Search results for: drift term
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4186

Search results for: drift term

1576 A Cost-Benefit Analysis of Routinely Performed Transthoracic Echocardiography in the Setting of Acute Ischemic Stroke

Authors: John Rothrock

Abstract:

Background: The role of transthoracic echocardiography (TTE) in the diagnosis and management of patients with acute ischemic stroke remains controversial. While many stroke subspecialist reserve TTE for selected patients, others consider the procedure obligatory for most or all acute stroke patients. This study was undertaken to assess the cost vs. benefit of 'routine' TTE. Methods: We examined a consecutive series of patients who were admitted to a single institution in 2019 for acute ischemic stroke and underwent TTE. We sought to determine the frequency with which the results of TTE led to a new diagnosis of cardioembolism, redirected therapeutic cerebrovascular management, and at least potentially influenced the short or long-term clinical outcome. We recorded the direct cost associated with TTE. Results: There were 1076 patients in the study group, all of whom underwent TTE. TTE identified an unsuspected source of possible/probable cardioembolism in 62 patients (6%), confirmed an initially suspected source (primarily endocarditis) in an additional 13 (1%) and produced findings that stimulated subsequent testing diagnostic of possible/probable cardioembolism in 7 patients ( < 1%). TTE results potentially influenced the clinical outcome in a total of 48 patients (4%). With a total direct cost of $1.51 million, the mean cost per case wherein TTE results potentially influenced the clinical outcome in a positive manner was $31,375. Diagnostically and therapeutically, TTE was most beneficial in 67 patients under the age of 55 who presented with 'cryptogenic' stroke, identifying patent foramen ovale in 21 (31%); closure was performed in 19. Conclusions: The utility of TTE in the setting of acute ischemic stroke is modest, with its yield greatest in younger patients with cryptogenic stroke. Given the greater sensitivity of transesophageal echocardiography in detecting PFO and evaluating the aortic arch, TTE’s role in stroke diagnosis would appear to be limited.

Keywords: cardioembolic, cost-benefit, stroke, TTE

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1575 A Literature Review about Responsible Third Cycle Supervision

Authors: Johanna Lundqvist

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Third cycle supervision is a multifaceted and complex task for supervisors in higher education. It progresses over several years and is affected by several proximal and distal factors. It can result in positive learning outcomes for doctoral students and high-quality publications. However, not all doctoral students thrive during their doctoral studies; nor do they all complete their studies. This is problematic for both the individuals themselves as well as society at large: doctoral students are valuable and important in current research, future research and higher education. The aim of this literature review is to elucidate what responsible third cycle supervision can include and be in practice. The question posed is as follows: according to recent literature, what is it that characterises responsible third cycle supervision in which doctoral students can thrive and develop their research knowledge and skills? A literature review was conducted, and the data gathered from the literature regarding responsible third cycle supervision was analysed by means of a thematic analysis. The analysis was inspired by the notion of responsible inclusion outlined by David Mitchell. In this study, the term literature refers to research articles and regulations. The results (preliminary) show that responsible third cycle supervision is associated with a number of interplaying factors (themes). These are as follows: committed supervisors and doctoral students; a clear vision and research problem; an individual study plan; adequate resources; interaction processes and constructive feedback; creativity; cultural awareness; respect and research ethics; systematic quality work and improvement efforts; focus on overall third cycle learning goals; and focus on research presentations and publications. Thus, responsible third cycle supervision can occur if these factors are realized in practice. This literature review is of relevance to evaluators, researchers, and management in higher education, as well as third cycle supervisors.

Keywords: doctoral student, higher education, third cycle supervisors, third cycle programmes

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1574 Predicting Emerging Agricultural Investment Opportunities: The Potential of Structural Evolution Index

Authors: Kwaku Damoah

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The agricultural sector is characterized by continuous transformation, driven by factors such as demographic shifts, evolving consumer preferences, climate change, and migration trends. This dynamic environment presents complex challenges for key stakeholders including farmers, governments, and investors, who must navigate these changes to achieve optimal investment returns. To effectively predict market trends and uncover promising investment opportunities, a systematic, data-driven approach is essential. This paper introduces the Structural Evolution Index (SEI), a machine learning-based methodology. SEI is specifically designed to analyse long-term trends and forecast the potential of emerging agricultural products for investment. Versatile in application, it evaluates various agricultural metrics such as production, yield, trade, land use, and consumption, providing a comprehensive view of the evolution within agricultural markets. By harnessing data from the UN Food and Agricultural Organisation (FAOSTAT), this study demonstrates the SEI's capabilities through Comparative Exploratory Analysis and evaluation of international trade in agricultural products, focusing on Malaysia and Singapore. The SEI methodology reveals intricate patterns and transitions within the agricultural sector, enabling stakeholders to strategically identify and capitalize on emerging markets. This predictive framework is a powerful tool for decision-makers, offering crucial insights that help anticipate market shifts and align investments with anticipated returns.

Keywords: agricultural investment, algorithm, comparative exploratory analytics, machine learning, market trends, predictive analytics, structural evolution index

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1573 Greenlight Laser Prostatectomy: A Safe and Effective Day Case Option for Bladder Outlet Obstruction in the Elderly Population

Authors: Gordon Weight, Hermione Tsoi, Patrick Cutinha, Sanjay Rajpal

Abstract:

Aim: Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction and lower urinary tract symptoms (LUTS). In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP. Methods: Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems. Results: 305 patients were included in this study with a mean age of 73 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and only 10.5% of patients requiring more than a single night admission. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC. Conclusions: Our study shows that GLLP is a safe and effective day case treatment and can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.

Keywords: urology, endourology, prostate, bladder outlet obstruction, laser

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1572 Impact of Applying Bag House Filter Technology in Cement Industry on Ambient Air Quality - Case Study: Alexandria Cement Company

Authors: Haggag H. Mohamed, Ghatass F. Zekry, Shalaby A. Elsayed

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Most sources of air pollution in Egypt are of anthropogenic origin. Alexandria Governorate is located at north of Egypt. The main contributing sectors of air pollution in Alexandria are industry, transportation and area source due to human activities. Alexandria includes more than 40% of the industrial activities in Egypt. Cement manufacture contributes a significant amount to the particulate pollution load. Alexandria Portland Cement Company (APCC) surrounding was selected to be the study area. APCC main kiln stack Total Suspended Particulate (TSP) continuous monitoring data was collected for assessment of dust emission control technology. Electro Static Precipitator (ESP) was fixed on the cement kiln since 2002. The collected data of TSP for first quarter of 2012 was compared to that one in first quarter of 2013 after installation of new bag house filter. In the present study, based on these monitoring data and metrological data a detailed air dispersion modeling investigation was carried out using the Industrial Source Complex Short Term model (ISC3-ST) to find out the impact of applying new bag house filter control technology on the neighborhood ambient air quality. The model results show a drastic reduction of the ambient TSP hourly average concentration from 44.94μg/m3 to 5.78μg/m3 which assures the huge positive impact on the ambient air quality by applying bag house filter technology on APCC cement kiln

Keywords: air pollution modeling, ambient air quality, baghouse filter, cement industry

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1571 Etiquette Learning and Public Speaking: Early Etiquette Learning and Its Impact on Higher Education and Working Professionals

Authors: Simran Ballani

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The purpose of this paper is to call education professionals to implement etiquette and public speaking skills for preschoolers, primary, middle and higher school students. In this paper the author aims to present importance of etiquette learning and public speaking curriculum for preschoolers, reflect on experiences from implementation of the curriculum and discuss the effect of the said implementation on higher education/global job market. Author’s aim to introduce this curriculum was to provide children with innovative learning and all around development. This training of soft skills at kindergarten level can have a long term effect on their social behaviors which in turn can contribute to professional success once they are ready for campus recruitment/global job markets. Additionally, if preschoolers learn polite, appropriate behavior at early age, it will enable them to become more socially attentive and display good manners as an adult. It is easier to nurture these skills in a child rather than changing bad manners at adulthood. Preschool/Kindergarten education can provide the platform for children to learn these crucial soft skills irrespective of the ethnicity, economic or social background they come from. These skills developed at such early years can go a long way to shape them into better and confident individuals. Unfortunately, accessibility of the etiquette learning and public speaking skill education is not standardized in pre-primary or primary level and most of the time embedding into the kindergarten curriculum is next to nil. All young children should be provided with equal opportunity to learn these soft skills which are essential for finding their place in job market.

Keywords: Early Childhood Learning, , public speaking, , confidence building, , innovative learning

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1570 Crossing Multi-Source Climate Data to Estimate the Effects of Climate Change on Evapotranspiration Data: Application to the French Central Region

Authors: Bensaid A., Mostephaoui T., Nedjai R.

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Climatic factors are the subject of considerable research, both methodologically and instrumentally. Under the effect of climate change, the approach to climate parameters with precision remains one of the main objectives of the scientific community. This is from the perspective of assessing climate change and its repercussions on humans and the environment. However, many regions of the world suffer from a severe lack of reliable instruments that can make up for this deficit. Alternatively, the use of empirical methods becomes the only way to assess certain parameters that can act as climate indicators. Several scientific methods are used for the evaluation of evapotranspiration which leads to its evaluation either directly at the level of the climatic stations or by empirical methods. All these methods make a point approach and, in no case, allow the spatial variation of this parameter. We, therefore, propose in this paper the use of three sources of information (network of weather stations of Meteo France, World Databases, and Moodis satellite images) to evaluate spatial evapotranspiration (ETP) using the Turc method. This first step will reflect the degree of relevance of the indirect (satellite) methods and their generalization to sites without stations. The spatial variation representation of this parameter using the geographical information system (GIS) accounts for the heterogeneity of the behaviour of this parameter. This heterogeneity is due to the influence of site morphological factors and will make it possible to appreciate the role of certain topographic and hydrological parameters. A phase of predicting the evolution over the medium and long term of evapotranspiration under the effect of climate change by the application of the Intergovernmental Panel on Climate Change (IPCC) scenarios gives a realistic overview as to the contribution of aquatic systems to the scale of the region.

Keywords: climate change, ETP, MODIS, GIEC scenarios

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1569 Prediction of Super-Response to Cardiac Resynchronisation Therapy

Authors: Vadim A. Kuznetsov, Anna M. Soldatova, Tatyana N. Enina, Elena A. Gorbatenko, Dmitrii V. Krinochkin

Abstract:

The aim of the study was to evaluate potential parameters related with super-response to CRT. Methods: 60 CRT patients (mean age 54.3 ± 9.8 years; 80% men) with congestive heart failure (CHF) II-IV NYHA functional class, left ventricular ejection fraction < 35% were enrolled. At baseline, 1 month, 3 months and each 6 months after implantation clinical, electrocardiographic and echocardiographic parameters, NT-proBNP level were evaluated. According to the best decrease of left ventricular end-systolic volume (LVESV) (mean follow-up period 33.7 ± 15.1 months) patients were classified as super-responders (SR) (n=28; reduction in LVESV ≥ 30%) and non-SR (n=32; reduction in LVESV < 30%). Results: At baseline groups differed in age (58.1 ± 5.8 years in SR vs 50.8 ± 11.4 years in non-SR; p=0.003), gender (female gender 32.1% vs 9.4% respectively; p=0.028), width of QRS complex (157.6 ± 40.6 ms in SR vs 137.6 ± 33.9 ms in non-SR; p=0.044). Percentage of LBBB was equal between groups (75% in SR vs 59.4% in non-SR; p=0.274). All parameters of mechanical dyssynchrony were higher in SR, but only difference in left ventricular pre-ejection period (LVPEP) was statistically significant (153.0 ± 35.9 ms vs. 129.3 ± 28.7 ms p=0.032). NT-proBNP level was lower in SR (1581 ± 1369 pg/ml vs 3024 ± 2431 pg/ml; p=0.006). The survival rates were 100% in SR and 90.6% in non-SR (log-rank test P=0.002). Multiple logistic regression analysis showed that LVPEP (HR 1.024; 95% CI 1.004–1.044; P = 0.017), baseline NT-proBNP level (HR 0.628; 95% CI 0.414–0.953; P=0.029) and age at baseline (HR 1.094; 95% CI 1.009-1.168; P=0.30) were independent predictors for CRT super-response. ROC curve analysis demonstrated sensitivity 71.9% and specificity 82.1% (AUC=0.827; p < 0.001) of this model in prediction of super-response to CRT. Conclusion: Super-response to CRT is associated with better survival in long-term period. Presence of LBBB was not associated with super-response. LVPEP, NT-proBNP level, and age at baseline can be used as independent predictors of CRT super-response.

Keywords: cardiac resynchronisation therapy, superresponse, congestive heart failure, left bundle branch block

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1568 A Qualitative Inquiry of Institutional Responsiveness in Public Land Development in the Urban Areas in Sri Lanka

Authors: Priyanwada I. Singhapathirana

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The public land ownership is a common phenomenon in many countries in the world however, the development approaches and the institutional structures are greatly diverse. The existing scholarship around public land development has been greatly limited to Europe and advanced Asian economies. Inferences of such studies seem to be inadequate and inappropriate to comprehend the peculiarities of public land development in developing Asian economies. The absence of critical inquiry on the public land ownership and the long-established institutional structures which govern the development has restrained these countries from institutional innovations. In this context, this research investigates the issues related to public land development and the institutional responses in Sri Lanka. This study introduces the concept of ‘Institutional Responsiveness’ in Public land development, which is conceptualized as the ability of the institutions to respond to the spatial, market and fiscal stimulus. The inquiry was carried out through in-depth interviews with five key informants from apex public agencies in order to explore the responsiveness of land institutions form decision-makers' perspectives. Further, the analysis of grey literature and recent media reports are used to supplement the analysis. As per the findings, long term abandonment of public lands and high transaction costs are some of the key issues in relation to public land development. The inability of the institutions to respond to the market and fiscal stimulus has left many potential public lands underutilized. As a result, the public sector itself and urban citizens have not been able to relish the benefits of the public lands in cities. Spatial analysis at the local scale is suggested for future studies in order to capture the multiple dimensions of the responsiveness of institutions to the development stimulus.

Keywords: institutions, public land, responsiveness, under-utilization

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1567 Effectiveness of a Malaysian Workplace Intervention Study on Physical Activity Levels

Authors: M. Z. Bin Mohd Ghazali, N. C. Wilson, A. F. Bin Ahmad Fuad, M. A. H. B. Musa, M. U. Mohamad Sani, F. Zulkifli, M. S. Zainal Abidin

Abstract:

Physical activity levels are low in Malaysia and this study was undertaken to determine if a four week work-based intervention program would be effective in changing physical activity levels. The study was conducted in a Malaysian Government Department and had three stages: baseline data collection, four-week intervention and two-month post intervention data collection. During the intervention and two-month post intervention phases, physical activity levels (determined by a pedometer) and basic health profiles (BMI, abdominal obesity, blood pressure) were measured. Staff (58 males, 47 females) with an average age of 33 years completed baseline data collection. Pedometer steps averaged 7,102 steps/day at baseline, although male step counts were significantly higher than females (7,861 vs. 6114). Health profiles were poor: over 50% were overweight/obese (males 66%, females 40%); hypertension (males 23%, females 6%); excess waist circumference (males 52%, females 17%). While 86 staff participated in the intervention, only 49 regularly reported their steps. There was a significant increase (17%) in average daily steps from 8,965 (week 1) to 10,436 (week 4). Unfortunately, participation in the intervention program was avoided by the less healthy staff. Two months after the intervention there was no significant difference in average steps/day, despite the fact that 89% of staff reporting they planned to make long-term changes to their lifestyle. An unexpected average increase of 2kg in body weight occurred in participants, although this was less than the 5.6kg in non-participants. A number of recommendations are made for future interventions, including the conclusion that pedometers were a useful tool and popular with participants.

Keywords: pedometers, walking, health, intervention

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1566 Assessment of the Road Safety Performance in National Scale

Authors: Abeer K. Jameel, Harry Evdorides

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The Assessment of the road safety performance is a challengeable issue. This is not only because of the ineffective and unreliability of road and traffic crash data system but also because of its systematic character. Recent strategic plans and interventions implemented in some of the developed countries where a significant decline in the rate of traffic and road crashes considers that the road safety is a system. This system consists of four main elements which are: road user, road infrastructure, vehicles and speed in addition to other supporting elements such as the institutional framework and post-crash care system. To assess the performance of a system, it is required to assess all its elements. To present an understandable results of the assessment, it is required to present a unique term representing the performance of the overall system. This paper aims to develop an overall performance indicator which may be used to assess the road safety system. The variables of this indicators are the main elements of the road safety system. The data regarding these variables will be collected from the World Health Organization report. Multi-criteria analysis method is used to aggregate the four sub-indicators for the four variables. Two weighting methods will be assumed, equal weights and different weights. For the different weights method, the factor analysis method is used. The weights then will be converting to scores. The total score will be the overall indicator for the road safety performance in a national scale. This indicator will be used to compare and rank countries according to their road safety performance indicator. The country with the higher score is the country which provides most sustainable and effective interventions for successful road safety system. These indicator will be tested by comparing them with the aggregate real crash rate for each country.

Keywords: factor analysis, Multi-criteria analysis, road safety assessment, safe system indicator

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1565 A Phenomenological Study on the Role of Civil Society Organizations in Supporting Urban Refugees in Thailand

Authors: Rowena Clemino Alcoba

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Thailand is host to the largest number of refugees in the region. The country has been one of the most accessible points of entry to refugees around the world because it has relatively lenient visa requirements, enabling asylum seekers to enter the country and subsequently search for legal assistance. However, because Thailand is not a signatory to the 1951 Geneva Convention on Refugees which governs the refugee status determination and safeguards several rights of the refugees, there are no national laws or administrative framework on the protection of refugees. Refugees are considered as illegal migrants, and certain groups are permitted to stay temporarily only upon executive discretion. Aside from the documented group of refugees from the Myanmar border, there are many others who came from different parts of the world. They are known as urban refugees believed to be in the thousands and are scattered in the impoverished areas of Bangkok and the suburbs. This study aims to advance understanding of the role of civil society organizations in supporting refugees, with particular focus on urban refugees. Using the method of triangulation in qualitative research, the study investigates the life journey of a refugee family from Pakistan, their difficulties and struggles to survive in perilous situations. The study presents the dynamics of how civil society works and collaborates to fill the gap for much-needed social services. It also discusses the depth and scope of the role of faith actors in the protection and support of this vulnerable sector. The engagement of civil society reveals framework and structure that aims to create long-term impact. The help provided is not merely monetary or material dole-outs but a platform for refugees to integrate with community, develop skills and make productive use of their time.

Keywords: asylum seeker, civil society, faith actors, refugees

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1564 Geographical Parthenogenesis in Plants

Authors: Elvira Hörandl

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The term “Geographical parthenogenesis” describes the phenomenon that asexual organisms usually occupy larger and more northern distribution areas than their sexual relatives and tend to colonize previously glaciated areas. Several case studies in flowering plants confirm the geographical pattern, but the causal factors behind the phenomenon are still unclear. Previous authors regarded predominant polyploidy in asexual (apomictic) plants as the main factor. However, the geographical pattern is not the rule for sexual polyploids. Recent research confirmed a previous hypothesis of the author that a combination of factors is acting: Although uniparental reproduction provides better colonization abilities, it is most efficient in combination with polyploidy. I will present results on case studies in the genus Ranunculus of both autopolyploid and allopolyploid species and species complexes reproducing via facultative apomixis. Polyploidy seems to contribute mainly to a better tolerance of colder climates and temperate extremes, whereby epigenetic flexibility, changes in gene expression, and phenotypic plasticity play an important role in occupying ecological niches under harsh conditions. Phylogenomic studies entangle complex hybrid origins of asexual taxa, which increases intragenomic heterozygosity of asexual plants. Interestingly, our results suggest an association of sexuality with abiotic stresses, specifically with light stress, which might explain that still, most plants in high altitudes and in southern areas retain sexual reproduction despite other climatic conditions that would favor apomictic plants. We conclude that geographical parthenogenesis results from the complex interplay of the genomic constitution, mode of reproduction and environmental factors.

Keywords: apomixis, polyploidy, hybridization, abiotic stress, epigenetics, phylogenomics

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1563 Field Evaluation of Concrete Using Hawaiian Aggregates for Alkali Silica Reaction

Authors: Ian N. Robertson

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Alkali Silica Reaction (ASR) occurs in concrete when the alkali hydroxides (Na, K and OH) from the cement react with unstable silica, SiO2, in some types of aggregate. The gel that forms during this reaction will expand when it absorbs water, potentially leading to cracking and overall expansion of the concrete. ASR has resulted in accelerated deterioration of concrete highways, dams and other structures that are exposed to moisture during their service life. Concrete aggregates available in Hawaii have not demonstrated a history of ASR, however, accelerated laboratory tests using ASTM 1260 indicated a potential for ASR with some aggregates. Certain clients are now requiring import of aggregates from the US mainland at great expense. In order to assess the accuracy of the laboratory test results, a long-term field study of the potential for ASR in concretes made with Hawaiian aggregates was initiated in 2011 with funding from the US Federal Highway Administration and Hawaii Department of Transportation. Thirty concrete specimens were constructed of various concrete mixtures using aggregates from all Hawaiian aggregate sources, and some US mainland aggregates known to exhibit ASR expansion. The specimens are located in an open field site in Manoa valley on the Hawaiian Island of Oahu, exposed to relatively high humidity and frequent rainfall. A weather station at the site records the ambient conditions on a continual basis. After two years of monitoring, only one of the Hawaiian aggregates showed any sign of expansion. Ten additional specimens were fabricated with this aggregate to confirm the earlier observations. Admixtures known to mitigate ASR, such as fly ash and lithium, were included in some specimens to evaluate their effect on the concrete expansion. This paper describes the field evaluation program and presents the results for all forty specimens after four years of monitoring.

Keywords: aggregate, alkali silica reaction, concrete durability, field exposure

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1562 Impacts of Hydrologic and Topographic Changes on Water Regime Evolution of Poyang Lake, China

Authors: Feng Huang, Carlos G. Ochoa, Haitao Zhao

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Poyang Lake, the largest freshwater lake in China, is located at the middle-lower reaches of the Yangtze River basin. It has great value in socioeconomic development and is internationally recognized as an important lacustrine and wetland ecosystem with abundant biodiversity. Impacted by ongoing climate change and anthropogenic activities, especially the regulation of the Three Gorges Reservoir since 2003, Poyang Lake has experienced significant water regime evolution, resulting in challenges for the management of water resources and the environment. Quantifying the contribution of hydrologic and topographic changes to water regime alteration is necessary for policymakers to design effective adaption strategies. Long term hydrologic data were collected and the back-propagation neural networks were constructed to simulate the lake water level. The impacts of hydrologic and topographic changes were differentiated through scenario analysis that considered pre-impact and post-impact hydrologic and topographic scenarios. The lake water regime was characterized by hydrologic indicators that describe monthly water level fluctuations, hydrologic features during flood and drought seasons, and frequency and rate of hydrologic variations. The results revealed different contributions of hydrologic and topographic changes to different features of the lake water regime.Noticeable changes were that the water level declined dramatically during the period of reservoir impoundment, and the drought was enhanced during the dry season. The hydrologic and topographic changes exerted a synergistic effect or antagonistic effect on different lake water regime features. The findings provide scientific reference for lacustrine and wetland ecological protection associated with water regime alterations.

Keywords: back-propagation neural network, scenario analysis, water regime, Poyang Lake

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1561 Factors Associated with Non-Adherence to Antiretroviral Treatment among HIV Infected Patients in Ukraine

Authors: Larissa Burruano, Sergey Grabovyj, Irina Nguen

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The study aimed to assess the level of adherence to anti retroviral therapy (ART) and to examine the relationship between adherence and risk behavior factor (drug use) among patients infected with HIV. The patients with newly diagnosed or established HIV infection under follow-up at the Sumskij Regional Centre for AIDS Prevention in Ukraine were eligible for this study. Medical records were used to measure the patient’s adherence to medication. Measurements were obtained at month 6 and at month 12 to calculate the number of medication omission during the past 30 days: (on a 2-point scale – once until three in a month – were considered adherent, three and more in a month – were considered non-adherent). Of the 50 study participants, 27 (54.0%) were men and 23 (46.0%) women. The mean age is 35.2 years (SD= 5.1). A majority of the patients (82.0%) is in the age group of 25-30 years. The main level of adherence was 74.0% and 66.0% at 6 and 12 months, respectively. The main routes of HIV transmission were drug injection among men 12 (44.4%) and sexual contact among women 11 (47.8%). Univariate analyses indicated that patients who had lower level of education were more likely to have been non-adherent at month 6- (X2 =5.1, n=50, p < .05) and at month 12 (X2 = 4.34, n=50, p < .05). Multivariate tests showed that only age (OR= 1.163 [95% CI 0.98–1.370]) was significant independent predictor of treatment adherence, while gender, education, employment status were not predictive for the risk of developing non-compliance. There was not a significant interaction between non-adherence and intravenous drug use. Consistent with these findings, younger people were more likely to have missed a dose of their medication because they had a greater sense of invulnerability than older patients. The study indicates that the socio demographic characteristic should be taken into an account in the future research regarding adherence in the case of HIV infection. If the patient anti retroviral adherence can be improved by qualitatively better medical care in all regions of the Ukraine, behavioral changes in the population can to be expected in the long term.

Keywords: HIV, antiretroviral therapy, adherence, Ukraine, Eastern Europe

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1560 Surface Sterilization Retain Postharvest Quality and Shelf Life of Strawberry and Cherry Tomato during Modified Atmosphere Packaging

Authors: Ju Young Kim, Mohammad Zahirul Islam, Mahmuda Akter Mele, Su Jeong Han, Hyuk Sung Yoon, In-Lee Choi, Ho-Min Kang

Abstract:

Strawberry and tomato fruits were harvested at the red ripens maturity stage in the Republic of Korea. The fruits were dipped in fungi solution and afterwards were sterilized with sodium hypochlorite (NaOCl) and chlorine dioxide (ClO2) gas. Some fruits were dipped in 150μL/L NaOCl solution for 10 minutes, and others were treated with 5μL/L ClO2 gas for 12 hours and packed with 20,000 cc OTR (oxygen transmission rate) film, the rest were packed in 10,000 cc OTR film inserted with 5μL/L ClO2 gas. 5μL/L ClO2 gas insert treatment showed the lowest carbon dioxide and ethylene, and the highest oxygen concentration was on the final storage day (15th day) in both strawberry and tomato fruits. Tomato fruits showed the lowest fresh weight loss in 5μL/L ClO2 gas insert treatment. The visual quality as well as shelf life showed the highest in 5μL/L ClO2 gas insert treatment of both strawberry and tomato fruits. In addition, the fungal incidence of strawberry and tomato fruits were the most suppressed in 5μL/L ClO2 gas insert treatment. 5μL/L ClO2 gas insert treatment showed higher firmness and soluble solids in both strawberry and tomato fruits. So, 5μL/L ClO2 gas insert treatment may be useful to prevent the fungal incidence as well as retaining the postharvest quality, and increase the shelf life of strawberry and tomato fruits for long term storage. This study was supported by Export Promotion Technology Development Program (314027-03), IPET, Ministry of Agriculture, Food and Rural Affairs, Republic of Korea.

Keywords: chlorine dioxide, ethylene, fungi, sodium hypochlorite

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1559 Impact of COVID-19 Pandemic on Iraqi Students’ Educational and Psychological Status

Authors: Bahman Gorjian

Abstract:

The notorious COVID-19 is known as an illness that is caused by a novel coronavirus. Since its breakthrough, most governments have decided to temporarily close educational institutions in an attempt to reduce the spread of this disease. Distance education in Iran, like other countries, started from the beginning of the pandemic and caused the closure of schools and universities as an immediate response to control the spread of the virus. The present study followed two aims: First, to investigate if Iraqi M.A students majoring in TEFL who have been studying in Iranian universities during the pandemic believe that COVID-19 had negative/positive effects on their educational achievement; and second, to find how frequently these Iraqi M.A students have experienced psychological problems (e.g., anxiety, numbness, nightmares, nervousness) during the COVID-19. The participants were both male and female students who were admitted for M.A. TEFL courses at 4 Iranian Universities (Abadan Brach, Ahvaz Branch, Science and Research Branch, and Shiraz Branch of Islamic Azad University) for the winter academic term of 2020. The start of their classes coincided with the global outbreak of COVID-19. They were invited to take part in the present study through snowball sampling and were asked to provide their views on two questionnaires. The instruments used for gathering the data were the educational achievement questionnaire and self-rating anxiety scale. The results of the analysis suggested that the participants believed in the negative effects of COVID-19 on their education; the results also suggested COVID-19 affected participants’ psychological states. The discussed findings may have implications for international students and experts interested in the online education system.

Keywords: COVID-19, distance education, Iraqi M.A. students, teaching English as a foreign language, educational impacts, psychological impacts

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1558 Effects of Drought on Microbial Activity in Rhizosphere, Soil Hydrophobicity and Leaching of Mineral Nitrogen from Arable Soil Depending on Method of Fertilization

Authors: Jakub Elbl, Lukáš Plošek, Antonín Kintl, Jaroslav Hynšt, Soňa Javoreková, Jaroslav Záhora, Libor Kalhotka, Olga Urbánková, Ivana Charousová

Abstract:

This work presents the first results from the long-term laboratory experiment dealing with impact of drought on soil properties. Three groups of the treatment (A, B and C) with different regime of irrigation were prepared. The soil water content was maintained at 70 % of soil water holding capacity in group A, at 40 % in group B. In group C, soil water regime was maintained in the range of wilting point. Each group of the experiment was divided into three variants (A1 = B1, C1; A2 = B2, C2 etc.) with three repetitions: Variants A1 (B1, C1) were controls without addition of another fertilizer. Variants A2 (B2, C2) were fertilized with mineral nitrogen fertilizer DAM 390 (0.140 Mg of N per ha) and variants A3 (B3, C3) contained 45 g of Cp per a pot. The significant differences (ANOVA, P<0.05) in the leaching of mineral nitrogen and values of saturated hydraulic conductivity (Ksat) were found. The highest values of Ksat were found in variants (within each group) with addition of compost (A3, B3, C3). Conversely, the lowest values of Ksat were found in variants with addition of mineral nitrogen. Low values of Ksat indicate an increased level of hydrophobicity in individual groups of the experiment. Moreover, all variants with compost addition showed lower amount of mineral nitrogen leaching and high level of microbial activity than variants without. This decrease of mineral nitrogen leaching was about 200 % in comparison with the control variant and about 300 % with variant, where mineral nitrogen was added. Based on these results, we can conclude that changes of soil water content directly have impact on microbial activity, soil hydrophobicity and loss of mineral nitrogen from the soil.

Keywords: drought, microbial activity, mineral nitrogen, soil hydrophobicity

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1557 The Relationship between Self-Care Behaviour and Quality of Life Among Heart Failure Patients in Jakarta, Indonesia

Authors: Shedy Maharani Nariswari, Prima Agustia Nova, I. Made Kariasa

Abstract:

Background. Heart Failure (HF) is a chronic and progressive condition associated with significant morbidity, mortality, health care expenditures, and a high readmission rate over the years. Self‐care is essential to manage chronic heart failure in the long term, and it is related to better outcomes and can enhance the quality of life. Objective. The aims of this study were to describe the relationship between self-care behavior and quality of life among heart failure patients in East Jakarta, Indonesia. Methods. This study used a correlational-descriptive design with a cross-sectional study, the sampling method used purposive sampling method. Self-care was measured using Self-care Heart Failure Index version 6.2, and quality of life was measured using The Minnesota Living with Heart Failure. Pearson correlation and Spearman-rho correlations are used to analyze the data. Results. We recruited 103 patients with HF in both outpatient and inpatient ward: mean age 59.26 ± 11.643 years, 63.1% male. Patients with higher levels of education were associated with higher self-care maintenance (p= 0.007). The patient's average quality of life is quite high, with a score of 72,07 ± 16,89. There were a significant relationship among self-care maintenance (r=0,305, p=0,001), self-care management (r=0,330, p=0,001), and self-care confidence (r=0,335, p=0,001) towards the quality of life. Most participants have inadequate self-care maintenance, self-care management, and self-care confidence (score < 70), while the score of quality of life is categorized as poor. Conclusion. The self-care behaviors were limited among patients living with HF in Indonesia yet was associated with better quality of life. It is necessary to promote health related to knowledge and adherence to self-care behavior so that it can improve the quality of life of heart failure patients. This study can be used as a reference to promote self-care among patients with heart failure, it can help to enhance their quality of life.

Keywords: heart failure, self-care maintenance, self-care management, self-care confidence, quality of life

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1556 Integrating Flipped Instruction to Enhance Second Language Acquisition

Authors: Borja Ruiz de Arbulo Alonso

Abstract:

This paper analyzes the impact of flipped instruction in adult learners of Spanish as a second language in a face-to-face course at Boston University. Given the limited amount of contact hours devoted to studying world languages in the American higher education system, implementing strategies to free up classroom time for communicative language practice is key to ensure student success in their learning process. In an effort to improve the way adult learners acquire a second language, this paper examines the role that regular pre-class and web-based exposure to Spanish grammar plays in student performance at the end of the academic term. It outlines different types of web-based pre-class activities and compares this approach to more traditional classroom practice. To do so, this study works for three months with two similar groups of adult learners in an intermediate-level Spanish class. Both groups use the same course program and have the same previous language experience, but one receives an additional set of instructor-made online materials containing a variety of grammar explanations and online activities that need to be reviewed before attending class. Since the online activities cover material and concepts that have not yet been studied in class, students' oral and written production in both groups is measured by means of a writing activity and an audio recording at the end of the three-month period. These assessments will ascertain the effects of exposing the control group to the grammar of the target language prior to each lecture throughout and demonstrate where flipped instruction helps adult learners of Spanish achieve higher performance, but also identify potential problems.

Keywords: educational technology, flipped classroom, second language acquisition, student success

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1555 An Exploration of Cross-culture Consumer Behaviour - The Characteristics of Chinese Consumers’ Decision Making in Europe

Authors: Yongsheng Guo, Xiaoxian Zhu, Mandella Osei-Assibey Bonsu

Abstract:

This study explores the effects of national culture on consumer behaviour by identifying the characteristics of Chinese consumers’ decision making in Europe. It offers a better understanding of how cultural factors affect consumers’ behaviour, and how consumers make decisions in other nations with different culture. It adopted a grounded theory approach and conducted twenty-four in-depth interviews. Grounded theory models are developed to link the causal conditions, process and consequences. Results reveal that some cultural factors including conservatism, emotionality, acquaintance community, long-term orientation and principles affect Chinese consumers when making purchase decisions in Europe. Most Chinese consumers plan and prepare their expenditure and stay in Europe as cultural learners, and purchase durable products or assets as investment, and share their experiences within a community. This study identified potential problems such as political and social environment, complex procedures, and restrictions. This study found that external factors influence on internal factors and then internal characters determine consumer behaviour. This study proposes that cultural traits developed in convergence evolution through social selection and Chinese consumers persist most characters but adapt some perceptions and actions overtime in other countries. This study suggests that cultural marketing could be adopted by companies to reflect consumers’ preferences. Agencies, shops, and the authorities could take actions to reduce the complexity and restrictions.

Keywords: national culture, consumer behaviour, decision making, cultural marketing

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1554 Assessment of Climate Change Impact on Meteorological Droughts

Authors: Alireza Nikbakht Shahbazi

Abstract:

There are various factors that affect climate changes; drought is one of those factors. Investigation of efficient methods for estimating climate change impacts on drought should be assumed. The aim of this paper is to investigate climate change impacts on drought in Karoon3 watershed located south-western Iran in the future periods. The atmospheric general circulation models (GCM) data under Intergovernmental Panel on Climate Change (IPCC) scenarios should be used for this purpose. In this study, watershed drought under climate change impacts will be simulated in future periods (2011 to 2099). Standard precipitation index (SPI) as a drought index was selected and calculated using mean monthly precipitation data in Karoon3 watershed. SPI was calculated in 6, 12 and 24 months periods. Statistical analysis on daily precipitation and minimum and maximum daily temperature was performed. LRAS-WG5 was used to determine the feasibility of future period's meteorological data production. Model calibration and verification was performed for the base year (1980-2007). Meteorological data simulation for future periods under General Circulation Models and climate change IPCC scenarios was performed and then the drought status using SPI under climate change effects analyzed. Results showed that differences between monthly maximum and minimum temperature will decrease under climate change and spring precipitation shall increase while summer and autumn rainfall shall decrease. The precipitation occurs mainly between January and May in future periods and summer or autumn precipitation decline and lead up to short term drought in the study region. Normal and wet SPI category is more frequent in B1 and A2 emissions scenarios than A1B.

Keywords: climate change impact, drought severity, drought frequency, Karoon3 watershed

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1553 Survey of Potato Viral Infection Using Das-Elisa Method in Georgia

Authors: Maia Kukhaleishvili, Ekaterine Bulauri, Iveta Megrelishvili, Tamar Shamatava, Tamar Chipashvili

Abstract:

Plant viruses can cause loss of yield and quality in a lot of important crops. Symptoms of pathogens are variable depending on the cultivars and virus strain. Selection of resistant potato varieties would reduce the risk of virus transmission and significant economic impact. Other way to avoid reduced harvest yields is regular potato seed production sampling and testing for viral infection. The aim of this study was to determine the occurrence and distribution of viral diseases according potato cultivars for further selection of virus-free material in Georgia. During the summer 2015- 2016, 5 potato cultivars (Sante, Laura, Jelly, Red Sonia, Anushka) at 5 different farms located in Akhalkalaki were tested for 6 different potato viruses: Potato virus A (PVA), Potato virus M (PVM), Potato virus S (PVS), Potato virus X (PVX), Potato virus Y (PVY) and potato leaf roll virus (PLRV). A serological method, Double Antibody Sandwich-Enzyme linked Immunosorbent Assay (DASELISA) was used at the laboratory to analyze the results. The result showed that PVY (21.4%) and PLRV (19.7%) virus presence in collected samples was relatively high compared to others. Researched potato cultivars except Jelly and Laura were infected by PVY with different concentrations. PLRV was found only in three potato cultivars (Sante, Jelly, Red Sonia) and PVM virus (3.12%) was characterized with low prevalence. PVX, PVA and PVS virus infection was not reported. It would be noted that 7.9% of samples were containing PVY/PLRV mix infection. Based on the results it can be concluded that PVY and PLRV infections are dominant in all research cultivars. Therefore significant yield losses are expected. Systematic, long-term control of potato viral infection, especially seed-potatoes, must be regarded as the most important factor to increase seed productivity.

Keywords: virus, potato, infection, diseases

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1552 Thermolysin Entrapment in a Gold Nanoparticles/Polymer Composite: Construction of an Efficient Biosensor for Ochratoxin a Detection

Authors: Fatma Dridi, Mouna Marrakchi, Mohammed Gargouri, Alvaro Garcia Cruz, Sergei V. Dzyadevych, Francis Vocanson, Joëlle Saulnier, Nicole Jaffrezic-Renault, Florence Lagarde

Abstract:

An original method has been successfully developed for the immobilization of thermolysin onto gold interdigitated electrodes for the detection of ochratoxin A (OTA) in olive oil samples. A mix of polyvinyl alcohol (PVA), polyethylenimine (PEI) and gold nanoparticles (AuNPs) was used. Cross-linking sensors chip was made by using a saturated glutaraldehyde (GA) vapor atmosphere in order to render the two polymers water stable. Performance of AuNPs/ (PVA/PEI) modified electrode was compared to a traditional immobilized enzymatic method using bovine serum albumin (BSA). Atomic force microscopy (AFM) experiments were employed to provide a useful insight into the structure and morphology of the immobilized thermolysin composite membranes. The enzyme immobilization method influence the topography and the texture of the deposited layer. Biosensors optimization and analytical characteristics properties were studied. Under optimal conditions AuNPs/ (PVA/PEI) modified electrode showed a higher increment in sensitivity. A 700 enhancement factor could be achieved with a detection limit of 1 nM. The newly designed OTA biosensors showed a long-term stability and good reproducibility. The relevance of the method was evaluated using commercial doped olive oil samples. No pretreatment of the sample was needed for testing and no matrix effect was observed. Recovery values were close to 100% demonstrating the suitability of the proposed method for OTA screening in olive oil.

Keywords: thermolysin, A. ochratoxin , polyvinyl alcohol, polyethylenimine, gold nanoparticles, olive oil

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1551 Predictors and 3-Year Outcomes of Compromised Left Circumflex Coronary Artery After Left Main Crossover Stenting

Authors: Hameed Ullah, Karim Elakabawi, Han KE, Najeeb Ullah, Habib Ullah, Sardar Ali Shah, Hamad Haider Khan, Muhammad Asad Khan, Ning Guo, Zuyi Yuan

Abstract:

Background: Predictors of decreased fractional flow reserve at left circumflex coronary artery after left main (LM) crossover stenting are still lacking. The objectives of the present study were to provide the predictors for low Fractional flow reserve (FFR) at coronary artery (LCx) and the possible treatment strategies for the compromised LCx-together with their long term outcomes. Methods: A total of 563 included patients out of 1974 patients admitted to our hospital from February 2015 to November 2020 with significant distal LM-bifurcation lesions. The enrolled patients underwent single-stent cross-over PCI under IVUS guidance with further LCx intervention as indicated by measured FFR. Results: The included patients showed angiographic significant LCx ostial affection after LM-stenting, but only 116 (20.6%) patients had FFR <0.8. The 3-year composite MACE rates were comparable between the high and low FFR groups (16.8% vs. 15.5%, respectively; P=0.744). In a multivariable analysis, a low FFR in the LCx was associated with post-stenting MLA of the LCx (OR: 0.032, P <0.001), post-stenting LCx-plaque burden (OR: 1.166, P <0.001), post-stenting LM-MLA (OR: 0.821, P =0.038) and pre-stenting LCx-MLA (OR: 0.371, P =0.044). In patients with low FFR, management of compromised LCx with DEB had the lowest 3-year MACE rate (8.1%) as compared to either KBI (17.5%) or stenting group (20.5%), P =0.299. Conclusion: FFR-guided LCx intervention can avoid unnecessary LCx intervention. The post-stenting predictors of low FFR include post-stenting MLA and plaque burden of the LCx and MV stent length. The 3-year MACE rates were comparable between high FFR patients and patients who had low FFR and were adequately managed.

Keywords: fractional flow reserve, left main stem, percutaneous coronary interventions, intravascular ultrasound

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1550 Enhancing Project Performance Forecasting using Machine Learning Techniques

Authors: Soheila Sadeghi

Abstract:

Accurate forecasting of project performance metrics is crucial for successfully managing and delivering urban road reconstruction projects. Traditional methods often rely on static baseline plans and fail to consider the dynamic nature of project progress and external factors. This research proposes a machine learning-based approach to forecast project performance metrics, such as cost variance and earned value, for each Work Breakdown Structure (WBS) category in an urban road reconstruction project. The proposed model utilizes time series forecasting techniques, including Autoregressive Integrated Moving Average (ARIMA) and Long Short-Term Memory (LSTM) networks, to predict future performance based on historical data and project progress. The model also incorporates external factors, such as weather patterns and resource availability, as features to enhance the accuracy of forecasts. By applying the predictive power of machine learning, the performance forecasting model enables proactive identification of potential deviations from the baseline plan, which allows project managers to take timely corrective actions. The research aims to validate the effectiveness of the proposed approach using a case study of an urban road reconstruction project, comparing the model's forecasts with actual project performance data. The findings of this research contribute to the advancement of project management practices in the construction industry, offering a data-driven solution for improving project performance monitoring and control.

Keywords: project performance forecasting, machine learning, time series forecasting, cost variance, earned value management

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1549 Hierarchical Porous Carbon Composite Electrode for High Performance Supercapacitor Application

Authors: Chia-Chia Chang, Jhen-Ting Huang, Hu-Cheng Weng, An-Ya Lo

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This study developed a simple hierarchical porous carbon (HPC) synthesis process and used for supercapacitor application. In which, mesopore provides huge specific surface area, meanwhile, macropore provides excellent mass transfer. Thus the hierarchical porous electrode improves the charge-discharge performance. On the other hand, cerium oxide (CeO2) have also got a lot research attention owing to its rich in content, low in price, environmentally friendly, good catalytic properties, and easy preparation. Besides, a rapid redox reaction occurs between trivalent cerium and tetravalent cerium releases oxygen atom and increase the conductivity. In order to prevent CeO2 from disintegration under long-term charge-discharge operation, the CeO2 carbon porous materials were was integrated as composite material in this study. For in the ex-situ analysis, scanning electron microscope (SEM), X-ray diffraction (XRD), transmission electron microscope (TEM) analysis were adopted to identify the surface morphology, crystal structure, and microstructure of the composite. 77K Nitrogen adsorption-desorption analysis was used to analyze the porosity of each specimen. For the in-situ test, cyclic voltammetry (CV) and chronopotentiometry (CP) were conducted by potentiostat to understand the charge and discharge properties. Ragone plot was drawn to further analyze the resistance properties. Based on above analyses, the effect of macropores/mespores and the CeO2/HPC ratios on charge-discharge performance were investigated. As a result, the capacitance can be greatly enhanced by 2.6 times higher than pristine mesoporous carbon electrode.

Keywords: hierarchical porous carbon, cerium oxide, supercapacitor

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1548 Saudi Arabian Aviation Construction Projects: Risks and Their Assessments

Authors: Ahmad Baghdadi, Mohammed Kishk

Abstract:

Construction projects are unique and involve different level of complexity. Airports projects, among other construction projects, are considered to be very complex as they face a number of challenges which make them inevitably exposed to risks. However, in Saudi Arabia, the sector of aviation is considered an important sector owing to the fact that it is the first destination for Muslims on an annual basis. As a result the Saudi government has allocated a huge amount of their general budget to this sector through the General Authority of Civil Aviation (GACA). However, it has been found that the projects are still delivered with a significant number of time and cost overruns. These consequences are typically generated from the risks involved in the projects. Thus, there is a need to identify the number of risks thought to cause such overruns in project times and costs, as well as to assess their significances in terms of their likelihoods of occurrence and their impacts. Accordingly, this paper aims to identify risks associated with aviation construction projects in Saudi Arabia, as well as to assess their likelihoods of occurrence and impacts on such projects. In total, forty four risks have been identified through a critical literature review of common risks in similar projects, as well as thirteen semi-structured interviews with expert project managers involved in GACA’s projects. However, the assessment of the identified risks in term of their likelihoods of occurrence and impacts was obtained through the analysis of forty five questionnaires. Respondents of questionnaires include clients, contractors and consultants. The results show the risks of design changes by the client, labour issue, and setting a tight schedule by the client have the highest likelihoods of occurrence in GACA projects, while the risks of earthquakes, design constructability, and corruption have the greatest impacts.

Keywords: aviation construction projects, GACA, risks, risk assessment, Saudi Arabia

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1547 The Birth Connection: An Examination of the Relationship between Her Birth Event and Infant Feeding among African American Mothers

Authors: Nicole Banton

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The maternal and infant mortality rate of Blacks is three times that of Whites in the US. Research indicates that breastfeeding lowers both. In this paper, the researcher examines how the ideas that Black/African American mothers had about breastfeeding before, during, and after pregnancy (postpartum) affected whether or not they initiated breastfeeding. The researcher used snowball sampling to recruit thirty African-American mothers from the Orlando area. At the time of her interview, each mother had at least one child who was at least three years old. Through in-depth face-to-face interviews, the researcher investigated how mothers’ healthcare providers affected their decision-making about infant feeding, as well as how the type of birth that she had (e.g., preterm, vaginal, c-section, full term) affected her actual versus idealized infant feeding practice. Through our discussions, we explored how pre-pregnancy perceptions, birth and postpartum experiences, social support, and the discourses surrounding motherhood within an African-American context affected the perceptions and experiences that the mothers in the study had with their infant feeding practice(s). Findings suggest that the pregnancy and birth experiences of the mothers in the study influenced whether or not they breastfed exclusively, combined breastfeeding and infant formula use, or used infant formula exclusively. Specifically, the interplay of invocation of agency (the ability to control their bodies before, during, and after birth), birth outcomes, and the interaction that the mothers in this study had with resources, human and material, had the highest impact on the initiation, duration, and attitude toward breastfeeding.

Keywords: African American mothers, maternal health, breastfeeding, birth, midwives, obstetricians, hospital birth, breast pumps, formula use, infant feeding, lactation consultant, postpartum, vaginal birth, c-section, familial support, social support, work, pregnancy

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