Search results for: reference groups
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9037

Search results for: reference groups

6487 Traumatic Brain Injury Induced Lipid Profiling of Lipids in Mice Serum Using UHPLC-Q-TOF-MS

Authors: Seema Dhariwal, Kiran Maan, Ruchi Baghel, Apoorva Sharma, Poonam Rana

Abstract:

Introduction: Traumatic brain injury (TBI) is defined as the temporary or permanent alteration in brain function and pathology caused by an external mechanical force. It represents the leading cause of mortality and morbidity among children and youth individuals. Various models of TBI in rodents have been developed in the laboratory to mimic the scenario of injury. Blast overpressure injury is common among civilians and military personnel, followed by accidents or explosive devices. In addition to this, the lateral Controlled cortical impact (CCI) model mimics the blunt, penetrating injury. Method: In the present study, we have developed two different mild TBI models using blast and CCI injury. In the blast model, helium gas was used to create an overpressure of 130 kPa (±5) via a shock tube, and CCI injury was induced with an impact depth of 1.5mm to create diffusive and focal injury, respectively. C57BL/6J male mice (10-12 weeks) were divided into three groups: (1) control, (2) Blast treated, (3) CCI treated, and were exposed to different injury models. Serum was collected on Day1 and day7, followed by biphasic extraction using MTBE/Methanol/Water. Prepared samples were separated on Charged Surface Hybrid (CSH) C18 column and acquired on UHPLC-Q-TOF-MS using ESI probe with inhouse optimized parameters and method. MS peak list was generated using Markerview TM. Data were normalized, Pareto-scaled, and log-transformed, followed by multivariate and univariate analysis in metaboanalyst. Result and discussion: Untargeted profiling of lipids generated extensive data features, which were annotated through LIPID MAPS® based on their m/z and were further confirmed based on their fragment pattern by LipidBlast. There is the final annotation of 269 features in the positive and 182 features in the negative mode of ionization. PCA and PLS-DA score plots showed clear segregation of injury groups to controls. Among various lipids in mild blast and CCI, five lipids (Glycerophospholipids {PC 30:2, PE O-33:3, PG 28:3;O3 and PS 36:1 } and fatty acyl { FA 21:3;O2}) were significantly altered in both injury groups at Day 1 and Day 7, and also had VIP score >1. Pathway analysis by Biopan has also shown hampered synthesis of Glycerolipids and Glycerophospholipiods, which coincides with earlier reports. It could be a direct result of alteration in the Acetylcholine signaling pathway in response to TBI. Understanding the role of a specific class of lipid metabolism, regulation and transport could be beneficial to TBI research since it could provide new targets and determine the best therapeutic intervention. This study demonstrates the potential lipid biomarkers which can be used for injury severity diagnosis and identification irrespective of injury type (diffusive or focal).

Keywords: LipidBlast, lipidomic biomarker, LIPID MAPS®, TBI

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6486 Radiofrequency Ablation: A Technique in the Management of Low Anal Fistula

Authors: R. Suresh, C. B. Singh, A. K. Sarda

Abstract:

Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.

Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing

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6485 Different Cognitive Processes in Selecting Spatial Demonstratives: A Cross-Linguistic Experimental Survey

Authors: Yusuke Sugaya

Abstract:

Our research conducts a cross-linguistic experimental investigation into the cognitive processes involved in distance judgment necessary for selecting demonstratives in deictic usage. Speakers may consider the addressee's judgment or apply certain criteria for distance judgment when they produce demonstratives. While it can be assumed that there are language and cultural differences, it remains unclear how these differences manifest across languages. This research conducted online experiments involving speakers of six languages—Japanese, Spanish, Irish, English, Italian, and French—in which a wide variety of drawings were presented on a screen, varying conditions from three perspectives: addressee, comparisons, and standard. The results of the experiments revealed various distinct features associated with demonstratives in each language, highlighting differences from a comparative standpoint. For one thing, there was an influence of a specific reference point (i.e., Standard) on the selection in Japanese and Spanish, whereas there was relatively an influence of competitors in English and Italian.

Keywords: demonstratives, cross-linguistic experiment, distance judgment, social cognition

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6484 Optimal Design of Concrete Shells by Modified Particle Community Algorithm Using Spinless Curves

Authors: Reza Abbasi, Ahmad Hamidi Benam

Abstract:

Shell structures have many geometrical variables that modify some of these parameters to improve the mechanical behavior of the shell. On the other hand, the behavior of such structures depends on their geometry rather than on mass. Optimization techniques are useful in finding the geometrical shape of shell structures to improve mechanical behavior, especially to prevent or reduce bending anchors. The overall objective of this research is to optimize the shape of concrete shells using the thickness and height parameters along the reference curve and the overall shape of this curve. To implement the proposed scheme, the geometry of the structure was formulated using nonlinear curves. Shell optimization was performed under equivalent static loading conditions using the modified bird community algorithm. The results of this optimization show that without disrupting the initial design and with slight changes in the shell geometry, the structural behavior is significantly improved.

Keywords: concrete shells, shape optimization, spinless curves, modified particle community algorithm

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6483 Research on the Cognition and Actual Phenomenon of School Bullying from the Perspective of Students

Authors: Chia-Chun Wu, Yu-Hsien Sung

Abstract:

This study aims to examine the consistency between students’ predictions and their actual observations on the bullying prevalence rate among different types of high-risk victims, thereby clarifying the reliability of students’ reports on the identification of bullying. A total of 1,732 Taiwanese students (734 males and 998 females) participated in this study. A Rasch model was adopted for data analysis. The results showed that students with “personality or behavioral issues” are more likely to be bullied in schools, based on both students’ predictions and actual observations. Moreover, the results differed significantly between genders and between various educational levels in students’ predictions and their actual observations on the bullying prevalence rate of different types of high-risk victims. To summarize, this study not only suggests that students’ reports on the identification of bullying are accurate and could be a valuable reference in terms of recognizing a bullying incident, but it also argues that more attention should be paid to students’ gender and educational level when taking their perspectives into consideration when it comes to identifying bullying behaviors.

Keywords: school bullying, student, bullying recognition, high-risk victims

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6482 In-Plane Shear Tests of Prefabricated Masonry Panel System with Two-Component Polyurethane Adhesive

Authors: Ekkehard Fehling, Paul Capewell

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In recent years, the importance of masonry glued by polyurethane adhesive has increased. In 2021, the Institute of Structural Engineering of the University of Kassel was commissioned to carry out quasi-static in-plane shear tests on prefabricated brick masonry panel systems with 2K PUR adhesive in order to investigate the load-bearing behavior during earthquakes. In addition to the usual measurement of deformations using displacement transducers, all tests were documented using an optical measuring system (“GOM”), which was used to determine the surface strains and deformations of the test walls. To compare the results with conventional mortar walls, additional reference tests were carried out on test specimens with thin-bed mortar joints. This article summarizes the results of the test program and provides a comparison between the load-bearing behavior of masonry bonded with polyurethane adhesive and thin bed mortar in order to enable realistic non-linear modeling.

Keywords: masonry, shear tests, in-plane, polyurethane adhesive

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6481 Mental Health Promotion for Children of Mentally Ill Parents in Schools. Assessment and Promotion of Teacher Mental Health Literacy in Order to Promote Child Related Mental Health (Teacher-MHL)

Authors: Dirk Bruland, Paulo Pinheiro, Ullrich Bauer

Abstract:

Introduction: Over 3 million children, about one quarter of all students, experience at least one parent with mental disorder in Germany every year. Children of mentally-ill parents are at considerably higher risk of developing serious mental health problems. The different burden patterns and coping attempts often become manifest in children's school lives. In this context, schools can have an important protective function, but can also create risk potentials. In reference to Jorm, pupil-related teachers’ mental health literacy (Teacher-MHL) includes the ability to recognize change behaviour, the knowledge of risk factors, the implementation of first aid intervention, and seeking professional help (teacher as gatekeeper). Although teachers’ knowledge and increased awareness of this topic is essential, the literature provides little information on the extent of teachers' abilities. As part of a German-wide research consortium on health literacy, this project, launched in March for 3 years, will conduct evidence-based mental health literacy research. The primary objective is to measure Teacher-MHL in the context of pupil-related psychosocial factors at primary and secondary schools (grades 5 & 6), while also focussing on children’s social living conditions. Methods: (1) A systematic literature review in different databases to identify papers with regard to Teacher-MHL (completed). (2) Based on these results, an interview guide was developed. This research step includes a qualitative pre-study to inductively survey the general profiles of teachers (n=24). The evaluation will be presented on the conference. (3) These findings will be translated into a quantitative teacher survey (n=2500) in order to assess the extent of socio-analytical skills of teachers as well as in relation to institutional and individual characteristics. (4) Based on results 1 – 3, developing a training program for teachers. Results: The review highlights a lack of information for Teacher-MHL and their skills, especially related to high-risk-groups like children of mentally ill parents. The literature is limited to a few studies only. According to these, teacher are not good at identifying burdened children and if they identify those children they do not know how to handle the situations in school. They are not sufficiently trained to deal with these children, especially there are great uncertainties in dealing with the teaching situation. Institutional means and resources are missing as well. Such a mismatch can result in insufficient support and use of opportunities for children at risk. First impressions from the interviews confirm these results and allow a greater insight in the everyday school-life according to critical life events in families. Conclusions: For the first time schools will be addressed as a setting where children are especially "accessible" for measures of health promotion. Addressing Teacher-MHL gives reason to expect high effectiveness. Targeting professionals' abilities for dealing with this high-risk-group leads to a discharge for teacher themselves to handle those situations and increases school health promotion. In view of the fact that only 10-30% of such high-risk families accept offers of therapy and assistance, this will be the first primary preventive and health-promoting approach to protect the health of a yet unaffected, but particularly burdened, high-risk group.

Keywords: children of mentally ill parents, health promotion, mental health literacy, school

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6480 Effective and Innovative Health Promotion Interventions for Promoting Life-Long Opportunities through Better Health and Nutrition Beginning from Early Childhood

Authors: Nadeesha Sewwandi, Dilini Shashikala, Rajarathnam Kanapathy, Shivakumaran Viyasan, Saman Kumara, Duminda Guruge

Abstract:

Introduction: Nutrition is fundamental for good health and development during the early years of life. This study describes how rural community does interventions for improving the nutrition and health of children less than 5 year ages using health promotion approach and this study was conducted with children society and mothers groups in a rural village called Welankulama in Sri Lanka. Methodology: The details got from Public Health Midwife in this village showed there were malnourished children under 5 years age. So, we discussed this problem with the children society, mothers groups and identified the determinants with them. Then they wanted to address some of the determinants that they prioritized from their discussions. ‘Evening school’ was a new place to this village to do collective feeding for small children. ‘Mobile library’ was another new concept in this village and nutrition books, evidence collection were there to read for villagers. Mothers marked the foods given to their kids in a book called ‘Nutrition book’. And also mothers tend to mark the level of eating foods to motivate their children in a ‘Hapana calendar’. Results: In terms of results, malnourished children under 5 years age got reduced and the number of children having illnesses got reduced. Marking nutrition book and ‘Hapana calendar’ were become as trend among mothers. Apart from the above, there was good improvement of physical, social and emotional wellbeing of children. Children who received early stimulation with nutrition supplements had better outcomes than children who only received nutrition supplements, thereby amplifying the impact of nutrition. Conclusion: Health promotion interventions are helped to change nutritional behaviors of early childhood in rural community and it makes children healthier and better able to learn.

Keywords: early childhood, nutrition, determinants, health promotion process

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6479 Exergy Analysis and Evaluation of the Different Flowsheeting Configurations for CO₂ Capture Plant Using 2-Amino-2-Methyl-1-Propanol

Authors: Ebuwa Osagie, Vasilije Manovic

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Exergy analysis provides the identification of the location, sources of thermodynamic inefficiencies, and magnitude in a thermal system. Thus, both the qualitative and quantitative assessment can be evaluated with exergy, unlike energy which is based on quantitative assessment only. The main purpose of exergy analysis is to identify where exergy is destroyed. Thus, reduction of the exergy destruction and losses associated with the capture plant systems can improve work potential. Furthermore, thermodynamic analysis of different configurations of the process helps to identify opportunities for reducing the steam requirements for each of the configurations. This paper presents steady-state simulation and exergy analysis of the 2-amino-2-methyl-1-propanol (AMP)-based post-combustion capture (PCC) plant. Exergy analysis performed for the AMP-based plant and the different configurations revealed that the rich split with intercooling configuration gave the highest exergy efficiency of 73.6%, while that of the intercooling and the reference AMP-based plant were 57.3% and 55.8% respectively.

Keywords: 2-amino-2-methyl-1-propanol, modelling, and simulation, post-combustion capture plant, exergy analysis, flowsheeting configurations

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6478 Wage Differentials in Pakistan by Focusing on Wage Differentials in Public and Private Sectors, Formal and Informal Sectors, and Major Occupational Groups

Authors: Asghar Ali, Narjis Khatoon

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This study focuses on the presence of wage differentials in Pakistan and also on the determinants that originate it. Since there are a smaller number of studies that are conducted on this topic in Pakistan, the current study aims to contribute in bridging the existing gap in this particular research genre. Hence, this study not only generates the desired results specific focus but it also contributes to the overall empirical work on the Pakistan economy. The preceding works which have been done to research wage determinants and wage differentials have used numerous different theories and approaches to reach their goals. The current study, in order to analyze the determinants of wage differentials in the developing economy, deals with the study of a number of such theories and approaches that are supposed as being beneficial for the purpose. This study undertakes the explanation of wage differentials in Pakistan by focusing on wage differentials in public and private sectors, formal and informal sectors, and major occupational groups. The study uses 'Wage Theory' to examine wage differentials among male and female employees in public and private sectors on varied levels of working conditions. This study also uses 'Segmented Labor Market Theory' to determine the wage differential in both public and private sectors, formal and informal, and major occupational groups in Pakistan. So the author has used various econometric techniques in order to explain and test these theories and to find out the required results. This study has employed seven different cross-sectional Labour Force Surveys for the time period between 2006-07 to 2012-13. Gender equality is not only a policy reform agenda for developing countries but also an important goal of Millennium Development Goals. This study investigates the nexus between wage inequality and economic growth and detects co-integration between gender wage differential and economic growth using ARDL bound test. It is confirmed from the empirical results that there exists long-run relationship between economic growth and wage differential. Our study indicated that half of the total female employees from fourteen major cities of Pakistan were employed in the public sector. Out of total female employees in private sector, 66 percent are employed in the formal sector, and 33 percent are working in the informal sector. Results also indicated that both men and women were paid more in the public sector compared to the private sector counterparts. Among the total female employees, only 9 percent had received any formal training, 52% were married and average years of schooling were 11 years. Further, our findings regarding wage differential between genders indicate that wage gap is lower in public sector as compared to private sector. In proportion, gender wage ratio was found to be 0.96, 0.62 and 0.66 in public, formal private and informal private sectors respectively. This suggests that in this case, private sector female employees with the same pay structure are compensated at a lower endowments rate as then public sector workers as compared to their counter parts.

Keywords: wage differentials, formal, informal, economic growth

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6477 The Sectoral Differences in the Use of Construction Incentive

Authors: Qiuwen Ma, Sai On Cheung

Abstract:

Incentive contracting has been developed to push the agent team for extra effort. Generally, there are three types of incentive arrangement, namely incentive/penalty for super performance/underperformance, risk/reward sharing and future business opportunities. It is found that there are significant differences in the use of incentive arrangement in private and public projects. In Hong Kong, very few public projects have used future business as incentivizer whereas private developers often signal repeated business coupled with heavy penalty. This study was conducted to identify various attributes affecting the use of I/D in both private and public engineering sectors of Hong Kong. The diverging preferences were unveiled with reference to a literature review and semi-structured interviews with industry experts. The findings reveal the public/private sectors would consider the implementation issues regarding the various performance targets. The most deterministic factor for the public sector is about accountability. The private sector is in general skeptical about the need to provide extra for the contractors for what they have already contracted to perform.

Keywords: construction incentive, public/private projects, semi-structured interview, hong kong

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6476 Mutations in MTHFR Gene Associated with Mental Retardation and Cerebral Palsy Combined with Mental Retardation in Erbil City

Authors: Hazha Hidayat, Shayma Ibrahim

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Folate metabolism plays a crucial role in the normal development of the neonatal central nervous system. It is regulated by MTHFR gene polymorphism. Any factors, which will affect this metabolism either by hereditary or gene mutation will lead to many mental disorders. The purpose of this study was to investigate whether MTHFR gene mutation contributes to the development of mental retardation and CP combined with mental retardation in Erbil city. DNA was isolated from the peripheral blood samples of 40 cases suffering from mental retardation (MR) and CP combined with MR were recruited, sequence the 4, 6, 7, 8 exons of the MTHFR gene were done to identify the variants. Exons were amplified by PCR technique and then sequenced according to Sanger method to show the differences with MTHFR reference sequences. We observed (14) mutations in 4, 6, 7, 8 exons in the MTHFR gene associated with Cerebral Palsy combined with mental retardation included deletion, insertion, Substitution. The current study provides additional evidence that multiple variations in the MTHFR gene are associated with mental retardation and Cerebral Palsy.

Keywords: methylenetetrahydrofolate reductase (MTHFR) gene, SNPs, homocysteine, sequencing

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6475 Education and Development: An Overview of Islam

Authors: Rasheed Sanusi Adeleke

Abstract:

Several attempts have been made by scholars, both medieval and contemporary on the impact of Islam on scientific discovery. Lesser attention, however, is always accorded to the historical antecedents of the earlier Muslim scholars, who made frantic efforts towards the discoveries. Islam as a divine religion places high premium on the acquisition of knowledge especially that of sciences. It considers knowledge as a comprehensive whole, which covers both spiritual and material aspects of human life. Islam torches every aspect of human life for the growth, development and advancement of society. Acquisition of knowledge of humanity, social sciences as well as the pure and applied sciences is comprehensively expressed in Islamic education. Not only this, the history portrays the leading indelible roles played by the early Muslims on these various fields of knowledge. That is why Islam has declared acquisition of knowledge compulsory for all Muslims. This paper therefore analyses the contributions of Islam to civilization with particular reference to sciences. It also affirms that Islam is beyond the religion of prayers and rituals. The work is historic, analytic and explorative in nature. Recommendations are also also put forward as suggestions for the present generation cum posterity in general and Muslims in particular.

Keywords: education, development, Islam, development and Islam

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6474 Gender Discrimination and Wellbeing in Family Sphere Due to Male Migration and Remittances: A Study of Doaba Region of Punjab

Authors: Atinder Pal Kaur

Abstract:

A central characteristic of people is their apparent movement from one station to other for their sustenance. Human migration has become one of the most challenging issues faced by the world today. Migration represents an important dimension in world-wide setting; and remittances received by families constitute a major agent in integrating societies in the all over the world, both economically and socially. This paper is an attempt to explore the impact of male migration and remittances upon the family system. This paper brings out how the women play the role of head of the household and take all the economic decisions, but still faces discrimination in the family, that bring loneliness and emotional breakdown on their personal front. For the purpose of this study, data was collected using 30 interviews and 10 case studies in the Doaba region of Punjab. The respondents were classified into two age groups 20-35 years and above 40 years aged women whose husbands migrated abroad. The findings of this study revealed that even though the women were taking some of the economic decisions, but in majority of the cases the patriarchal structure still existed and power remained in the hands of their husbands or in-laws. It was found that women of different age groups reported differently in terms of authority that they have regarding remittances and its consequences in their emotional well-being. The distinction related to their participation in public and private spheres still exists and public spheres are mostly dominated by male members of the family. It can be concluded that freedom of women to take decision on their own is still restricted and they are subjugated to follow their husband or in-law’s opinion in matters related to both public and private spheres. However, old age group women enjoyed more independence and freedom to take decision in comparison to young age women. Loneliness and depression were more common in the young age respondent’s group than in old age women.

Keywords: gender discrimination, migration, patriarchal structure, remittances

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6473 Beyond Empathy: From Justice to Reconciliation

Authors: Nissim Avissar

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This paper aims to question the practice of bringing together people belonging to groups in conflict with the aim of bridging differences through universal empathy and interpersonal connections. It is argued that in cases where one group has the power, and the other is in a struggle to change the balance assuming universal equality between the groups and encouraging emphatic understanding is a non-emphatic practice. Accordingly, a new concept is posited–justice-sensitive empathy, conditioning empathy in such situations on the acknowledgement of an imbalance of power/injustice. With this reframing in mind, educational practices promoting social justice are discussed. In order to create conditions for justice-seeking or politically sensitive empathy, we need to go beyond the conventional definitions of empathy and offer other means and possibilities. Three possibilities are discussed. The first focuses on intra-group (as opposed to inter-group) processes within each group. It means temporary and tactical separation that may allow each group to focus on its own needs and values and perhaps to return to the dialogue more confidently. The second option emphasizes the notion of "constructive conflict," which means that each side still aspires to promote his own interests but without demolishing the other side (which is a rival but also an unwanted and forced partner). Here, alongside the "obligation to resist" and to act to promote justice as we view and understand it, we have to take into account the other side. The third and last option relates to the practice of Restorative Justice. This practice originated in the Truth and Reconciliation committees in South Africa, but it is now widely used in other contexts. Those committees had the authority to punish (or pardon) people; however, their main purpose was to seek truth and, from there, nourish reconciliation. This is the main idea of restorative justice; it seeks justice for the sake of restoring relationships. All the above options involve action and are aware of power relations (i.e., politics). They all seek justice. They may create conditions for the more conventional empathic practice to evolve, but no less than that, they are examples of justice-seeking and politically sensitive empathetic practice.

Keywords: education, empathy, justice, reconciliation

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6472 From Biowaste to Biobased Products: Life Cycle Assessment of VALUEWASTE Solution

Authors: Andrés Lara Guillén, José M. Soriano Disla, Gemma Castejón Martínez, David Fernández-Gutiérrez

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The worldwide population is exponentially increasing, which causes a rising demand for food, energy and non-renewable resources. These demands must be attended to from a circular economy point of view. Under this approach, the obtention of strategic products from biowaste is crucial for the society to keep the current lifestyle reducing the environmental and social issues linked to the lineal economy. This is the main objective of the VALUEWASTE project. VALUEWASTE is about valorizing urban biowaste into proteins for food and feed and biofertilizers, closing the loop of this waste stream. In order to achieve this objective, the project validates three value chains, which begin with the anaerobic digestion of the biowaste. From the anaerobic digestion, three by-products are obtained: i) methane that is used by microorganisms, which will be transformed into microbial proteins; ii) digestate that is used by black soldier fly, producing insect proteins; and iii) a nutrient-rich effluent, which will be transformed into biofertilizers. VALUEWASTE is an innovative solution, which combines different technologies to valorize entirely the biowaste. However, it is also required to demonstrate that the solution is greener than other traditional technologies (baseline systems). On one hand, the proteins from microorganisms and insects will be compared with other reference protein production systems (gluten, whey and soybean). On the other hand, the biofertilizers will be compared to the production of mineral fertilizers (ammonium sulphate and synthetic struvite). Therefore, the aim of this study is to provide that biowaste valorization can reduce the environmental impacts linked to both traditional proteins manufacturing processes and mineral fertilizers, not only at a pilot-scale but also at an industrial one. In the present study, both baseline system and VALUEWASTE solution are evaluated through the Environmental Life Cycle Assessment (E-LCA). The E-LCA is based on the standards ISO 14040 and 14044. The Environmental Footprint methodology was the one used in this study to evaluate the environmental impacts. The results for the baseline cases show that the food proteins coming from whey have the highest environmental impact on ecosystems compared to the other proteins sources: 7.5 and 15.9 folds higher than soybean and gluten, respectively. Comparing feed soybean and gluten, soybean has an environmental impact on human health 195.1 folds higher. In the case of biofertilizers, synthetic struvite has higher impacts than ammonium sulfate: 15.3 (ecosystems) and 11.8 (human health) fold, respectively. The results shown in the present study will be used as a reference to demonstrate the better environmental performance of the bio-based products obtained through the VALUEWASTE solution. Other originalities that the E-LCA performed in the VALUEWASTE project provides are the diverse direct implications on investment and policies. On one hand, better environmental performance will serve to remove the barriers linked to these kinds of technologies, boosting the investment that is backed by the E-LCA. On the other hand, it will be a germ to design new policies fostering these types of solutions to achieve two of the key targets of the European Community: being self-sustainable and carbon neutral.

Keywords: anaerobic digestion, biofertilizers, circular economy, nutrients recovery

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6471 The Relational Approach under the Angle of the CSR

Authors: Fatima El Kandoussi, Hind Benouakrim, Afafe El Amrani El Hassani

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CSR in the relational approach is imposed today as a matter of concerns lighthouses in the academic environment and managerial. This study presents the issues of the CSR dimension in the field of relationship marketing. This exploratory research was conducted with two groups of Moroccan enterprises having the label of the CSR /CGEM. It presents a better understanding of the approaches taken by the companies interviewed in a CSR and contributed to understand the reasons that lead them to adopt the process of CSR and also allows explaining how these enterprises maintain their relationship with the most important customers in a context of CSR.

Keywords: relationship marketing, CSR, stakeholders, business

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6470 The Effects of Lipid Emulsion, Magnesium Sulphate and Metoprolol in Amitryptiline-Induced Cardiovascular Toxicity in Rats

Authors: Saylav Ejder Bora, Arife Erdogan, Mumin Alper Erdogan, Oytun Erbas, Ismet Parlak

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Objective: The aim of this study was to evaluate histological, electrical and biochemical effects of metoprolol, lipid emulsion and magnesium sulphate as an alternative method to be used in preventing long QT emergence, that is among the lethal consequences of amitryptiline toxicity. Methods: Thirty Sprague- Dawley male rats were included. Rats were randomly separated into 5 groups. First group was administered saline only while the rest had received amitryptiline 100 mg/kg + saline, 5 mg/kg metoprolol, 20 ml/kg lipid emulsion and 75 mg/kg magnesium sulphate (MgSO4) intraperitoneally. ECG at DI lead, biochemical tests following euthanasia were performed in all groups after 1 hour of administration. Cardiac tissues were removed, sections were prepared and examined. Results: QTc values were significantly shorter in the rest when compared to amitryptiline+ saline group. While lipid emulsion did not affect proBNP and troponin values biochemically as compared to that of the control group, histologically, it was with reduced caspase 3 expression. Though statistically insignificant in the context of biochemical changes, pro-BNP and urea levels were lower in the metoprolol group when compared to controls. Similarly, metoprolol had no statistically significant effect on histological caspase 3 expression in the group that was treated with amitryptiline+metoprolol. On the other hand, there was a statistically significant decrease in Troponin, pro-BNP and urea levels as well as significant decline in histological caspase 3 expression within the MgSO4 group when compared to controls. Conclusion: As still a frequent cause of mortality in emergency units, administration of MgSO4, lipid emulsion and metoprolol might be beneficial in alternative treatment of cardiovascular toxicity caused by tricyclic antidepressant overdose, whether intake would be intentional or accidental.

Keywords: amitryptiline, cardiovascular toxicity, long QT, Rat Model

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6469 The Effect of Sexual Assault on Sport Participation Trajectories from Adolescence through Young Adulthood

Authors: Chung Gun Lee

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Objectives: Certain life change events were shown to have strong effects on physical activity-related behavior, but more research is needed to investigate the longer-term effects of different life change events on physical activity-related behaviors. The purpose of this study is to examine the effect of experiencing physically or non-physically forced sexual activity on sports participation from adolescence to young adulthood. Methods: This study used the National Longitudinal Study of Adolescent Health (Add Health) data. Group-based trajectory modeling was utilized to examine the effect of experiencing sexual assault on trajectories of sports participation from adolescence to young adulthood. Results: Male participants were divided into three trajectory groups (i.e., Low-stable, High-decreasing, and High-stable) and female participants were divided into two trajectory groups (i.e., Low-stable and High-decreasing). The main finding of this study is that women who experienced non-physically forced sexual activity significantly decreases sports participation throughout the trajectory in ‘High-decreasing group.’ The effect of non-physically forced sexual activity on women’s sports participation was considerably weakened and became insignificant after including psychological depression in the model as a potential mediator. Discussion: Special attention should be paid to sport participation among women victims of non-physically forced sexual activity. Further studies are needed to examine other potential mediators in addition to psychological depression when examining the effect of non-physically forced sexual activity on sport participation in women.

Keywords: adolescent, group-based trajectory modeling, sexual assault, young adult

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6468 Effect of Smoking on Tear Break-Up Time and Basal Tear Secretion

Authors: Kalsoom Rani

Abstract:

Tobacco contains nicotine, which causes addiction to many toxic chemicals. In the world, people consume it in the form of smoke, chew, and sniffing, smoke of it is composed of almost 7000 active chemicals, which are very harmful to human health as well as for eye health, inhalation of tobacco smoke and fumes can accelerate and cause many blinding eye diseases. Dry eye and smoking have not been covered extensively in researches; more studies are required to unveil the relationship between smoking and dry eye. This study was conducted to determine the quantity and quality of tears in smokers. 60 subjects participated in the study, which was divided into two groups on the basis of consumption of cigarettes per day with age matched non smokers of 15-50 years. All participants have gone through a study based questioner, eye examination, and diagnostic 'Dry Eye Tests' for evaporative tears evaluation and measurement of basal tear secretion. Subjects were included in the criteria of 10 cigarettes per day with a minimum duration of 1 year; passive smokers for control groups were excluded. The study was carried out in a Medina Teaching Hospital, Faisalabad, Pakistan, ophthalmology department for the duration of 8 months. Mean values for tear break up time (TBUT), was reported 10sec with SD of +3.74 in controlled group, 5sec with SD + 2.32 in smokers and 4sec SD +3.77 heavy smokers in right eye (RE) and left eye (LE) 10.35sec with SD of +3.88 in controlled 5sec with SD + 2.3 in smokers and much reduced TBUT in heavy smokers was 3.85sec SD+2.20. Smoking has a very strong association with TRUT with a significance of P=.00 both eyes. Mean Schirmer-I value of the subjects was reported 12.6mm with SD + 8.37 in RE and 12.59mm with SD + 8.96 LE. The mean Schirmer-II test value was reported in the right, and left eye with a mean value for control was 20.23mm with SD + 8.93, 20.75mm with SD + 8.84 respectively, and in Smokers 9.90mm with SD + 5.74, and 10.07mm with SD + 6.98, and in heavy smokers 7.7mm, SD + 3.22 and 6.9, SD + 3.50 mm, association with smoking showed p=.001 in RE and .003 in LE. Smoking has deteriorated effect on both evaporative tear and aqueous tear secretion and causing symptoms of dry eye burning, itching, redness, and watering with epithelial cell damage.

Keywords: tear break-up time, basal tear secretion, smokers, dry eye

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6467 The Effect of Stress on Job Performance of Frontline Employees of Hotels: Reference to Star Class Hotels in North Central Province, Sri Lanka

Authors: W. M. M. Weerasooriya, K. T. N. P. Abeywickrama

Abstract:

There has been some research on stress in the hotel industry in Sri Lanka and elsewhere. Still, the amount is not proportionate to the severity of the issue. This paper examined the effect of stress on job performance of frontline employees of Sri Lankan hotel context. Duly completed 70 self-administered questionnaires filled by frontline employees of star class hotels in North Central Province in Sri Lanka were used for the purpose with a response rate of 70%. The researcher employed empirical analysis using statistical tools such as regression analysis of Pearson’s correlation of coefficient. It was found that there is a high level of workload and role ambiguity existing among the frontline employees of hotels located in North Central Province and existing role ambiguity significantly reduce the job performance of the frontline employees of star class hotels while the existing low level of physical work environment also leads to a low level of job performance.

Keywords: hotel front line employees, job stress, job performance, Sri Lanka

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6466 Prospective Cohort Study on Sequential Use of Catheter with Misoprostol vs Misoprostol Alone for Second Trimester Medical Abortion

Authors: Hanna Teklu Gebregziabher

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Background: A variety of techniques for medical termination of second-trimester pregnancy can be used, but there is no consensus about which is the best. Even though most evidence suggests the combined use of intracervical Foley catheter and vaginal misoprostol is safe, effective, and acceptable method for termination of second-trimester pregnancy, which is comparable to mifepristone-misoprostol combination regimen with lower cost and no additional maternal risks. The use of mifepristone and misoprostol alone with no other procedure is still the most common procedure in different institutions for 2nd-trimester pregnancy. Methods: A cross-sectional comparative prospective study design is employed on women who were admitted for 2nd-trimester medical abortion and medical abortion failed or if there was no change in cervical status after 24 hours of 1st dose of misoprostol. The study was conducted at St. Paulose Hospital Millennium Medical College. A sample of 44 participants in each arm was necessary to give a two-tailed test, a type 1 error of 5%, 80% statistical power, and a 1:1 ratio among groups. Thus, a total of 94 cases, 47 from each arm, were recruited. Data was entered and cleaned by using Epi-info and analyzed using SPSS version 29.0 statistical software and was presented in descriptive and tabular forms. Different variables were cross-tabulated and compared for significant differences and statistical analysis using the chi-square test and independent t-test, to conclude. Result: There was a significant difference between the two groups on induction to expulsion time and number of doses used. The mean ± SD of induction to expulsion time for those used misoprostol alone was 48.09 ± 11.86 and those who used trans-cervical catheter sequentially with misoprostol were 36.7 ±6.772. Conclusion: The use of a trans-cervical Foley catheter in conjunction with misoprostol in a sequential manner is a more effective, safe, and easily accessible procedure. In addition, the cost of utilizing the catheter is less compared to the cost of misoprostol and is readily available. As a good substitute, we advised using Trans-cervical Catether even for medical abortions performed in the second trimester.

Keywords: second trimester, medical abortion, catheter, misoprostol

Procedia PDF Downloads 39
6465 Health Ramifications of Workplace Bullying: Gender, Race and Sexual Orientation as Risk Factors

Authors: Kathleen Canul

Abstract:

Bullying is on the rise according to several recent studies. Workplace bullying has garnered less attention than other forms yet incidence rates range from 35-45%. The consequences of being bullied at work are broad, ranging from physiological to psychological to occupational. As the bullying progresses, employees begin to exhibit physical and psychological symptoms. Blood pressure rises, along with other cardiac related concerns. For men, covert coping with job unfairness was associated with a four-fold risk of heart attack and death. Gastrointestinal distress, headaches, muscle tension, sleep disorders and exhaustion are also common. Workplace bullying appears to contribute to the risk of subsequent psychotropic medication, as well. Emotionally, anxiety and depression increase along with lowered self-esteem and problems concentrating on the duties of the job. In an attempt to cope, individuals may succumb to unhealthy practices involving food, alcohol and other drugs. Patterns of bullying vary by gender, race, and ethnicity, as well as sexual orientation, with women, ethnic minorities and LGBTQ employees reporting higher rates of bullying in the workplace. Not only is this an issue of inequity on the job, but also a problem of health disparities as there are few mental health professionals confident and competent in dealing with workplace bullying issues, and the lack of culturally competent clinicians exacerbates this inequality in receiving adequate care. Alone, the topic of workplace bullying is not unique; however, the diverse experiences of underrepresented groups who disproportionately are affected on the job and suffer untreated, health related concerns represent a significant and emerging problem requiring attention. Conference participants who have experienced, witnessed or help those bullied on the job would benefit most from this review of the literature on the consequences of bullying experienced by diverse and underrepresented groups in the workplace.

Keywords: bullying, ethnic minorities, health disparities, workplace conflict

Procedia PDF Downloads 278
6464 Class Size Effects on Reading Achievement in Europe: Evidence from Progress in International Reading Literacy Study

Authors: Ting Shen, Spyros Konstantopoulos

Abstract:

During the past three decades, class size effects have been a focal debate in education. The idea of having smaller class is enormously popular among parents, teachers and policy makers. The rationale of its popularity is that small classroom could provide a better learning environment in which there would be more teacher-pupil interaction and more individualized instruction. This early stage benefits would also have a long-term positive effect. It is a common belief that reducing class size may result in increases in student achievement. However, the empirical evidence about class-size effects from experimental or quasi-experimental studies has been mixed overall. This study sheds more light on whether class size reduction impacts reading achievement in eight European countries: Bulgaria, Germany, Hungary, Italy, Lithuania, Romania, Slovakia, and Slovenia. We examine class size effects on reading achievement using national probability samples of fourth graders. All eight European countries had participated in the Progress in International Reading Literacy Study (PIRLS) in 2001, 2006 and 2011. Methodologically, the quasi-experimental method of instrumental variables (IV) has been utilized to facilitate causal inference of class size effects. Overall, the results indicate that class size effects on reading achievement are not significant across countries and years. However, class size effects are evident in Romania where reducing class size increases reading achievement. In contrast, in Germany, increasing class size seems to increase reading achievement. In future work, it would be valuable to evaluate differential class size effects for minority or economically disadvantaged student groups or low- and high-achievers. Replication studies with different samples and in various settings would also be informative. Future research should continue examining class size effects in different age groups and countries using rich international databases.

Keywords: class size, reading achievement, instrumental variables, PIRLS

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6463 Health Promoting Behaviors among Thai Older Adults: Trend and Association with Health Status

Authors: Alongkorn Pekalee, Rossarin Gray

Abstract:

Various determinants associated with older health include socio-demographic factors and health-promoting behaviors but lack in scholars recommended what factors associated with health status in specific sub-groups of older adults. The current study aims to explore the health-promoting behaviors and to examine and compare the associations of these factors with self-rated health status among three older age cohorts in Thai traditional context. Methods: This study is based on the Survey of Older Persons in Thailand (SOPT), in 2017, conducted by the National Statistical Office (NSO) of Thailand. Participants were classified into three groups by using the Thai contextual recommendation: youngest-old cohort (60-69), old-old cohort (70-79) and oldest old cohort (80 or older). Health promoting behaviors are the behaviors which associated with the health status of older adults include alcohol consumption, smoking, diet, and physical activity. Health status was defined as a subjective measurement by using self-rated health, a simple measure of general health. The socio-demographic factors, health-promoting behaviors, and health status were explained and summarized by descriptive statistics. The binary logistic regression was performed to analyze the data and evaluate the associations between independent and dependent variables. Results: Increase of age contributes to a higher proportion of health-promoting behaviors. All variables were associated with self-reported health status as good health among three older age cohorts statistically significant (p-value = 0.000). However, the influence of income sufficiency on health status is more notable, especially in older adults who aged 60-69 and 70-79. The influence of dietary and physical activity on health status became greater as age increased. Conclusion: the results suggest that income sufficiency should be noted in a plan to promote healthy aging, and co-residence should be more concerned especially in the oldest old cohort. Moreover, the interventions or policies to promote older health behaviors like diet and physical activity should be emphasized in the oldest old cohort more than others.

Keywords: health-promoting behaviors, older adults, self- rated health, Thailand

Procedia PDF Downloads 134
6462 Evaluation of Anti-Arthritic Activity of Eulophia ochreata Lindl and Zingiber cassumunar Roxb in Freund's Complete Adjuvant Induced Arthritic Rat Model

Authors: Akshada Amit Koparde, Candrakant S. Magdum

Abstract:

Objective: To investigate the anti-arthritic activity of chloroform extract and Isolate 1 of Eulophia ochreata Lindl and dichloromethane extract and Isolate 2 of Zingiber cassumunar Roxb in adjuvant arthritic (AA) rat model induced by Freund’s complete adjuvant (FCA). Methods: Forty two healthy albino rats were selected and randomly divided into six groups. Freund’s complete adjuvant (FCA) was used to induce arthritis and then treated with chloroform extract, isolate 1 and dichloromethane extract, isolate 2 for 28 days. The various parameters like paw volume, haematological parameters (RBC, WBC, Hb and ESR), were studied. Structural elucidation of active constituents isolate 1 and isolate 2 from Eulophia ochreata Lindl and Zingiber cassumunar Roxb will be done using GCMS and H1NMR. Results: In FCA induced arthritic rats, there was significant increase in rat paw volume whereas chloroform extract and Isolate 1 of Eulophia ochreata Lindl and dichloromethane extract and Isolate 2 of Zingiber cassumunar Roxb treated groups showed strong significant reduction in paw volume. The altered haematological parameters in the arthritic rats were significantly recovered to near normal by the treatment with extracts at the dose of 200 mg/kg. Further histopathological studies revealed the anti-arthritic activity of Eulophia ochreata Lindl and Zingiber cassumunar Roxb by preventing cartilage and bone destruction of the arthritic joints of AA rats. Conclusion: Extracts and isolates of Eulophia ochreata Lindl and Zingiber cassumunar Roxb have shown anti-arthritic activity. Decrease in paw volume and normalization of haematological abnormalities in adjuvant induced arthritic rats is significantly seen in the experiment. Further histopathological studies confirmed the anti-arthritic activity of Eulophia ochreata Lindl and Zingiber cassumunar Roxb.

Keywords: arthritis, Eulophia ochreata Lindl, Freund's complete adjuvant, paw volume, Zingiber cassumunar Roxb

Procedia PDF Downloads 169
6461 Effects of Virtual Reality on the Upper Extremity Spasticity and Motor Function in Patients with Stroke: A Single Blinded Randomized Controlled Trial

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini, Omid Seyed Esmaeili, Rouzbeh Kezemi, Noushin Mehrbod, Nazanin Vahed, Tahereh Hajiahmad, Noureddin Nakhostin Ansari

Abstract:

Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of VR beside conventional rehabilitation versus conventional rehabilitation alone on spasticity and motor function in stroke patients. Materials and Methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran, in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were modified Ashworth scale, recovery stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in the combination group (P=0.003). Only wrist extension was varied between groups and was better in the combination group. The variables generally had a statistically significant difference (P < 0.05). Conclusion: Virtual reality plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Keywords: stroke, virtual therapy, rehabilitation, treatment

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6460 The City Ecological Corridor Construction Based on the Concept Of "Sponge City"(Case Study: Lishui)

Authors: Xu Mengyuan, Xu Lei

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Behind the rapid development of Chinese city, the contradiction of frequent urban waterlogging and the shortage of water resources is deepening. In order to solve this problem, introduce the low impact development "sponge city" construction mode in the process of the construction of new urbanization in China, make our city " resilience to adapt" environmental change and natural disaster. Firstly this paper analyses the basic reason of urban waterlogging, then introduces the basic connotation and realization approach of “sponge city”. Finally, study on the project in Lishui Guazhou, focuses on the analysis of the "urban ecological corridor" construction strategy and the positive impact on city in the construction of “sponge city”. Meanwhile, we put forward the ”local conditions” and ”sustainable” as the construction ideas, make use of ecological construction leading city development, explore the ecological balance through the city to enhance the regional value, and providing reference and reflection for the development and future of the “sponge city” in China.

Keywords: urban water logging, sponge city, urban ecological corridor, sustainable development, China

Procedia PDF Downloads 634
6459 A Geographical Information System Supported Method for Determining Urban Transformation Areas in the Scope of Disaster Risks in Kocaeli

Authors: Tayfun Salihoğlu

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Following the Law No: 6306 on Transformation of Disaster Risk Areas, urban transformation in Turkey found its legal basis. In the best practices all over the World, the urban transformation was shaped as part of comprehensive social programs through the discourses of renewing the economic, social and physical degraded parts of the city, producing spaces resistant to earthquakes and other possible disasters and creating a livable environment. In Turkish practice, a contradictory process is observed. In this study, it is aimed to develop a method for better understanding of the urban space in terms of disaster risks in order to constitute a basis for decisions in Kocaeli Urban Transformation Master Plan, which is being prepared by Kocaeli Metropolitan Municipality. The spatial unit used in the study is the 50x50 meter grids. In order to reflect the multidimensionality of urban transformation, three basic components that have spatial data in Kocaeli were identified. These components were named as 'Problems in Built-up Areas', 'Disaster Risks arising from Geological Conditions of the Ground and Problems of Buildings', and 'Inadequacy of Urban Services'. Each component was weighted and scored for each grid. In order to delimitate urban transformation zones Optimized Outlier Analysis (Local Moran I) in the ArcGIS 10.6.1 was conducted to test the type of distribution (clustered or scattered) and its significance on the grids by assuming the weighted total score of the grid as Input Features. As a result of this analysis, it was found that the weighted total scores were not significantly clustering at all grids in urban space. The grids which the input feature is clustered significantly were exported as the new database to use in further mappings. Total Score Map reflects the significant clusters in terms of weighted total scores of 'Problems in Built-up Areas', 'Disaster Risks arising from Geological Conditions of the Ground and Problems of Buildings' and 'Inadequacy of Urban Services'. Resulting grids with the highest scores are the most likely candidates for urban transformation in this citywide study. To categorize urban space in terms of urban transformation, Grouping Analysis in ArcGIS 10.6.1 was conducted to data that includes each component scores in significantly clustered grids. Due to Pseudo Statistics and Box Plots, 6 groups with the highest F stats were extracted. As a result of the mapping of the groups, it can be said that 6 groups can be interpreted in a more meaningful manner in relation to the urban space. The method presented in this study can be magnified due to the availability of more spatial data. By integrating with other data to be obtained during the planning process, this method can contribute to the continuation of research and decision-making processes of urban transformation master plans on a more consistent basis.

Keywords: urban transformation, GIS, disaster risk assessment, Kocaeli

Procedia PDF Downloads 116
6458 Self-Reliant Peer Learning for Nursing Students

Authors: U.-B. Schaer, M. Wehr, R. Hodler

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Background: Most nursing students require more training time for necessary nursing skills than defined by nursing schools curriculum to acquire basic nursing skills. Given skills training lessons are too brief to enable effective student learning, meaning in-depth skills practice and repetition various learning steps. This increases stress levels and the pressure to succeed for a nursing student with slower learning capabilities. Another possible consequence is that nursing students are less prepared in the required skills for future clinical practice. Intervention: The Bern College of Higher Education of Nursing, Switzerland, started the independent peer practice learning program in 2012. A concept was developed which defines specific aims and content as well as student’s rights and obligations. Students enlist beforehand and order the required materials. They organize themselves and train in small groups in allocated training location in the area of Learning Training and Transfer (LTT). During the peer practice, skills and knowledge can be repeatedly trained and reflected in the peer groups without the presence of a tutor. All invasive skills are practiced only on teaching dummies. This allows students to use all their potential. The students may access learning materials as literature and their own student notes. This allows nursing students to practice their skills and to deepen their knowledge on corresponding with their own learning rate. Results: Peer group discussions during the independent peer practice learning support the students in gaining certainty and confidence in their knowledge and skills. This may improve patient safety in future daily care practice. Descriptive statics show that the number of students who take advantage of the independent peer practice learning increased continuously (2012-2018). It has to be mentioned that in 2012, solely students of the first semester attended the independent peer practice learning program, while in 2018 over one-third of the participating students were in their fifth semester and final study year. It is clearly visible that the demand for independent peer practice learning is increasing. This has to be considered in the development of future teaching curricula.

Keywords: learning program, nursing students, peer learning, skill training

Procedia PDF Downloads 115