders and Eating Behaviors in Morbid Obese Women with and without Type 2 Diabetes

Authors: Azadeh Mottaghi, Zeynab Shakeri

Abstract:

Background: Eating disorders (ED) are group of psychological disorders that significantly impair physical health and psychosocial function. EDconsists wide range of morbidity such as loss of eating control, binge eating disorder(BED), night eating syndrome (NES), and bulimia nervosa. Eating behavior is a wide range term that includes food choices, eating patterns, eating problems. In this study, current knowledge will be discussed aboutcomparison of eating disorders and eating behaviors in morbid obese women with and without type 2 diabetes. Methods: 231 womenwith morbid obesity were included in the study.Loss of eating control, Binge eating disorder and Bulimia nervosa, Night eating syndrome, and eating behaviors and psychosocial factorswere assessed. SPSS version 20 was used for statistical analysis. A p-value of <0.05 was considered significant. Results: There was a significant difference between women with and without diabetes in case of binge eating disorder (76.3% vs. 47.3%, p=0.001). Women with the least Interpersonal support evaluation list (ISEL) scores had a higher risk of eating disorders, and it is more common among diabetics (29.31% vs. 30.45%, p= 0.050). There was no significant difference between depression level and BDI score among women with or without diabetes. Although 38.5% (n=56) of women with diabetes and 50% (n=71) of women without diabetes had minimal depression. The logistic regression model has shown that women without diabetes had lower odds of exhibiting BED (OR=0.28, 95% CI 0.142-0.552).Women with and without diabetes with high school degree (OR=5.54, 95% CI 2.46-9.45, P= 0.0001 & OR=6.52, 95% CI 3.15-10.56, respectively) and moderate depression level (OR=2.03, 95% CI 0.98-3.95 & OR=3.12, 95% CI 2.12-4.56, P= 0.0001) had higher odds of BED. Conclusion: The result of the present study shows that the odds of BED was lower in non-diabetic women with morbid obesity. Women with morbid obesity who had high school degree and moderate depression level had more odds for BED.

Keywords: eating disorders binge eating disorder, night eating syndrome, bulimia nervosa, morbid obesity

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10753 Dietary Intake, Serum Vitamin D Status, and Sun Exposure of Malaysian Women of Different Ethnicity

Authors: H. Z. M. Chong, M. E. Y. Leong, G. L. Khor, S. C. Loke

Abstract:

Vitamin D insufficiency is reported to be prevalent among women living in different altitudes including the equator where sunshine is available throughout the year. Multiple factors for vitamin D insufficiency include poor intake of vitamin D rich food and inadequate sun exposure, especially among women working indoor with a sedentary lifestyle. Furthermore, Muslim women in Malaysia whose attire covers the entire body are likely to receive poor sun exposure. This research determined serum vitamin D status, vitamin D intake and sun exposure of women aged 20-45 years of different ethnicity in Kuala Lumpur, Malaysia. Blood samples were collected from 106 women for determination of serum 25(OH)D levels. Information about vitamin D intake and sun exposure were obtained by interviewing the subjects using pre-tested questionnaires. The overall mean serum 25(OH)D was found to be 29.9 ± 14 nmol/L. Vitamin D deficiency and insufficiency was prevalent and highest among the Malay women. Less than ten percent of the subjects in this study met the sufficient vitamin D level recommendation of ≥50 nmol/L. Intake of vitamin D rich food such as oily fishes was poor across the different ethnicity. Other dietary sources of vitamin D in the diet were fortified bread and skim milk. On the other hand, the median sunlight exposure of the subjects was 3.9 hours per week. The Malay women reported to have the highest duration being exposed to the sun. Nevertheless, due to cultural clothing practices, these women had the least body surface area exposed to sunlight, resulting in the lowest calculated sun index score compared to the Chinese and the Indians. Low intake of vitamin D rich foods and sun exposure were negatively correlated with serum 25(OH)D level. In conclusion, intake of food sources rich in vitamin D and adequate body surface area exposed to the sun are essential to ensure healthy vitamin D level. Supplementation of vitamin D may be recommended to women whom unable to meet these recommendations.

Keywords: serum 25-OH, sun exposure, vitamin D food frequency, vitamin D deficiency

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10752 Maturity Model for Agro-Industrial Logistics

Authors: Erika Tatiana Ruiz, Wilson Adarme Jaimes

Abstract:

This abstract presents the methodology for improving the logistics processes of agricultural production units belonging to the coffee, cocoa, and fruit sectors, starting from the fundamental concepts and detailing each of the phases to carry out the diagnosis, which will be the basis for the formulation of its action plan and implementation of the maturity model. As a result of this work, the maturity model is formulated to improve logistics processes. This model seeks to: generate a progressive model that is useful for all productive units belonging to these sectors at the national level, regardless of their initial conditions, focus on the improvement of logistics processes as a strategy that contributes to improving the competitiveness of the agricultural sector in Colombia and spread the implementation of good logistics practices in postharvest in all departments of the country through autonomous tools. This model has been built through a series of steps that allow the evaluation and improvement of the logistics dimensions or indicators. The potential improvements for each dimension provide the foundation on which to advance to the next level. Within the maturity model, a methodology is indicated for the design and execution of strategies to improve its logistics processes, taking into account the current state of each production unit.

Keywords: agroindustrial, characterization, logistics, maturity model, processes

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10751 Community Communications and Micro-Level Shifts: The Case of Video Volunteers’ IndiaUnheard Program

Authors: Pooja Ichplani, Archna Kumar, Jessica Mayberry

Abstract:

Community Video (CV) is a participatory medium that has immense potential to strengthen community communications and amplify the voice of people for their empowerment. By building capacities especially of marginalized community groups and providing a platform to freely voice their ideas, CV endeavours to bring about shifts towards more participatory, bottom up development processes and greater power in the hands of the people, especially the disadvantaged. In various parts of the world, among marginalized community groups, community video initiatives have become instrumental in facilitating micro-level, yet significant changes in communities. Video Volunteers (VV) is an organization that promotes community media and works towards providing disadvantaged communities with journalistic, critical thinking and creative skills they need for catalysing change in their communities. Working since 2002, VV has evolved a unique community media model fostering locally-owned and managed media production, as well as building people’s capacities to articulate and share their perspectives on the issues that matter to them – on a local and a global scale. Further, by integrating a livelihood aspect within its model, VV has actively involved people from poor marginalized communities and provided them a new tool for serving their communities whilst keeping their identities intact. This paper, based on a qualitative research, seeks to map the range of VV impacts in communities and provide an in-depth analysis of factors contributing to VV impacting change in communities. Study tools included content analysis of a longitudinal sample of impact videos produced, narratives of community correspondents using the Most Significant Change Technique (MSCT) and interviews with key informants. Using a multi-fold analysis, the paper seeks to gain holistic insights. At the first level, the paper profiles the Community Correspondents (CCs), spearheading change, and maps their personal and social context and their perceptions about VV in their personal lives. Secondly, at an organizational level, the paper maps the significance of impacts brought about in the CCs communities and their association, challenges and achievements while working with VV. Lastly, at the community level, it consists of analysis of the nature of impacts achieved and aspects influencing the same. Finally, the study critiques the functioning of Video Volunteers as a community media initiative using the tipping point theory emphasizing on the power of context that is constituted by their socio-cultural environment. It concludes how empowerment of its Community Correspondents, multifarious activities during pre and post video production, and other innovative mechanisms have enabled in center staging issues of marginalized communities and snowballing processes of change in communities.

Keywords: community media, empowerment, participatory communication, social change

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10750 Wicking Bed Cultivation System as a Strategic Proposal for the Cultivation of Milpa and Mexican Medicinal Plants in Urban Spaces

Authors: David Lynch Steinicke, Citlali Aguilera Lira, Andrea León García

Abstract:

The proposal posed in this work comes from a researching-action approach. In Mexico, a dialogue of knowledge may function as a link between traditional, local, pragmatic knowledge, and technological, scientific knowledge. The advantage of generating this nexus lies on the positive impact in the environment, in society and economy. This work attempts to combine, on the one hand the traditional Mexican knowledge such as the usage of medicinal herb and the agroecosystem milpa; and on the other hand make use of a newly created agricultural ecotechnology which main function is to take advantage of the urban space and to save water. This ecotechnology is the wicking bed. In a globalized world, is relevant to have a proposal where the most important aspect is to revalorize the culture through the acquisition of traditional knowledge but at the same time adapting them to the new social and urbanized structures without threatening the environment. The methodology used in this work comes from a researching-action approach combined with a practical dimension where an experimental model made of three wickingbeds was implemented. In this model, there were cultivated medicinal herb and milpa components. The water efficiency and the social acceptance were compared with a traditional ground crop, all this practice was made in an urban social context. The implementation of agricultural ecotechnology has had great social acceptance as its irrigation involves minimal effort and it is economically feasible for low-income people. The wicking bed system raised in this project is attainable to be implemented in schools, urban and peri-urban environments, homemade gardens and public areas. The proposal managed to carry out an innovative and sustainable knowledge-based traditional Mexican agricultural technology, allowing regain Milpa agroecosystem in urban environments to strengthen food security in favour of nutritional and protein benefits for the Mexican fare.

Keywords: milpa, traditional medicine, urban agriculture, wicking bed

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10749 Lung Cancer Detection and Multi Level Classification Using Discrete Wavelet Transform Approach

Authors: V. Veeraprathap, G. S. Harish, G. Narendra Kumar

Abstract:

Uncontrolled growth of abnormal cells in the lung in the form of tumor can be either benign (non-cancerous) or malignant (cancerous). Patients with Lung Cancer (LC) have an average of five years life span expectancy provided diagnosis, detection and prediction, which reduces many treatment options to risk of invasive surgery increasing survival rate. Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) for earlier detection of cancer are common. Gaussian filter along with median filter used for smoothing and noise removal, Histogram Equalization (HE) for image enhancement gives the best results without inviting further opinions. Lung cavities are extracted and the background portion other than two lung cavities is completely removed with right and left lungs segmented separately. Region properties measurements area, perimeter, diameter, centroid and eccentricity measured for the tumor segmented image, while texture is characterized by Gray-Level Co-occurrence Matrix (GLCM) functions, feature extraction provides Region of Interest (ROI) given as input to classifier. Two levels of classifications, K-Nearest Neighbor (KNN) is used for determining patient condition as normal or abnormal, while Artificial Neural Networks (ANN) is used for identifying the cancer stage is employed. Discrete Wavelet Transform (DWT) algorithm is used for the main feature extraction leading to best efficiency. The developed technology finds encouraging results for real time information and on line detection for future research.

Keywords: artificial neural networks, ANN, discrete wavelet transform, DWT, gray-level co-occurrence matrix, GLCM, k-nearest neighbor, KNN, region of interest, ROI

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10748 Comparative Analysis of the Impact of Urbanization on Land Surface Temperature in the United Arab Emirates

Authors: A. O. Abulibdeh

Abstract:

The aim of this study is to investigate and compare the changes in the Land Surface Temperature (LST) as a function of urbanization, particularly land use/land cover changes, in three cities in the UAE, mainly Abu Dhabi, Dubai, and Al Ain. The scale of this assessment will be at the macro- and micro-levels. At the macro-level, a comparative assessment will take place to compare between the four cities in the UAE. At the micro-level, the study will compare between the effects of different land use/land cover on the LST. This will provide a clear and quantitative city-specific information related to the relationship between urbanization and local spatial intra-urban LST variation in three cities in the UAE. The main objectives of this study are 1) to investigate the development of LST on the macro- and micro-level between and in three cities in the UAE over two decades time period, 2) to examine the impact of different types of land use/land cover on the spatial distribution of LST. Because these three cities are facing harsh arid climate, it is hypothesized that (1) urbanization is affecting and connected to the spatial changes in LST; (2) different land use/land cover have different impact on the LST; and (3) changes in spatial configuration of land use and vegetation concentration over time would control urban microclimate on a city scale and control macroclimate on the country scale. This study will be carried out over a 20-year period (1996-2016) and throughout the whole year. The study will compare between two distinct periods with different thermal characteristics which are the cool/cold period from November to March and warm/hot period between April and October. The best practice research method for this topic is to use remote sensing data to target different aspects of natural and anthropogenic systems impacts. The project will follow classical remote sensing and mapping techniques to investigate the impact of urbanization, mainly changes in land use/land cover, on LST. The investigation in this study will be performed in two stages. Stage one remote sensing data will be used to investigate the impact of urbanization on LST on a macroclimate level where the LST and Urban Heat Island (UHI) will be compared in the three cities using data from the past two decades. Stage two will investigate the impact on microclimate scale by investigating the LST and UHI using a particular land use/land cover type. In both stages, an LST and urban land cover maps will be generated over the study area. The outcome of this study should represent an important contribution to recent urban climate studies, particularly in the UAE. Based on the aim and objectives of this study, the expected outcomes are as follow: i) to determine the increase or decrease of LST as a result of urbanization in these four cities, ii) to determine the effect of different land uses/land covers on increasing or decreasing the LST.

Keywords: land use/land cover, global warming, land surface temperature, remote sensing

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10747 Assessing the Informed Consent Practices during Normal Vaginal Delivery Process and Immediate Postpartum Care in Tertiary Level Hospitals of Bangladesh

Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

Abstract:

Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

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